基于“调枢通胃”理论的针刺疗法治疗脑卒中后便秘疗效及对肠道菌群的影响

Efficacy of acupuncture therapy based on theory of “regulating pivot and unblocking stomach”on poststroke constipation and its effect on intestinal flora

目的 观察“调枢通胃”理论指导下的针刺疗法结合乳果糖治疗脑卒中后便秘的临床疗效及对患者肠道菌群的影响。方法 纳入2022年1月—2023年1月在湖南中医药大学第二附属医院就诊的脑卒中后便秘患者60例,随机分为观察组30例和对照组30例。2组患者均按卒中单元模式予内科基础治疗,对照组每天早餐前口服乳果糖口服液,视患者情况调整服用剂量,每周连服6 d停1 d,治疗3周;观察组在对照组的基础上给予基于“调枢通胃”理论的针刺治疗,穴取百会、内关、支沟、天枢、三阴交,得气后每隔10 min行针1次,留针30 min,每天1次,每周针刺6 d停1 d,治疗3周。观察比较2组患者治疗前及治疗1周、3周后的便秘患者症状自评量表(PAC-SYM)评分、粪便中肠道菌群数量和短链脂肪酸含量,统计2组患者治疗1周、3周后的临床疗效。结果 观察组和对照组各脱落2例,每组28例患者完成研究。随治疗时间延长,2组患者PAC-SYM评分及粪便中大肠杆菌数量、肠球菌数量均逐渐减少,粪便中双歧杆菌数量、乳酸杆菌数量及乙酸、丙酸、丁酸含量和总短链脂肪酸含量均逐渐增加(P均<0.05),各时间点两两比较差异均有统计学意义(P均<0.05);且治疗3周后观察组患者PAC-SYM评分及粪便中大肠杆菌数量、肠球菌数量均明显低于对照组,粪便中双歧杆菌数量、乳酸杆菌数量及乙酸、丙酸、丁酸含量和总短链脂肪酸含量均明显高于对照组(P均<0.05)。观察组和对照组治疗1周后总有效率分别为82.1%(23/28)和75.0%(21/28),治疗3周后分别为96.4%(27/28)和89.3%(25/28),观察组均明显高于对照组(P<0.05)。结论 基于“调枢通胃”理论的针刺疗法联合乳果糖口服能明显改善脑卒中后便秘患者的临床症状,调节肠道菌群结构,促进排便,效果优于单纯乳果糖治疗,且呈一定时间效应。

Objective It is to observe the clinical efficacy of acupuncture therapy combined with lactulose under the guidance of theory of“regulating pivot and unblocking stomach”in the treatment of post-stroke constipation and its influence on the patients’intestinal flora.Methods A total of 60 patients with post-stroke constipation diagnosed and treated in the Second Affiliated Hospital of Hunan University of Chinese Medicine from January 2022 to January 2023 were collected and were randomly divided into observation group and control group,with 30 cases in each group.The patients in both groups were given basic medical treatment according to the stroke unit model.The control group was orally given lactulose oral solution before breakfast every day,and the dose was adjusted according to the patient’s condition,the treatment lasted for 6 days and stopped one day every week,totally treated for 3 weeks.The observation group was treated with acupuncture treatment based on the theory of“regulating the pivot to pass the stomach”,and the acupoints were taken as Baihui,Neiguan,Zhigou,The observation group was given acupuncture treatment at Baihui(DU 20),Neiguan(PC 6),Zhigou(TE 6),Tianshu(ST 25),Sanyinjiao(SP 6)based on the theory of“regulating pivot and unblocking stomach”on the basis of the control group,manipulated the needle every 10 min after achieving qi arrival,and the needles were retained for 30 min,once a day,and the needles were injected for 6 days and stopped for 1 days every week,totally treated for 3 weeks.The scores of Patient Assessment of Constipation Symptoms(PAC-SYM)scores,intestinal flora count and the content of fecal short-chain fatty acids of patients of the two groups were observed and compared before treatment,1 week after treatment and 3 weeks after treatment,and the clinical efficacy was of the two groups was assessed after treatment for 1 week and 3 weeks.Results Totally 2 cases of patients dropped off in each group,and finally 28 cases of patients in each group completed the study.With the prolongation of the treatment time,the PAC-SYM score and the counts of Escherichia coli and Enterococcus in feces of patients in the two groups were gradually decreased,and the counts of Bifidobacterium and Lactobacillus,and the content of acetic acid,propionic acid,butyric acid and total short-chain fatty acids in feces were gradually increased(all P<0.05),and the difference at each time point was statistically significant between the two groups(all P<0.05).After 1 week of treatment,the total effective rate was 82.14%(23/28)in the observation group and 75.00%(21/28)in the control group,after 3 weeks of treatment,the total effective rate was 96.43%(27/28)in the observation group and 89.29%(25/28)in the control group,the total effective rates of the observation group were both significantly higher than those of the control group(both P<0.05).Conclusion Acupuncture therapy based on the theory of“regulating pivot and unblocking stomach”combined with lactulose can obviously improve the clinical symptoms,regulate the structure of intestinal flora,promote defecation of patients with post-stroke constipation,it is more effective than simple use of lactulose,and the curative effect is more significant after persisting in treatment.