理肠饮治疗腹泻型肠易激综合征肝郁脾虚证的疗效及对结肠动力的影响

Efficacy of decoction for regulating intestine on diarrhea-type irritable bowel syndrome with syndrome of liver-depression and spleen-deficiency and its effect on colonic dynamics

目的观察理肠饮治疗腹泻型肠易激综合征(IBS-D)肝郁脾虚证患者的临床疗效及对结肠动力的影响。方法选择2020年9月—2021年10月在山东中医药大学附属医院治疗的IBS-D肝郁脾虚证患者66例,按2∶1比例将受试者随机分为2组,中药组44例给予理肠饮治疗,西药组22例给予双歧杆菌三联活菌胶囊联合匹维溴铵治疗,2组疗程均为4周。比较2组治疗前及治疗第2周、第4周、第8周、第12周的腹痛程度评分、稀便时间、大便性状评分,比较2组治疗前及治疗4周后餐前5 min、餐后10 min、餐后20 min、餐后30 min不同肠段的肠电波幅及频率。结果2组治疗第2周、第4周、第8周、第12周的腹痛程度评分和大便性状评分均明显低于治疗前(P均<0.05),稀便时间均明显短于治疗前(P均<0.05),且治疗第4周各指标改善最明显;中药组治疗第8周、第12周的腹痛程度评分与治疗第4周比较差异均无统计学意义(P均>0.05),西药组治疗第8周、第12周的腹痛程度评分均明显高于治疗第4周(P均<0.05);中药组治疗第4周、第8周、第12周的腹痛程度评分和大便性状评分均明显低于同期西药组(P均<0.05),稀便时间均明显短于同期西药组(P均<0.05)。治疗4周后,2组各导联肠电波幅及频率均较治疗前明显降低(P均<0.05),但2组间各导联肠电波幅及频率比较差异均无统计学意义(P均>0.05)。结论理肠饮改善IBS-D肝郁脾虚证患者腹痛、稀便、大便性状的效果明显优于西药治疗,且具有一定的远期疗效,能降低结肠电活动的波幅及频率,负性调节结肠动力。

Objective It is to observe the clinical efficacy of decoction for regulating intestine on diarrhea-type irritable bowel syndrome with syndrome of liver-depression and spleen-deficiency and its effect on colonic dynamics.Methods Sixty-six patients with diarrhea-type irritable bowel syndrome with syndrome of liver-depression and spleen-deficiency treated at the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from September 2020 to October 2021 were selected,and the subjects were randomly divided into 2 groups according to the ratio of 2∶1.44 cases in the Chinese medicine group were treated with decoction for regulating intestine,and 22 cases in the western medicine group were treated with bifidobacterium trituberculatum capsules combined with pivetonium bromide,both groups were treated for 4 weeks.The abdominal pain severity,days of loose stools and stool consistency before and at the 2nd,4th,8th and 12th weeks of treatment were compared between the two groups,and the amplitude and frequency of different bowel segments at 5 min before,10 min after,20 min after and 30 min after meals before and after 4 weeks of treatment were compared between the two groups.Results The scores of abdominal pain and stool consistency at the 2nd,4th,8th and 12th weeks of treatment were significantly lower than those before treatment in the two groups(all P<0.05),and the days of loose stool was significantly shorter than that before treatment(P<0.05),and the improvement of each index was the most obvious in the 4th week of treatment.The differences in the abdominal pain scores at the 8th and 12th weeks of treatment were not statistically significant compared with those at 4th week of treatment in the Chinese medicine group(all P>0.05),while the abdominal pain scores at the 8th and 12th weeks of treatment were significantly higher than those at the 4th week of treatment in the western medicine group(all P<0.05);The abdominal pain scores and stool consistency scores of the Chinese medicine group at the 4th,8th and 12th weeks of treatment were significantly lower than those of the western medicine group in the same period(all P<0.05),and the days of loose stool was significantly shorter than that of the western medicine group(P<0.05).After 4 weeks of treatment,the amplitude and frequency of bowel electric waves in each lead of the two groups were significantly lower than those before treatment(all P<0.05),but the differences in the amplitude and frequency of bowel electric waves in each lead were not statistically significant between the two groups(all P>0.05).Conclusion The efficacy of decoction for regulating intestine in improving abdominal pain,loose stools and stool consistency is significantly better than that of western medicine treatment in patients with diarrhea-type irritable bowel syndrome with syndrome of liver-depression and spleen-deficiency,and its long-term efficacy is expected,and could reduce the wave amplitude and frequency of colonic electrical activity and negatively regulate colonic dynamics.