基于脑-肠轴理论的济川煎加减治疗脑卒中后便秘(肾阳虚型)的临床效果

Clinical Effect of Jichuan Decoction in the Treatment of Post-stroke Constipation(Kidney-Yang Deficiency Type)Based on the Theory of Brain-Gut Axis

目的观察基于脑-肠轴理论的济川煎加减治疗脑卒中后便秘(肾阳虚型)的临床效果。方法选取2018年1月至2020年1月苏州高新区人民医院收治的80例脑卒中后便秘(肾阳虚型)患者。将患者按住院号单双分为对照组(40例)和观察组(40例)。给予对照组患者常规干预,观察组在对照组基础上口服中药济川煎加减治疗。两组均以7 d为1个疗程,连续干预治疗4个疗程。比较两组患者便秘消失率。分别于治疗前后评估两组患者的便秘症状,包括粪便性状、排便困难程度和排便频度共3个方面。比较两组治疗前后5-羟色胺(5-HT)、血管活性肠肽(VIP)、大便双歧杆菌水平。结果治疗后,对照组和观察组便秘消失率分别为40.0%(16/40)、72.5%(29/40)。观察组便秘消失率高于对照组(P<0.05)。治疗后,两组症状(粪便性状、排便困难程度、排便频度)积分均低于治疗前,观察组症状(粪便性状、排便困难程度、排便频度)积分均低于对照组(P<0.05)。治疗后,两组5-HT水平高于治疗前,两组VIP水平低于治疗前(P<0.05);观察组治疗后大便双歧杆菌水平高于治疗前(P<0.05);治疗后,观察组5-HT和大便双歧杆菌水平均高于对照组,观察组VIP水平低于对照组(P<0.05)。结论基于脑-肠轴理论的济川煎加减治疗脑卒中后便秘(肾阳虚型)的效果显著,能够标本兼治,有效缓解患者的症状。

Objective To observe the clinical effect of Jichuan decoction on post-stroke constipation(kidney-yang deficiency type)based on the theory of brain-gut axis.Methods From January 2018 to January 2020,80 patients with constipation after stroke(kidney-yang deficiency type)in the People’s Hospital of Suzhou New District were selected.They were divided into control group(40 cases)and observation group(40 cases)according to the number of admission.The patients in control group were given routine intervention,and the patients in observation group were treated with oral administration of Jichuan decoction on the basis of control group.Both groups had one course of treatment for 7 days and four courses of continuous intervention.The disappearance rate of constipation between the two groups was compared.The constipation symptoms of the two groups were evaluated before and after treatment,including fecal characteristics,difficulty in defecation and frequency of defecation.The levels of 5-hydroxytryptamine(5-HT),vasoactive intestinal peptide(VIP)and fecal bifidobacteria were compared between the two groups before and after treatment.Results After treatment,the disappearance rates of constipation in control group and observation group were 40.0%(16/40)and 72.5%(29/40),respectively.The disappearance rate of constipation in observation group was higher than that in control group(P<0.05).After treatment,the scores of symptoms(fecal characteristics,difficulty in defecation and frequency of defecation)in the two groups were lower than those before treatment,and the scores of symptoms(fecal characteristics,difficulty in defecation and frequency of defecation)in observation group were lower than those in control group(P<0.05).After treatment,the levels of 5-HT in both groups were higher than those before treatment,and the levels of VIP in both groups were lower than those before treatment(P<0.05).The level of fecal bifidobacteria in observation group after treatment was higher than that before treatment(P<0.05).After treatment,the levels of 5-HT and fecal bifidobacteria in observation group were higher than those in control group,while the level of VIP in observation group was lower than that in control group(P<0.05).Conclusion Jichuan decoction based on the theory of brain-intestine axis has a remarkable effect on constipation after stroke(kidney-yang deficiency type),which could treat both the symptoms and root causes,and effectively relieve the symptoms of patients.