针药联合生物反馈治疗功能性便秘疗效回顾性分析
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摘要
目的:分析针药联合生物反馈治疗功能性便秘(FC)的近远期疗效及其相关因素。方法:通过电话随访方式,对2015年6月至2017年11月在南京中医药大学附属医院南京中医院行针药联合生物反馈治疗的FC患者进行回顾性分析,完成便秘症状积分评估,评价患者治疗后(近期)及随访结束时(远期)的有效率(疗效指数≥30%)及满意率。共计72例患者纳入研究,随访时间4～34(中位数14)个月。结果:治疗后及随访期间患者便秘症状积分较治疗前降低(P<0.05),随访期间患者便秘症状积分较治疗后有所上升(P> 0.05)但优于治疗前。治疗后有效率和满意率处于较高水平,随访期间有所降低,其中满意率降低更多。62例治疗有效的患者,治疗后到随访期间疗效下降≤5%及≤30%的人数分别占总人数的51.61%和66.12%,各中医证型治疗后及随访期间有效率差异无统计学意义(P> 0.05)。年龄、病程、治疗次数与疗效指数之间不存在线性关系。结论:针药联合生物反馈治疗FC,近远期疗效较稳定,患者满意度尚可。年龄大小及病程长短不影响疗效估计。患者满意度的高低取决于疗效及护理方式。
Objective:To analyze the short-term and lone-term efficacy and related factors of acupuncture,traditional Chinese medicine combined with biofeedback in the treatment of functional constipation(FC).Methods:A retrospective analysis of patients with FC who underwent acupuncture and Chinese medicine combined with biofeedback therapy in the Nanjing Hospital of Traditional Chinese Medicine,Affiliated Hospital of Nanjing University of Chinese Medicine from June 2015 to November 2017 was conducted by telephone follow-up. The constipation symptom score assessment was completed. Efficacy(effectiveness index ≥ 30%) and satisfaction rate were evaluated after treatment(short-term) and at the end of follow-up(long-term). A total of 72 patients were enrolled in the study,with a follow-up of 4 to 34(median 14) months. Results:The clinical manifestations of the patients were mostly difficulty in defecation and prolonged defecation time. After treatment and during follow-up,the scores of constipation symptoms were lower than those before treatment(P< 0.05). During the follow-up period,the scores of constipation symptoms increased after treatment(P> 0.05) but better than before treatment. After treatment,the efficiency and satisfaction rate were at a high level,which decreased during the follow-up period,and the satisfaction rate decreased more. Among the 62 patients with effective treatment,the number of patients who decreased by ≤5% and ≤30% after treatment to the follow-up period accounted for 51.61% and 66.12% of the total number respectively. There was no significant difference in the efficiency of each TCM syndrome type after treatment and during follow-up(P< 0.05). There is no linear relationship between age,duration of disease,number of treatment and efficacy index. Conclusions:Acupuncture and Chinese medicine combined with biofeedback treatment of FC,the efficacy of the short and long term is significant and stable,and patient satisfaction is high. The age and duration of disease don't affect the efficacy. The level of patient satisfaction is related to the efficacy and the nursing method.
Objective:To analyze the short-term and lone-term efficacy and related factors of acupuncture,traditional Chinese medicine combined with biofeedback in the treatment of functional constipation(FC).Methods:A retrospective analysis of patients with FC who underwent acupuncture and Chinese medicine combined with biofeedback therapy in the Nanjing Hospital of Traditional Chinese Medicine,Affiliated Hospital of Nanjing University of Chinese Medicine from June 2015 to November 2017 was conducted by telephone follow-up. The constipation symptom score assessment was completed. Efficacy(effectiveness index ≥ 30%) and satisfaction rate were evaluated after treatment(short-term) and at the end of follow-up(long-term). A total of 72 patients were enrolled in the study,with a follow-up of 4 to 34(median 14) months. Results:The clinical manifestations of the patients were mostly difficulty in defecation and prolonged defecation time. After treatment and during follow-up,the scores of constipation symptoms were lower than those before treatment(P< 0.05). During the follow-up period,the scores of constipation symptoms increased after treatment(P> 0.05) but better than before treatment. After treatment,the efficiency and satisfaction rate were at a high level,which decreased during the follow-up period,and the satisfaction rate decreased more. Among the 62 patients with effective treatment,the number of patients who decreased by ≤5% and ≤30% after treatment to the follow-up period accounted for 51.61% and 66.12% of the total number respectively. There was no significant difference in the efficiency of each TCM syndrome type after treatment and during follow-up(P< 0.05). There is no linear relationship between age,duration of disease,number of treatment and efficacy index. Conclusions:Acupuncture and Chinese medicine combined with biofeedback treatment of FC,the efficacy of the short and long term is significant and stable,and patient satisfaction is high. The age and duration of disease don't affect the efficacy. The level of patient satisfaction is related to the efficacy and the nursing method.
引文
[1]柯美云,方秀才,侯晓华.功能性胃肠病:肠-脑互动异常[M].北京:北京科学出版社,2016:642-653.
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[9]宋玉磊,林征,林琳,等.生物反馈治疗联合综合护理干预对功能性便秘患者临床症状及生活质量的影响[J].中华护理杂志,2012,47(6):485-487.
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[13]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.
[14]丁曙晴,金洵,丁义江.丁泽民治疗慢性便秘临证经验探析[J].江苏中医药,2015,47(8):1-4.
[15]郭荣,丁义江,张建淮.慢性功能性便秘症状量化临床研究[J].辽宁中医药大学学报,2011,13(5):137-139.
[16]丁义江.挂线疗法在盆底失弛缓综合征所致便秘治疗中的临床应用[J].江苏中医药,2006(8):5-6.
[17]中华医学会消化病学分会胃肠动力学组,中华医学会外科分会结直肠肛门外科学组.中国慢性便秘诊治指南(2013,武汉)[J].胃肠病学,2013,18(10):605-612.
[18]张其健,贺爱兰,戴薇薇,等.门诊慢性伤口患者满意度调查分析与对策[J].现代医院,2018,18(3):345-349.
[19]夏磊,马丽春,艾祎,等. 652例住院患者满意度分析与评价[J].中国医院管理,2015,35(2):59-61.
[20]于洋.整形美容受术者一般自我效能感与术后满意度的相关性研究[D].北京:中国协和医科大学,2007.
[21] AKKAYA S,AKKAYA N,KITER E,et al. Functional status,patient satisfaction and quality of life in patients with arthroscopic partial meniscectomy[J]. Eklem hastaliklari ve cerrahisi=Joint diseases&related surgery,2012,23(1):9.
[22] GORDON J. Medical humanities:to cure sometimes,to relieve often,to comfort always[J]. Medical Journal of Australia,2005,182(8):5-8.
[2] ZHAO Y-F,MA X-Q,WANG R,et al. Epidemiology of functional constipation and comparison with constipationpredominant irritable bowel syndrome:the Systematic Investigation of Gastrointestinal Diseases in China(SILC)[J].Aliment Pharmacol Ther,2011,34(8):1020-1029.
[3]朱兰,郎景和,王静怡,等.七省(市)城乡成年女性功能性便秘的流行病学调查[J].中华医学杂志,2009,89(35):2513-2515.
[4]李军祥,陈誩,柯晓.功能性便秘中西医结合诊疗共识意见(2017年)[J].中国中西医结合消化杂志,2018,26(1):18-26.
[5] VITTON V,DAMON H,BENEZECH A,et al. Clinical practice guidelines from the French National Society of Coloproctology in treating chronic constipation[J]. European Journal of Gastroenterology&Hepatology,2018,30(4):1.
[6] LEE H-Y,KWON O-J,KIM J-E,et al. Efficacy and safety of acupuncture for functional constipation:a randomised,sham-controlled pilot trial[J]. Bmc Complementary&Alternative Medicine,2018,18(1):186.
[7]汪开洋,肖贵容,吴群.疏肝健脾针法治疗功能性便秘疗效观察[J].上海针灸杂志,2017,36(7):803-807.
[8]袁继云,曹家玮,潘立华.中医疗法治疗功能性便秘的临床疗效研究[J].内蒙古中医药,2017,36(8):58.
[9]宋玉磊,林征,林琳,等.生物反馈治疗联合综合护理干预对功能性便秘患者临床症状及生活质量的影响[J].中华护理杂志,2012,47(6):485-487.
[10]中华中医药学会脾胃病分会.慢性便秘中医诊疗共识意见[J].北京中医药,2011,30(1):3-7.
[11]国家中医药管理局医政司. 24个专业105个病种中医诊疗方案[M].北京:中国中医药出版社,2011:407.
[12]丁曙晴.盆底功能障碍所致便秘的诊治策略[J].中华结直肠疾病电子杂志,2015,4(2):11-14.
[13]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.
[14]丁曙晴,金洵,丁义江.丁泽民治疗慢性便秘临证经验探析[J].江苏中医药,2015,47(8):1-4.
[15]郭荣,丁义江,张建淮.慢性功能性便秘症状量化临床研究[J].辽宁中医药大学学报,2011,13(5):137-139.
[16]丁义江.挂线疗法在盆底失弛缓综合征所致便秘治疗中的临床应用[J].江苏中医药,2006(8):5-6.
[17]中华医学会消化病学分会胃肠动力学组,中华医学会外科分会结直肠肛门外科学组.中国慢性便秘诊治指南(2013,武汉)[J].胃肠病学,2013,18(10):605-612.
[18]张其健,贺爱兰,戴薇薇,等.门诊慢性伤口患者满意度调查分析与对策[J].现代医院,2018,18(3):345-349.
[19]夏磊,马丽春,艾祎,等. 652例住院患者满意度分析与评价[J].中国医院管理,2015,35(2):59-61.
[20]于洋.整形美容受术者一般自我效能感与术后满意度的相关性研究[D].北京:中国协和医科大学,2007.
[21] AKKAYA S,AKKAYA N,KITER E,et al. Functional status,patient satisfaction and quality of life in patients with arthroscopic partial meniscectomy[J]. Eklem hastaliklari ve cerrahisi=Joint diseases&related surgery,2012,23(1):9.
[22] GORDON J. Medical humanities:to cure sometimes,to relieve often,to comfort always[J]. Medical Journal of Australia,2005,182(8):5-8.