摘要
目的:分析耻骨直肠肌综合征中医内治与中医挂线外治疗法相结合治疗的最佳时机和节点。方法:选择符合纳入标准的160例患者,实施耻骨直肠肌挂线治疗后辨证施治分为胃肠积热证、肠道气滞证、气血两虚证、脾肾阳虚证等4组各40例,根据时间节点再分为每个证型10例,分别于挂线后第1周、第2周、第3周、第4周等4个时间点进行中药口服治疗,并在中药干预治疗1个月后观察患者排便顺畅度,粪便性状,排便时间,肛门下坠、排便不尽、肛门胀感,腹胀等5个证候积分改变以及远期总体疗效。结果:经混合效应多因素重复测量方差分析,4组患者在排便顺畅度,粪便性状,排便时间,肛门下坠、排便不尽、肛门胀感,腹胀5个证候积分改变方面,第2周给药改善显著(P <0. 05),其余3个时间点给药无显著差异(P> 0. 05)。第2周给药的远期疗效也显著优于其他时间给药(P <0. 05)。结论:在耻骨直肠肌综合征的治疗中,中医挂线治疗后在第2周根据中医辨证对患者采取相应的中药口服治疗,能起到最佳的治疗效果,远期疗效理想。
Objective: To analyze the best timing and node of the treatment of puborectalis syndrome with combined treatment of Chinese medicine internal treatment and Chinese medicine line hanging treatment. Methods: 160 patients who met the inclusion criteria were selected and treated with puborectal muscle line hanging treatment. The syndrome differentiation was divided into four groups: syndrome of accumulated heat in stomach and intestine,syndrome of intestinal qi stagnation,syndrome of deficiency of both qi and blood,syndrome of yang deficiency of spleen and kidney,40 cases in each group. According to the time node,it was further divided into 10 cases of each syndrome. Oral Chinese medicine was given at the first week,the second week,the third week and the fourth week after line hanging,and the patient's defecation smoothness,fecal characteristics,defecation time,anal falling,incomplete defecation,anal distension,abdominal swelling 5 syndrome score changes and long-term overall efficacy were observed after one month of Chinese medicine intervention. Results: According to the analysis of variance of repeated measurements of mixed effects,there were significant improvements in defecation smoothness,fecal characteristics,defecation time,anal falling,incomplete defecation,anal distension and abdominal swelling 5 syndrome score changes in the second week( P < 0. 05),and there were no significant differences in the other three time points( P > 0. 05). The long-term efficacy of the second week was also significantly better than that of the other time( P < 0. 05). Conclusion: In the treatment of puborectalis syndrome,taking corresponding oral Chinese medicine according to TCM syndrome differentiation in the second week after line hanging treatment can achieve the best therapeutic effect,and the long-term effect is ideal.
引文
[1]辛世勇,田昕.耻骨直肠肌部分切除挂线加中药口服治疗耻骨直肠肌综合征型便秘[J].辽宁中医药大学学报,2012,14(5):182-184.
[2]刘丛丛.中西医结合治疗耻骨直肠肌综合征所致便秘的临床研究[D].济南:山东中医药大学,2013.
[3]SUARES N C,FORD A C. Prevalence of and risk factors for chronic idiopathic constipation in the community:systematic review and metaanalysis[J]. Am J Gastroenterol,2011,16(9):1582-1591.
[4]ZHAO Y F,MA X Q,WANG R,et al. Epidemiology of functional constipation and comparision with constipation-predominant irritable bowel syndrome:the Systematic Investigation of Gastrointestinal Diseases in China(SILC)[J]. Aliment Pharmacol Tlier,2011,34(8):1020-1029.
[5]JIANG C,XU Q,WEN X,et al. Current developments in pharmacological therapeutics for chronic constipation[J]. Acta Pharm Sin B,2015,5(4):300-309.
[6]刘宝华.慢性便秘外科手术治疗原则[J].中华结直肠疾病电子杂志,2013,2(1):10-13.
[7]陈红风.中医外科学[M].上海:上海科学技术出版社,2012:297-978.
[8]DROSSMAN D A. The funetional gastrointestinal disorders and the RomeⅢproeess[J]. Gastroenterology,2006,130:1377-1390.
[9]江明月.中医辨证施治与西药治疗慢性传输型便秘的对照研究[D].福州:福建中医药大学,2016.
[10]MENEES S,KIM H M,WREN P,et al. Patient compliance and suboptimal bowel preparation with split-dose bowel regimen in averagrrisk screening colonoscopy[J]. Gsatrointest Endosc,2014,79(6):811-820.
[11]周鹏飞,刘佃温,曹晛,等.补中益气汤联合中医外治法治疗脾虚气陷型出口梗阻型便秘疗效的对比研究[J].中医临床研究,2017,9(18):125-127.
[12]白小华,高玲. MRI排粪造影术在出口梗阻型便秘诊断及治疗方式选择中的临床价值[J].中国药物与临床,2017,17(10):1480-1483.
[13]黄帝内经[M].田代华,整理.北京:人民卫生出版社,2005.
[14]刘忠权.排便造影检查技术及其临床应用体会[J].中外医学研究,2012,10(11):52.
[15]沈艳婷,阙任烨,陶智会,等.出口梗阻型便秘的中西医研究进展[J].吉林中医药,2016,36(1):97-102.
[16]潘冬,孙尚颖,杨光.生物反馈治疗盆底失弛缓型便秘的效果观察[J].实用临床医药杂志,2014,18(23):183-184.
[17]方秀才.肠道动力和肛门直肠功能检测在慢性便秘诊治中的应用[J].临床消化病杂志,2013,25(4):243-244.
[18]郑德先,李传亭.功能性出口梗阻性便秘的影像学研究进展[J].医学影像学杂志,2009,19(6):773-775.
[19]连娟,李俊达,白倩茹,等.高分辨率肛门直肠测压法用于功能性排便障碍的表型鉴定和分类[J].河北医药,2017,39(8):1172-1175.
[20]刘佃温,柳越冬,吉强,等.挂线疗法治疗耻骨直肠肌综合征所致慢性便秘160例[J].河南中医,2011,31(8):878-879.
