东垣针法联合匹维溴铵治疗腹泻型肠易激综合征脾胃虚弱型的临床观察

Clinical Observation on Dongyuan Acupuncture Therapy Combined with Pinaverium Bromide in the Treatment of Diarrhea-predominant Irritable Bowel Syndrome with Deficiency of Spleen and Stomach Syndrome

【目的】观察东垣针法联合匹维溴铵治疗腹泻型肠易激综合征脾胃虚弱型的临床疗效。【方法】将76例腹泻型肠易激综合征脾胃虚弱型患者随机分为观察组和对照组。每组各38例,2组均给予匹维溴铵片口服,每次50 mg,每日3次。对照组给予参苓白术颗粒口服,每次1袋,每日3次,观察组给予东垣针法(中脘、天枢、章门、关元、昆仑、胃俞、足三里、内庭、陷谷)治疗,每日1次,每周5次,连续治疗6周。治疗6周后,评价2组患者的临床疗效,观察2组患者治疗前后中医症候积分、胃肠道症状评分与肠易激综合征严重程度评测(IBS-SSS)量表评分的变化情况,以及肠易激综合征生活质量量表(IBS-QOL)评分的情况。比较2组患者治疗前后血清5-羟色胺(5-HT)、结肠黏膜P物质(SP)、血管活性肠肽(VIP)的变化情况。【结果】(1)研究过程中,观察组脱落1例;对照组脱落1例、剔除1例。最终观察组37例,对照组36例纳入疗效统计。(2)治疗后,2组患者的中医症候积分、胃肠道症状评分、IBS-SSS评分均明显改善(P<0.05),且观察组在改善中医症候积分、胃肠道症状评分、IBS-SSS评分方面均明显优于对照组,差异均有统计学意义(P<0.05)。(3)治疗后,2组患者的IBSQOL量表各维度评分均明显改善(P<0.05),且观察组在改善IBS-QOL量表各维度评分方面均明显优于对照组,差异均有统计学意义(P<0.05)。(4)治疗后,2组患者的血清5-HT、SP、VIP水平均明显改善(P<0.05),且观察组在改善血清5-HT、SP、VIP水平方面均明显优于对照组,差异均有统计学意义(P<0.05)。(5)观察组总有效率为94.59%(35/37),对照组为72.22%(26/36)。观察组疗效优于对照组,差异有统计学意义(P<0.05)。【结论】东垣针法联合匹维溴铵治疗腹泻型肠易激综合征脾胃虚弱型,能明显地改善患者的胃肠道症状,有效调节机体胃肠激素的分泌,从而提高患者生活质量,疗效显著。

Objective To observe the clinical efficacy of Dongyuan acupuncture therapy combined with Pivirium bromide in treating diarrhea-predominant pattern irritable bowel syndrome with deficiency of spleen and stomach syndrome. Methods Seventy-six patients with diarrhea-predominant irritable bowel syndrome with deficiency of spleen and stomach syndrome were randomly divided into the observation group and the control group, with38 patients in each group. Both groups were given oral use of Piveronium bromide tablets with 50 mg each time and3 times a day. The control group was given oral use of Shenling Baizhu Granules with one bag each time and 3 times a day, while the observation group was given Dongyuan acupuncture therapy [Zhongwan(RN12), Tianshu(ST25),Zhangmen(LR13),Guanyuan(RN4),Kunlun(BL60),Weishu(BL21),Zusanli(ST36),Neiting(ST44), Xiangu(ST43)] once a day and 5 times a week, lasted for 6 consecutive weeks. After 6 weeks of treatment,the clinical efficacy of patients in the two groups was evaluated,and the changes of traditional Chinese medicine(TCM)syndrome scores,gastrointestinal symptom score,irritable bowel syndrome severity scale(IBSSSS)and irritable bowel syndrome quality of life scale(IBS-QOL)score were observed before and after treatment.The changes of serum 5-hydroxytryptamine(5-HT),colonic mucosal substance P(SP)and vasoactive intestinal peptide(VIP)in the two groups were compared before and after treatment. Results(1)During the study,one case fell off in the observation group,one case fell off and one case was excluded in the control group. Finally,37 cases in the observation group and 36 cases in the control group were included in the curative effect statistics.(2)After treatment,the TCM syndrome scores,gastrointestinal symptom score and IBS-SSS score of the two groups were significantly improved(P<0.05), and the observation group was significantly superior to the control group in improving TCM syndrome scores, gastrointestinal symptom score and IBS-SSS score(P<0.05), and the differences were statistically significant.(3)After treatment,the scores of all dimensions of IBS-QOL scale in the two groups were significantly improved(P<0.05), and the observation group was significantly superior to the control group in improving the scores of all dimensions of IBS-QOL scale(P<0.05).(4)After treatment,the levels of serum 5-HT,SP and VIP in the two groups were significantly improved(P<0.05),and the observation group was significantly superior to the control group in improving the levels of serum 5-HT,SP and VIP(P<0.05).(5)The total effective rate was 94.59%(35/37)in the observation group and 72.22%(26/36)in the control group. The curative effect of the observation group was superior to that of the control group(P<0.05). Conclusion Dongyuan acupuncture therapy combined with Pivirium bromide in treating diarrhea-predominant irritable bowel syndrome with deficiency of spleen and stomach syndrome has significant therapeutic effect in improving the gastrointestinal symptoms, effectively regulating the secretion of gastrointestinal hormones, and improving the quality of life of patients.