“通督调神”灸法干预脊髓损伤肠道功能障碍：随机对照研究

Intestinal dysfunction of spinal cord injury treated with tongdu tiaoshen moxibustion: a randomized controlled trial

目的:比较"通督调神"灸法联合康复训练与单纯康复训练治疗脊髓损伤(SCI)肠道功能障碍的临床疗效。方法:将60例SCI肠道功能障碍患者随机分为综合治疗组与康复组,每组30例(每组各脱落3例)。在常规西医治疗及康复训练基础上,康复组予以排便训练及直肠功能训练,每天1次;综合治疗组在康复组的治疗基础上予以"通督调神"灸法,穴取腰阳关、命门、至阳、大椎、百会等,每天1次,每次30 min。两组均4周为一疗程,共治疗3个疗程。分别于治疗前与治疗4、8、12周后行神经源性肠功能障碍(NBD)评分、世界卫生组织生存质量测定量表简表(WHOQOL-BREF)评分,并于治疗12周后评定临床疗效。结果:治疗后,综合治疗组总有效率为88.9%(24/27),高于康复组的74.1%(20/27,P<0.05)。治疗4、8、12周后,两组患者NBD评分均较治疗前明显降低(均P<0.01);治疗8、12周后,综合治疗组NBD评分均低于康复组(均P<0.05)。治疗4、8、12周后,两组患者WHOQOL-BREF心理、生理、社会环境、环境各领域评分均高于治疗前(均P<0.01);治疗4周后,综合治疗组心理、生理领域评分高于康复组(均P<0.05);治疗8、12周后,综合治疗组各领域评分均高于康复组(均P<0.05)。结论:"通督调神"灸法联合康复训练治疗SCI肠道功能障碍疗效优于单纯康复训练,能进一步提高患者的生存质量。

Objective To compare the clinical effect on intestinal dysfunction of spinal cord injury(SCI) between the comprehensive therapy of tongdu tiaoshen moxibustion(moxibustion for opening the governor vessel and regulating the spirit) and rehabilitation training and the simple treatment with rehabilitation training. Methods A total of 60 patients with intestinal dysfunction of SCI were randomized into a comprehensive therapy group and a rehabilitation group, 30 cases in each one(3 cases were dropped out in each group). On the base of the routine western medicine treatment and rehabilitation training, the bowel training and rectal function training were provided, once a day in the rehabilitation group. In the comprehensive therapy group, on the base of the treatment as the rehabilitation group, the tongdu tiaoshen moxibustion was exerted at Yaoyangguan(GV 3), Mingmen(GV 4), Zhiyang(GV 9), Dazhui(GV 14) and Baihui(GV 20), etc, once a day, 30 min each time. In both groups, the treatment for 4 weeks was as one course and 3 courses of treatment were required. Separately, before treatment, after 4, 8 and 12 weeks of treatment, the scores of neurogenic bowel dysfunction(NBD) and World Health Organization quality of life scale(WHOQOL-BREF) were observed and the clinical effect was evaluated after 12 weeks of treatment. Results After treatment, the total effective rate was 88.9%(24/27) in the comprehensive therapy group, which was higher than 74.1%(20/27) in the rehabilitation group(P<0.05). After 4, 8 and 12 weeks of treatment, NBD scores were all reduced obviously as compared with those before treatment in the two groups(all P<0.01). After 8 and 12 weeks of treatment, NBD scores in the comprehensive therapy group were lower than the rehabilitation group(both P<0.05). After 4, 8 and 12 weeks of treatment, the scores of all of the domains(psychology, physiology, social relations and environment) in WHOQOL-BREF were higher than those before treatment in the two groups(all P<0.01). After 4 weeks of treatment, the scores in the psychology and physiology domains in the comprehensive therapy group were higher than the rehabilitation group(all P<0.05). After 8 and 12 weeks of treatment, the scores of all of the domains in the comprehensive therapy group were higher than the rehabilitation group(all P < 0.05). Conclusion The comprehensive treatment of tongdu tiaoshen moxibustion and rehabilitation training achieves the better effect on intestinal dysfunction of SCI than the simple rehabilitation training and greatly improves the quality of life in SCI patients.