热敏灸治疗中风后气虚型便秘的疗效观察及对血清SP、VIP水平的影响

Observation of the therapeutic effect of heat-sensitive moxibustion on constipation of qi deficiency after stroke and its influence on serum SP and VIP levels

目的观察热敏灸治疗中风后气虚型便秘的临床疗效以及对血清P物质(substance P,SP)和血管活性肠肽(vasoactive intestinal peptide,VIP)水平的影响。方法将60例中风后气虚型便秘患者随机分为针刺组和热敏灸组,每组30例。两组均予药物对症治疗,针刺组采用针刺治疗,热敏灸组采用热敏穴悬灸治疗。观察两组治疗前后的症状积分评定表、便秘临床评分(clinic constipation score,CCS)量表、便秘患者生存质量量表(patient assessment of constipation quality of life,PAC-QOL)评分及血清SP和VIP水平变化,并比较两组临床疗效。结果两组治疗后症状积分均低于治疗前,且热敏灸组低于针刺组;两组治疗后CCS均下降,且热敏灸组低于针刺组;两组治疗后PAC-QOL评分均下降,且热敏灸组低于针刺组,差异均有统计学意义(P<0.05)。两组治疗后血清SP水平升高,血清VIP水平下降;且热敏灸组血清SP水平高于针刺组,血清VIP水平低于针刺组,差异均有统计学意义(P<0.05)。两组临床疗效比较,差异有统计学意义(P<0.05)。结论在药物治疗的基础上,热敏灸治疗中风后气虚型便秘疗效优于针刺,可有效改善便秘症状,提高生存质量,机制可能与升高血清SP水平、降低血清VIP水平有关。

Objective To observe the clinical efficacy of heat-sensitive moxibustion in the treatment of constipation of qi deficiency after stroke and its influence on the levels of serum substance P(SP)and vasoactive intestinal peptide(VIP).Method Sixty patients with post-stroke constipation of qi deficiency were randomly divided into an acupuncture group and a heat-sensitive moxibustion group,with 30 cases in each group.Both groups were given symptomatic medication.The acupuncture group was treated with acupuncture,and the heat-sensitive moxibustion group was treated with suspended moxibustion at heat-sensitive points.Changes of the symptom score rating scale,clinic constipation score(CCS)scale,patient assessment of constipation quality of life(PAC-QOL)scale,and serum SP and VIP levels before and after treatment were observed in the two groups.The clinical efficacy was compared between the two groups.Result After treatment,the symptom scores of the two groups were lower than those before treatment,and the symptom scores of the heat-sensitive moxibustion group were lower than those of the acupuncture group;the CCS decreased in the two groups,and the CCS in the heat-sensitive moxibustion group was lower than that in the acupuncture group;the PAC-QOL score of the two groups decreased,and the score in the heat-sensitive moxibustion group was lower than that in the acupuncture group,all showing statistically significant(P<0.05).After treatment,the serum SP level increased and the serum VIP level decreased in the two groups,and the serum SP level in the heat-sensitive moxibustion group was higher than that in the acupuncture group,and the serum VIP level in the heat-sensitive moxibustion group was lower than that in the acupuncture group,and the differences were all statistically significant(P<0.05).There was statistically significant difference in clinical efficacy between the two groups(P<0.05).Conclusion In addition to the medication treatment,heat-sensitive moxibustion is better than acupuncture in the treatment of post-stroke constipation of qi deficiency,which can effectively improve the symptoms of constipation and the quality of life.The mechanism of action may be related to the up-regulation of the serum SP level and down-regulation of the serum VIP level.