基于“调枢通胃”理论针刺治疗血虚肠燥型脑卒中后便秘的临床疗效观察

Clinical efficacy observation of acupuncture based on the theory of'regulating pivot and promoting stomach function'on constipation after stroke of blood deficiency and intestinal dryness type

目的:观察“调枢通胃”理论指导下的针刺疗法治疗血虚肠燥型脑卒中后便秘的临床疗效,并探讨可能的作用机制。方法:将60例血虚肠燥型脑卒中后便秘患者随机分为针刺组(30例)和药物组(30例),在内科基础治疗和对症处理的基础上,针刺组采用“调枢通胃”理论指导下的针刺疗法,穴取百会、内关、支沟、天枢、三阴交,留针30 min,得气后每隔10分钟行针1次,每日针刺1次,7 d为1个疗程,共3个疗程;药物组口服生血通便颗粒,每日1次,每次10 g,7 d为1个疗程,连续3个疗程。观察两组治疗前后的便秘临床症状积分以及血清胃动素(MTL)、P物质(SP)、生长抑素(SS)、血管活性肠肽(VIP)水平,并比较两组治疗临床疗效差异。结果:两组患者治疗后便秘积分及SS、VIP水平均较治疗前显著降低(P<0.05),MTL、SP水平均较治疗前显著升高(P<0.05)。针刺组患者治疗3周后便秘积分及SS、VIP水平均显著低于药物组(P<0.05),MTL、SP水平均显著高于药物组(P<0.05)。治疗1周后针刺组总有效率为63.33%(19/30),药物组为60.00%(18/30),差异无统计学意义;治疗3周后针刺组总有效率为83.33%(25/30),显著高于药物组73.33%(22/30)(P<0.05)。结论:基于“调枢通胃”理论的针刺疗法对血虚肠燥型脑卒中后便秘疗效显著,短期内疗效与口服生血通便颗粒相当,坚持治疗后疗效优于口服生血通便颗粒,其作用机制可能与调节MLT、SP、SS、VIP水平有关。

Objective:To observe the clinical efficacy of acupuncture therapy under the guidance of‘regulating pivot and promoting stomach function'theory on constipation after stroke of blood deficiency and intestinal dryness type.Methods:Sixty patients with constipation after stroke of blood deficiency and intestinal dryness type were randomly divided into acupuncture group(30 cases)and drug group(30 cases),on the basis of the medical treatment and symptomatic treatment,the acupuncture group took the therapy of acupuncture under the guidance of the theory of‘regulating pivot and promoting stomach function',at Baihui(DU20),Neiguan(PC6),Zhigou(TE6),Tianshu(ST25),Sanyinjiao(SP6),retaining needle 30 min,after acu-esthesia,acupuncture was performed once every 10 min,once a day,7 days as a course of treatment,a total of 3 courses.The drug group took Shengxue Tongbian Granules orally,once a day,10 g each time,7 days as a course of treatment,consecutive 3 courses.The clinical symptom scores of constipation and the levels of motilin(MTL),substance P(SP),somatostatin(SS)and vasculo active intestinal peptide(VIP)in serum were observed before and after treatment,and the clinical efficacy differences between the two groups were compared.Results:After treatment,the clinical symptom score of constipation and the levels of SS and VIP in 2 groups were decreased compared with before treatment(P<0.05),while MTL and SP in serum were increased compared with before treatment(P<0.05).After 3 weeks of treatment,the clinical symptom score of constipation and the levels of SS and VIP in the acupuncture group were lower than those in the drug group(P<0.05),and MTL and SP in serum were higher than those in the drug group(P<0.05).After 1 week of treatment,the healing rate of acupuncture group was 63.33%(19/30)and drug group was 60.00%(18/30),the difference was not statistically significant.After 3 weeks of treatment,the improvement rate of acupuncture group was 83.33%(25/30),which was significantly higher than that of drug group 73.33%(22/30)(P<0.05).Conclusion:Acupuncture therapy based on the theory of‘regulating pivot and promoting stomach function'has significant efficacy in the treatment of constipation after stroke of blood deficiency and intestinal dryness type,the short-term curative effect is similar to that of took Shengxue Tongbian Granules orally,and the curative effect after persistent treatment is better than that of took Shengxue Tongbian Granules orally.The mechanism of action may be related to the regulation of MTL,SP,SS and VIP levels.