中医“身心”综合方案治疗气阴两虚型重度混合型便秘的临床观察

Clinical observation on Chinese medical psychosomatic comprehensive therapy in the treatment of severe mixed constipation with syndrome of deficiency of both qi and yin

目的:观察中医"身心"综合方案(中药方剂、生物反馈、认知疗法)治疗气阴两虚型重度混合型便秘的临床疗效。方法:将64例气阴两虚型重度混合型便秘患者随机分为治疗组、对照组,每组32例,对照组口服琥珀酸普芦卡必利片与乳果糖口服液,治疗组采用中医"身心"综合方案治疗。两组疗程均为4周,治疗后随访3个月,观察临床疗效,比较便秘症状积分、便秘患者生活质量自评量表(PAC-QOL)评分的变化情况,并进行安全性评价。结果:(1)治疗组脱落1例,对照组脱落2例,最终完成试验者61例,其中治疗组31例、对照组30例。(2)治疗4周后,治疗组、对照组总有效率分别为58.1%、50.0%,差异无统计学意义(P>0.05);治疗后3个月,治疗组、对照组总有效率分别为74.2%、66.7%,治疗组临床疗效优于对照组(P<0.05)。(3)治疗4周、治疗后3个月组内比较,两组便秘症状总积分及各分项(粪便性状、排便困难、排便频率、下坠不尽感、腹胀)积分均较治疗前降低(P<0.05);治疗4周、治疗后3个月组间比较,治疗组粪便性状、排便困难积分及便秘症状总积分低于对照组(P<0.05)。(4)治疗4周、治疗后3个月组内比较,两组PAC-QOL总分及各分项(生理状态、社会心理、担忧状态、满意度)评分均较治疗前降低(P<0.05);治疗后3个月组间比较,治疗组担忧状态、满意度评分及PAC-QOL总分低于对照组(P<0.05)。(5)对照组有5例患者出现不良反应,治疗组无不良反应发生,治疗组不良反应发生率低于对照组(P<0.05)。结论:中医"身心"综合方案治疗气阴两虚型重度混合型便秘疗效满意,与西医常规治疗(促动力药、缓泻剂)相比,能更好地缓解便秘症状,提高患者的生活质量,且作用持久、安全性好。

Objective:To observe the clinical efficacy of Chinese medical psychosomatic comprehensive therapy(Chinese medicine prescription combined with biofeedback and cognitive therapy)in the treatment of severe mixed constipation with syndrome of deficiency of both qi and yin.Methods:Sixty-four patients of serve mixed constipation with syndrome of deficiency of both qi and yin were randomly divided into the treatment group and control group,32 cases in each group.The control group was treated with prucalopride succinate tablets and lactulose oral liquids,while the treatment group was treated with Chinese medical psychosomatic comprehensive therapy.The course of treatment was 4 weeks in both groups,and all patients were followed-up for 3 months after treatment.The clinical efficacy was observed.The changes of constipation symptom scores and patient assessment of constipation-quality of life(PAC-QOL)questionnaire scores were compared,and the safety was evaluated.Results:(1)One case in the treatment group and two cases in the control group fell off.Finally,61 cases completed the trial,including 31 cases in the treatment group and 30 cases in the control group.(2)After treatment for 4 weeks,the total effective rates of the treatment group and the control group were 58.1%and 50.0%respectively,with no statistically significant difference(P>0.05).Three months after treatment,the total effective rates of the treatment group and the control group were74.2%and 66.7%respectively,and the clinical efficacy of the treatment group was better than that of the control group(P<0.05).(3)Compared with those before treatment,the total score of constipation symptoms and the scores of each item(stool character,defecation difficulty,defecation frequency,defecation incompletion and abdominal distention)were decreased in both groups after treatment for 4 weeks and 3 months after treatment(P<0.05).After treatment for 4 weeks and 3 months after treatment,the stool character score,defecation difficulty score and the total score of constipation symptoms in the treatment group were lower than those in the control group(P<0.05).(4)Compared with those before treatment,the total score of PAC-QOL and the scores of each item(physiological state,social psychology,anxiety state and satisfaction degree)were decreased in both groups after treatment for 4 weeks and 3 months after treatment(P<0.05).Three months after treatment,the scores of anxiety state and satisfaction degree and the total score of PAC-QOL in the treatment group were lower than those in the control group(P<0.05).(5)Five cases in the control group showed the adverse reactions,and no adverse reactions were found in the treatment group.The incidence rate of adverse reactions in the treatment group was lower than that in the control group(P<0.05).Conclusion:Chinese medical psychosomatic comprehensive therapy shows good efficacy in the treatment of severe mixed constipation with syndrome of deficiency of both qi and yin.Compared with the conventional treatment of western medicine(prokinetic agents and laxatives),this therapy can better relieve the constipation symptoms,and improve the life quality of patients,with long-term effects and good safety.