耳穴压豆对吗啡引发便秘患者胃肠激素的影响及疗效观察
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摘要
目的探讨耳穴压豆对吗啡引发便秘患者胃肠激素的影响及疗效。方法选择2016年1月～2017年12月在我院内科门诊治疗的吗啡引发便秘患者74例,采用随机数字表分为观察组(n=37)和对照组(n=37)。对照组患者均给予养成良好的生活方式、饮食调整和加强排便功能锻炼等常规治疗;观察组在对照组基础上加用耳穴压豆治疗,连用2周。观察两组治疗前与治疗2周后血清胃动素(MT)及一氧化氮(NO)水平的变化,并比较其临床效果。结果治疗2周后,两组患者血清MT水平较治疗前显著上升,血清NO水平较治疗前显著下降,差异均有统计学意义(P<0.05或P<0.01),且观察组患者变化幅度较对照组更显著,差异有统计学意义(P<0.05);同时观察组患者临床总有效率明显高于对照组(94.59%vs 78.38%),差异有统计学意义(χ2=4.16,P<0.05)。结论耳穴压豆用于吗啡引发便秘患者的效果确切,其作用机制可能通过调节胃肠道激素的分泌,加快MT的分泌,抑制NO的分泌,从而升高血清MT水平,降低血清NO水平,提高结肠传输功能,缓解其便秘症状,达到治疗目的。
Objective To investigate the effect of auricular pressure on gastrointestinal hormones in the patients with morphine-induced constipation and its curative effect.Methods A total of 74 patients with morphine-induced consti pation who were treated in the outpatient clinic of internal medicine from January 2016 to December 2017 were selected.The random number table was used to divide the patients into observation group(n=37) and control group(n=37).Patients in the control group were all given conventional treatment measures such as developing a good lifestyle,adjusting diet and strengthening defecation exercise;the observation group was further given auricular pressure on the basis of the control group for 2 weeks.The changes of serum motilin(MT) and nitric oxide(NO) levels before treatment and 2 weeks after treatment were observed and their clinical effects were compared.Results After 2 weeks of treatment,the serum MT levels in the two groups of patients were significantly higher than those before treatment,and serum NO levels were significantly lower than those before treatment.The differences were statistically significant(P<0.05 or P<0.01).The degree of changes in the observation group were more significant than those in the control group,and the difference was statistically significant(P<0.05);at the same time,the clinical total effective rate in the observation group was significantly higher than that in the control group(94.59% vs 78.38%),and the difference was statistically significant(χ2=4.16,P<0.05).Conclusion The effect of auricular pressure on the patients with morphine-induced constipation is definite.Its mechanism of action may be through regulating the secretion of gastrointestinal hormones,accelerating the secretion of MT and inhibiting the secretion of NO,in order to increase the level of serum MT,reduce the level of serum NO,improve the colon transport function,relieve constipation symptoms and achieve therapeutic goals.
Objective To investigate the effect of auricular pressure on gastrointestinal hormones in the patients with morphine-induced constipation and its curative effect.Methods A total of 74 patients with morphine-induced consti pation who were treated in the outpatient clinic of internal medicine from January 2016 to December 2017 were selected.The random number table was used to divide the patients into observation group(n=37) and control group(n=37).Patients in the control group were all given conventional treatment measures such as developing a good lifestyle,adjusting diet and strengthening defecation exercise;the observation group was further given auricular pressure on the basis of the control group for 2 weeks.The changes of serum motilin(MT) and nitric oxide(NO) levels before treatment and 2 weeks after treatment were observed and their clinical effects were compared.Results After 2 weeks of treatment,the serum MT levels in the two groups of patients were significantly higher than those before treatment,and serum NO levels were significantly lower than those before treatment.The differences were statistically significant(P<0.05 or P<0.01).The degree of changes in the observation group were more significant than those in the control group,and the difference was statistically significant(P<0.05);at the same time,the clinical total effective rate in the observation group was significantly higher than that in the control group(94.59% vs 78.38%),and the difference was statistically significant(χ2=4.16,P<0.05).Conclusion The effect of auricular pressure on the patients with morphine-induced constipation is definite.Its mechanism of action may be through regulating the secretion of gastrointestinal hormones,accelerating the secretion of MT and inhibiting the secretion of NO,in order to increase the level of serum MT,reduce the level of serum NO,improve the colon transport function,relieve constipation symptoms and achieve therapeutic goals.
引文
[1]孙岩萍,牛润桂,康金秀,等.吗啡缓释片不同给药途径疗效与安全性的对比研究[J].中国现代药物应用,2014,8(1):148-150.
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[13] Iijima K,Iwabuchi T,Ara N,et al. Reactive increase in gastric mucus secretion is an adaptive defense mechanism against low-dose aspirin-induced gastropa thy[J].Dig Dis Sci,2013,58(8):2266-2274.
[14] Bravo JA,Forsythe P,Chew MV,et al. Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve[J]. Proc Natl Acad Sci USA,2011,108(38):16050-16055.
[15]张兰花,焦俊,郭晓山,等.慢传输型便秘患者结肠动力与胃肠激素的关系[J].临床消化病杂志,2005,17(1):17-19.
[16] Lin Y,Chen XJ. Clinical study on functional dyspepsia by auricular point sticking therapy[J]. J Acupunct Tuina Sci,2011,9(1):39-41.
[17]张翔,顾芳红,张建林,等.耳穴贴压联合杜秘克预防阿片性便秘33例疗效观察[J].云南中医中药杂志,2017,38(9):47-48.
[18] Sahmeddini MA,Fazelzadeh A. Does auricular acupuncture reduce postoperative vomiting after cholecystectomy?[J].Journal of Alternative&Complementary Medicine,2008,14(10):1275-1279.
[19] Rumessen JJ. Gastrointestinal function following cholecystectomy[J]. Ugeskrift for Laeger,2005,167(24):2623-2624.
[20] Yeh CH,Chien LC,Chiang YC,et al. Reduction in nausea and vomiting in children undergoing cancer chemotherapy by either appropriate or sham auricular acupuncture points with standard care[J]. J Altern Complement Med,2012,18(4):334-336.
[21]汪桔仙,宁欢,吴旭敏.耳穴压丸加大黄敷脐预防阿片类药物所致便秘51例[J].浙江中医杂志,2014,49(8):582.
[22]张益娥,任观莉,王巧利.大黄敷脐联合耳穴压豆对口服奥施康定患者预防便秘的作用观察[J].浙江中医杂志,2018,53(3):196.
[2]王莉娜,刘杰,李道睿,等.阿片类药物所致便秘的中医治疗现状[J].中国中西医结合外科杂志,2010,16(1):116-118.
[3]董凤良,杜方民,董小芳,等.阿片类药物导致便秘的机制及治疗[J].医学综述,2014,20(2):288-291.
[4]王欢,黄永坤,刘梅.胃肠激素与胃肠道功能及疾病的关系[J].医学综述,2013,19(15):2735-2738.
[5]钟敏钰,胡作为,黄琳,等.耳穴贴压联合强阿片类药物治疗中重度癌痛50例疗效观察[J].中医杂志,2012,53(13):1123-1125.
[6]郑美珍.耳穴贴压防治强阿片类药物相关便秘的疗效观察[J].上海针灸杂志,2012,31(12):895-896.
[7]张万岱.功能性胃肠病罗马标准的简介和解读[J].世界华人消化杂志,2008,16(2):120-124.
[8]杨丽华,段培蓓.强阿片类药物相关性便秘患者耳穴敏感点探测分析[J].护理学杂志,2014,29(1):37-39.
[9]中华医学会外科学分会肛肠外科学组.便秘症状及疗效评估[J].中华胃肠外科杂志,2005,8(4):355-356.
[10] Desbonnet L,Garrett L,Clarke G,et al. Effects of the probiotic Bifidobacterium infantis in the maternal separation model of depression[J]. Neuroscience,2010,170(4):1179-1188.
[11] Chan AO,Cheng C,Hui WM,et al. Differing coping mechanisems stress level and anorectal physiology in patients with function constipation[J]. World J Gastroenterology,2005,11(4):5362-5366
[12] Papatheodoridis GV,Vlachogiannakos J,Karaitianos I,et al. A Greek survey of community prevalence and characteristics of constipation[J]. Eur J Gastroenterol Hepatol,2010,22(3):354-360.
[13] Iijima K,Iwabuchi T,Ara N,et al. Reactive increase in gastric mucus secretion is an adaptive defense mechanism against low-dose aspirin-induced gastropa thy[J].Dig Dis Sci,2013,58(8):2266-2274.
[14] Bravo JA,Forsythe P,Chew MV,et al. Ingestion of Lactobacillus strain regulates emotional behavior and central GABA receptor expression in a mouse via the vagus nerve[J]. Proc Natl Acad Sci USA,2011,108(38):16050-16055.
[15]张兰花,焦俊,郭晓山,等.慢传输型便秘患者结肠动力与胃肠激素的关系[J].临床消化病杂志,2005,17(1):17-19.
[16] Lin Y,Chen XJ. Clinical study on functional dyspepsia by auricular point sticking therapy[J]. J Acupunct Tuina Sci,2011,9(1):39-41.
[17]张翔,顾芳红,张建林,等.耳穴贴压联合杜秘克预防阿片性便秘33例疗效观察[J].云南中医中药杂志,2017,38(9):47-48.
[18] Sahmeddini MA,Fazelzadeh A. Does auricular acupuncture reduce postoperative vomiting after cholecystectomy?[J].Journal of Alternative&Complementary Medicine,2008,14(10):1275-1279.
[19] Rumessen JJ. Gastrointestinal function following cholecystectomy[J]. Ugeskrift for Laeger,2005,167(24):2623-2624.
[20] Yeh CH,Chien LC,Chiang YC,et al. Reduction in nausea and vomiting in children undergoing cancer chemotherapy by either appropriate or sham auricular acupuncture points with standard care[J]. J Altern Complement Med,2012,18(4):334-336.
[21]汪桔仙,宁欢,吴旭敏.耳穴压丸加大黄敷脐预防阿片类药物所致便秘51例[J].浙江中医杂志,2014,49(8):582.
[22]张益娥,任观莉,王巧利.大黄敷脐联合耳穴压豆对口服奥施康定患者预防便秘的作用观察[J].浙江中医杂志,2018,53(3):196.