针刺疗法改善维持性血液透析患者便秘的临床疗效观察

Observation of clinical effect of acupuncture therapy in the improvement of constipation in maintenance hemodialysis patients

目的:观察针刺疗法对维持性血液透析(血透)患者便秘的临床疗效。方法:选取2018年1月-2019年12月在上海市普陀区中心医院血液净化中心长期进行维持性血透的便秘患者60例,随机分为治疗组和对照组,每组30例。对照组给予服用乳果糖、开塞露通便等常规治疗,治疗组给予常规通便联合针刺穴位治疗,总疗程为12周,观察两组临床疗效及相关炎症因子表达。结果:治疗后,两组患者的便秘症状均有改善,治疗组中医证候疗效优于对照组(P<0.05),但两组临床疗效、便秘评分比较差异无统计学意义(P>0.05)。两组治疗后血磷、血钙较治疗前均降低,且治疗组血磷水平降低幅度大于对照组(P<0.05);治疗组治疗后甲状旁腺激素水平较治疗前降低(P<0.01),且降低幅度大于对照组(P<0.01)。两组治疗后可降低相关炎症因子(IL-6、IL-8、IL-10)水平,其中治疗组IL-8水平下降幅度大于对照组(P<0.05)。结论:针刺疗法可改善维持性血透患者便秘症状,降低血磷水平,改善血清中相关炎症因子指标,尤其是IL-8水平,具有良好的临床效果。

Objective:To observe the clinical effect of acupuncture therapy on constipation in patients with maintenance hemodialysis.Methods:A total of 60 patients with constipation who had long term maintenance hemodialysis in the blood purification center of Putuo Hospital,Shanghai were selected and randomly divided into a treatment group and a control group with 30 patients in each group.The control group was given routine treatment such as lactulose,kaiseru defecation,and the treatment group was given routine defecation treatment combined with acupuncture point treatment for a total course of 12 weeks.The clinical efficacy and the expression of related inflammatory factors were observed in the two groups.Results:Constipation symptoms were improved after treatment in both groups after treatment,TCM symptoms curative effect in the treatment group was better than that in the control group(P<0.05),the differences in clinical effect and constipation scores in two groups had no obvious statistical significant(P<0.05).After treatment,blood phosphorus and blood calcium decreased compared to before treatment,and reduction amplitude of blood phosphorus level in the treatment group was greater than that in the control group(P<0.05);parathyroid hormone level in the treatment group decreased compared to before treatment(P<0.01),which was greater than that in the control group(P<0.01).The two groups after treatment could decrease the inflammation factors associated(IL-6,IL-8,IL-10),and the IL-8 level in the treatment group decreased greater than that in the control group(P<0.05).Conclusion:Acupuncture therapy can improve the constipation condition of patients with maintenance hemodialysis,reduce the blood phosphorus level,and improve the indicators of related inflammatory factors in serum,which are closely related to IL-8 and have good clinical effects.