揿针联合大黄敷脐治疗糖尿病肾病Ⅳ~Ⅴ期患者便秘的临床研究

Acupuncture therapy combined with rhubarb applied to the umbilicus for constipation in patients with stage IV-V diabetic nephropathy

目的观察揿针联合大黄敷脐治疗糖尿病肾病Ⅳ~Ⅴ期患者便秘的临床效果。方法选取2019年12月至2020年12月于温州市中医院治疗的糖尿病肾病Ⅳ~Ⅴ期便秘患者90例为研究对象,采用随机数字表法分为研究组(45例)、对照组(45例);对照组给予常规治疗;研究组在对照组基础上给予揿针联合大黄敷脐治疗;观察比较两组患者治疗前后血清胃动素(MTL)、胃泌素(GAS)、生长抑素(SS)水平及口-结肠转运时间(OCTT)变化,采用便秘严重度评分量表(CSS)评价患者便秘情况,采用便秘患者生存质量自评量表(PAC-QOL)评价患者生活质量,比较两组患者临床疗效。结果治疗后,研究组SS[(13.66±4.24)ng/L]、OCTT[(80.58±10.11)min]均低于对照组的(19.31±6.13)ng/L、(87.16±12.04)min(t=5.08、2.80,均P<0.05);研究组MTL[(281.07±41.16)ng/L]、GAS[(181.07±35.16)ng/L],均高于对照组的(259.64±39.83)ng/L、(162.65±32.83)ng/L(t=2.51、2.56,均P<0.05);治疗后,研究组CSS[(10.66±3.14)分]、PAC-QOL[(60.14±13.64)分]均低于对照组的(15.31±4.13)分、(71.61±14.72)分(t=6.01、3.83,均P<0.05);研究组总有效率(97.78%)高于对照组(80.00%)(χ^(2)=5.51,P<0.05)。结论揿针联合大黄敷脐治疗糖尿病肾病Ⅳ~Ⅴ期便秘患者,可调整胃肠道相关激素分泌,降低患者OCTT,改善患者临床症状,提升患者临床疗效及生活质量。

Objective To investigate the efficacy of acupuncture therapy combined with rhubarb applied to the umbilicus in the treatment of constipation in patients with stage IV-V diabetic nephropathy.Methods Ninety stage IV-V diabetic nephropathy patients with constipation,who received treatment in Wenzhou Hospital of Traditional Chinese Medicine from December 2019 to December 2020,were included in this study.They were randomly assigned to receive either routine treatment(control group,n=45)or routine treatment plus acupuncture therapy combined with rhubarb applied to the umbilicus(study group,n=45).Serum motilin,gastrin,and somatostatin levels and orocecal transit time pre-and post-treatment were compared between the two groups.The constipation severity was evaluated using the Constipation Severity Scale(CSS).Quality of life was evaluated using the Patient Assessment of Constipation Quality of Life Questionnaire.Clinical efficacy was compared between the two groups.Results The somatostatin level and orocecal transit time post-treatment in the study group were(13.66±4.24)ng/L and(80.58±10.11)minutes,respectively,which were significantly lower than those in the control group[(19.31±6.13)ng/L,(87.16±12.04)minutes,t=5.08,2.80,both P<0.05].Serum motilin and gastrin levels post-treatment in the study group were(281.07±41.16)ng/L and(181.07±35.16)ng/L,respectively,which were significantly higher than those in the control group[(259.64±39.83)ng/L,(162.65±32.83)ng/L,t=2.51,2.56,both P<0.05].The scores of the Constipation Severity Scale and the Patient Assessment of Constipation Quality of Life Questionnaire post-treatment in the study group were(10.66±3.14)points and(60.14±13.64)points,respectively,which were significantly lower than those in the control group[(15.31±4.13)points,(71.61±14.72)points,t=6.01,3.83,both P<0.05).Total response rate was significantly higher in the study group than in the control group(97.78%vs.80.00%,χ^(2)=5.51,P<0.05).Conclusion Acupuncture therapy combined with rhubarb applied to the umbilicus can be used to treat constipation in patients with stage IV-V diabetic nephropathy.The combined therapy can adjust the secretion of gastrointestinal tract-related hormones,shorten orocecal transit time,improve clinical symptoms,and improve clinical efficacy and quality of life.