加味八珍汤对脾气亏虚证直肠前突STARR术后患者心理-生物动力学的影响

Effect of Modified Bazhentang on Psychology and Biodynamics of Patients with Encysted Rectum After STARR

目的：观察加味八珍汤对脾气亏虚证直肠前突经肛吻合器直肠切除术（STARR）术后患者心理因素和肛门直肠动力学的影响。方法：将140例直肠前突STARR术后患者,随机根据入组先后分为对照组和观察组各70例。对照组采用益气通便颗粒,9 g/次,2次/d,温开水冲服。观察组采用加味八珍汤,1剂/d。两组疗程均为连续治疗4周。采用出口梗阻综合征（ODS）量表评估临床症状,便秘患者生活质量自评问卷（PAC-QOL）评估治疗前后的生活质量,分别采用汉密尔顿焦虑量表（HAMA）和汉密尔顿抑郁量表（HAMD）量表评估治疗前后精神心理状态,进行治疗前后肛管测压,检测治疗前后血管活性肠肽（VIP）,P物质（SP）和一氧化氮（NO）水平。结果：经Ridit分析,观察组临床疗效优于对照组（P〈0.05）;观察组在治疗后第4周ODS评分低于对照组（P〈0.01）,观察组ODS评分治疗前后差值多于对照组（P〈0.01）;观察组PAC-QOL量表躯体不适、心理不适、担忧和和满意度4个维度评分和总分均低于对照组（P〈0.01）;观察组HAMA和HAMD评分均低于对照组（P〈0.01）;观察组肛管静息压、最大肛门括约肌收缩压、肛管残余压均低于对照组（P〈0.05,P〈0.01）,最小松弛容积、初始感觉阈值、初始便意阈值和直肠最大耐受量均小于对照组（P〈0.05,P〈0.01）,直肠排便压高于对照组（P〈0.05）;观察组血清VIP和SP水平均高于对照组,NO水平低于对照组（P〈0.01）。结论：加味八珍汤用于直肠前突STARR手术后脾气亏虚证患者可进一步的减轻临床症状,提高患者的生活质量,并可减轻焦虑、抑郁等负性情绪,改善直肠动力功能和直肠感知功能,调节脑肠肽因子水平。

Objective： To observe the effect of modified Bazhentang on psychological factors and anorectal dynamics of patients with encysted rectum after stapled transanal rectal resection（ STARR）. Method：One hundred and forty patients with encysted rectum after STARR were randomly divided into control group（ 70 cases） and observation group（ 70 cases）. Patients in control group got Yiqi Tongbian granules,9 g/time,bid.Patients in observation group got modified Bazhentang,1 dose/day. The treatment course was 4 weeks in both groups. Before and after treatment,clinical symptoms were discussed by obstructed defecation syndrome（ ODS）.Quality of life was discussed by patient assessment of constipation-quality of life questionnaire（ PAC-QOL）. Mental state before and after treatment was discussed by hamilton anxiety scale（ HAMA） and hamilton depression scale（ HAMD） respectively. Anorectal manometry and levels of vasoactive intestinal peptide（ VIP）,substance P（ SP）and nitric oxide（ NO） were detected before and after treatment. Result： Ridit analysis showed that the clinical efficacy in observation group was better than that in control group（ P〈0. 05）. Score of ODS in observation group was lower than that in control group at the 4 thweek after treatment（ P〈0. 01）,and the change in ODS scores in observation group was greater than that in control group（ P〈0. 01）. Scores of body discomfort,psychological discomfort,worry and satisfaction,as well as the total score in PAC-QOL scale,and the scores in HAMA and HAMD were lower than those in control group（ P〈0. 01）. The anal canal resting pressure,maximal contractile pressure of anal sphincter,and residual pressure of anal canal in observation group were all lower than those in control group（ P〈0. 05,P〈0. 01）,and minimum relaxation volume,initial sensory threshold,initial defecation awareness threshold and maximum rectal tolerance were all lower than those in control group（ P〈0. 05,P〈0. 01）,while rectal defecation pressure was greater than that in control group（ P〈0. 05）. Levels of VIP and SP in serum were higher than those in control group（ P〈0. 01）,and the change in NO level was lower than that in control group（ P〈0. 01）. Conclusion： Modified Bazhentang can relieve clinical symptoms,anxiousness and depression,improve quality of life,ameliorate rectal motility and rectal perception function,and regulate level of brain gut peptide factors for the patients with encysted rectum after STARR.