加味增液汤联合凝结芽孢杆菌活菌片治疗小儿功能性便秘(肠燥津亏证)的疗效观察

Efficacy of Jiawei Zengye Decoction combined with Bacillus coagulans Tablets, Live in the treatment of functional constipation in children(intestinal dryness and fluid deficiency syndrome)

目的 观察加味增液汤联合凝结芽孢杆菌活菌片治疗小儿功能性便秘(肠燥津亏证)的疗效。方法 选取2019年3月至2021年3月在陕西省中医医院儿科门诊就诊的102例功能性便秘肠燥津亏证患儿为研究对象,按随机数表法分为研究组和对照组各51例。对照组患儿予以凝结芽孢杆菌活菌片治疗,研究组患儿在对照组治疗的基础上联合加味增液汤治疗,两组均治疗1个月。比较两组患儿治疗前后的中医证候积分、排便情况[每周自发完全排便次数(SCBM)、平均排便时间、Bristol粪便形状评分表(BSFS)]、胃肠功能指标[一氧化氮(NO)、P物质(P)、胃动素(MTL)、胃泌素(GAS)]、肠动力指标(肛门静息压、肛门最大收缩压、直肠最大耐受阈)、肠道菌群(肠球菌、葡萄球菌、乳酸菌)水平,同时比较两组患儿治疗1个月内的不良反应发生情况。结果 治疗1个月后,两组患儿中医证候积分与治疗前比较差异有统计学意义,且研究组的粪便干结评分、排便费力评分和排便间隔时间评分分别为(1.08±0.46)分、(1.24±0.52)分、(1.17±0.50)分,明显低于对照组的(1.54±0.48)分、(1.66±0.53)分、(1.69±0.57)分,差异均有统计学意义(P均<0.05);治疗后,研究组患儿的平均排便时间、NO、直肠最大耐受阈、肠球菌和葡萄球菌明显短(少)于对照组,差异均有统计学意义(P<0.05);治疗后,两组患儿的SCBM、BSFS、P、GAS、乳酸菌水平与治疗前比较差异均有统计学意义(P<0.05),且研究组明显优于对照组,差异均有统计学意义(P<0.05);治疗后,两组患儿的肛门静息压与治疗前比较差异均无统计学意义(P>0.05);治疗1个月内,两组患儿的总不良反应发生率比较差异无统计学意义(P>0.05)。结论 加味增液汤联合凝结芽孢杆菌活菌片可以更好地调理肠燥津亏证功能型便秘患儿胃肠功能、调节肠道菌群,临床疗效显著,且安全性较高。

Objective To observe the efficacy of Jiawei Zengye Decoction combined with Bacillus coagulans Tablets, Live in the treatment of children with functional constipation(intestinal dryness and fluid deficiency syndrome).Methods A total of 102 children with functional constipation of intestinal dryness and fluid deficiency syndrome admitted to Department of Pediatrics, Shaanxi Provincial Hospital of Chinese Medicine were selected as the study subjects between March 2019 and March 2021, which were divided into a study group and a control group by random number table method, with 51 cases in each group. The children in the control group were treated with Bacillus coagulans Tablets,Live, and the children in the study group were treated with Jiawei Zengye Decoction on the basis of treatment in the control group. Both groups were treated for 1 month. The scores of TCM syndromes, defecation status [weekly spontaneous complete bowel movement(SCBM), average defecation time, Bristol Stool Form Scale(BSFS)], gastrointestinal function indicators [nitric oxide(NO), substance P(P), motilin(MTL), gastrin(GAS)], intestinal motility indicators(anal resting pressure, anal maximum systolic pressure, rectal maximum tolerance threshold), and intestinal flora(Enterococcus, Staphylococcus, Lactobacillus) of the two groups of children were compared before and after treatment. The occurrence of adverse reactions within 1 month of treatment were compared between the two groups of children. Results After 1 month of treatment, the scores of TCM syndromes in the two groups showed statistically significant differences compared with those before treatment, and the scores of dry stool, difficulty in defecation, and interval time between defecation were(1.08±0.46) points,(1.24±0.52) points, and(1.17±0.50) points in the study group, which were significantly lower than(1.54±0.48) points,(1.66±0.53) points, and(1.69±0.57) points in the control group(all P<0.05). The average defecation time, NO, rectal maximum tolerance threshold, Enterococcus count, and Staphylococcus count in the study group after treatment were significantly shorter or less than those in the control group(P<0.05). After treatment, the SCBM, BSFS, P, GAS, and Lactobacillus in the two groups were significantly different from those before treatment(P<0.05), and the above indicators in the study group were significantly better than those in the control group(P<0.05). After treatment, anal resting pressure in the two groups showed no statistically significant difference with those before treatment(P>0.05). Within 1 month of treatment, there was no statistically significant difference in the incidence rate of total adverse reactions between the two groups(P>0.05). Conclusion Jiawei Zengye Decoction combined with Bacillus coagulans Tablets, Live in treating children with functional constipation of intestinal dryness and fluid deficiency syndrome can better adjust gastrointestinal function and regulate intestinal flora, with significant clinical efficacy and high safety.