运脾调中推拿法治疗小儿轮状病毒肠炎临床研究
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摘要
研究目的：
小儿轮状病毒肠炎(Infant Rotavirus enteritis, IRVE)又称秋季腹泻,是由轮状病毒(RV)感染引起的急性肠道感染。1973年在腹泻病人的十二指肠上皮细胞中首次被发现。目前认为RV感染是引起全球范围内婴幼儿急性腹泻的主要病因。该病起病急,潜伏期1-3天,以大便次数增多,粪色淡黄、质稀薄如水样或蛋花汤样为主要临床表现,常可伴有发热、鼻塞流清涕、咳嗽、呕吐等呼吸系统或消化系统症状,同时易致脱水、电解质紊乱和酸中毒。据统计全球每年因RV感染所致腹泻的婴幼儿高达1.3亿,其中1800万患儿病情严重,每年约死亡87万例,且在发展中国家死亡率较高。3岁以内的婴幼儿90%都感染过轮状病毒,轮状病毒感染每年在我国引起约3万例5岁以下儿童死亡。近年来的研究发现轮状病毒感染往往不仅仅是肠道感染,而经常是全身性感染,可导致机体多个器官和系统的感染和损伤。由RV感染引起的病毒血症是引起肠道外感染的途径。血液检测结果表明约有近90%的患儿心肌酶谱发生异常,提示轮状病毒可引起心肌损伤。心肌损伤主要表现为心肌酶谱和心电图的异常,但以心肌酶谱的异常更为显著。
西医对于本病的治疗一般采用对症和液体疗法。近年来中医对RV肠炎的治疗取得了较大进展。然而,关于RV肠炎伴发心肌损伤,中医方面的临床研究报道不多。因此发挥和研究中医对轮状病毒肠炎伴发心肌损伤的干预作用具有重要意义。
轮状病毒肠炎属于中医“泄泻”范畴,其病位在大肠,病机的根本则是脾胃虚弱、脾失健运,湿邪是主要的致病因素,即病机关键为脾虚湿困。在临床中我们以运脾调中推拿法治疗轮状病毒肠炎伴发心肌损伤,取得了较好疗效。本课题在以往研究的基础上进一步观察运脾调中推拿法对小儿轮状病毒肠炎的治疗作用,并探讨其对患儿心肌酶谱的影响。
研究方法：
采用临床病例随机入组法。将60例患儿随机分为治疗组、对照一组和对照二组,治疗组采用运脾调中推拿法,对照一组予传统推拿方法,对照二组予口服思密达,三组均根据病情在必要时予对症处理或液体疗法。观察记录治疗前后三组症状、体征、病毒转阴情况和心肌酶谱的变化,进行临床疗效分析和探讨治疗对心肌酶谱的影响。
结果：
治疗组总有效率90%,对照一组为55%,对照二组55%,治疗组与对照组比较,有非常显著性差异(P<0.01),说明治疗组临床疗效优于对照组；三组在治疗轻型RV肠炎时,治疗组的总有效率89%,对照一组56%,对照二组57%,治疗组疗效显著优于对照组；三组在治疗中型RV肠炎治疗组的总有效率91%,对照一组54%,对照二组54%,治疗组疗效显著优于对照组；治疗组在止泻及食欲恢复时间上均较对照组明显缩短。治疗前,治疗组心肌酶谱的均值与与对照组具有可比性。治疗后,治疗组与对照一组、二组之间AST、CK-MB、HBDH、LDH的下降具有显著性差异,p均<0.05。说明治疗后AST、CK-MB、HBDH、LDH下降程度治疗组优于对照组。治疗前、后AST、CK、CK-MB、HBDH、LDH组内比较,经t检验,治疗组AST、CK-MB治疗前后具有显著性差异,p均<0.05。其余无显著性差异,p均>0.05。说明治疗组治疗后AST、CK-MB均有明显下降。
结论：
1、小儿RV肠炎的病机关键是脾虚湿困,故以“运脾调中、清肠化湿”为治疗法则。
2、运脾调中推拿法用于治疗小儿RV肠炎时,在缩短病程,改善症状体征方面疗效显著。
3、运脾调中推拿法用于治疗小儿RV肠炎伴发心肌损伤时能降低异常升高的心肌酶,特别是降低AST、CK-MB,从而减轻心肌损伤。
4、运脾调中推拿法治疗小儿RV肠炎是中医内病外治特色的体现,解决了小儿服药打针不配合的难题,操作简单方便,无毒副作用,值得临床进一步推广
Objective:
Infant Rotavirus Enteritis (IRVE) is a kind of acute gastrointestinal disease that infected by Rotavirus(RV), especially prevalent in autumn. Since RV was discovered in1973 in duodenal epithelial cell from a patient with diarrhea, rotavirus has been recognized as the most important cause of acute infantile diarrhea worldwide. The onset of it is very urgent with a latency of 1-3 days. Main symptoms of rotavirus infection include increased frequency of feces, yellowish and watery stool, usually accompanied by respiratory symptoms or digestive symptoms such as fever, stuffy nose or running nose, coughing, vomiting etc.
It is also subject to dehydration, electrolyte disorder and acidosis. According to statistics, infants with diarrhea infected by rotavirus are up to 130 million every year all over the world, among those 18 million ones have severe symptoms, and 870 thousand ones died each year, and the mortalities are higher in developed countries. Almost all the infants less than 3 year old have infected to rotavirus. In our country, about 30 thousand infants less than 5 year old died from rotavirus infection every year. In the resent years, it's founded that rotavirus infect not only intestines but also all organs of the whole body. Viremia related to rotavirus infection is the path lead to parenteral infection. Abnormal results of the cardiac muscle enzymes are found in about 90% affected infants in their blood tests, as indicates that rotavirus can give rise to cardiac muscle injury, cardiac muscle injury manifests the abnormality in cardiac muscle enzyme and ECG, and especially in cardiac muscle enzyme.
Western medicine Treatment on IRVE is non-specific. The traditional Chinese medicine (TCM) treatment as well as its research has made great progress. However, there is few TCM research report about poly-organs injury (such as cardiac muscle injury) relevant to Infant Rotavirus Enteritis. Therefore, it is meaningful to study the effect of TCM intervention on IRVE.
IRVE, in the eyes of traditional Chinese medicine, falls into the category of "diarrhoea". The pathological mechanism of IRVE is the asthenia of the spleen and dampness. The therapy of IRVE with Tuina follows the basic rule of Invigorating spleen and conditioning middle-jiao, and had gained a good treatment effect in the before research. Base on it, this research observes the clinical effect of the Chinese Tuina of invigorating spleen and conditioning middle-jiao in treating IRVE, and discuss its action on cardiac muscle enzymes initially.
Methods:
Adopt randomized controlled trial. Stochastically divided 60 examples troubles into the treatment group and control groupl and control group 2. The treatment group used the Chinese Tuina of invigorating spleen and conditioning middle-jiao. The control group 1 used the traditional Chinese Tuina. The control group 2 used orally Smecta, observing its clinical curative effect and discusses their action on cardiac muscle enzymes initially.
Results:
The effect rate of the treatment group was 90%, the effect rate of the control group 1 was 55%, the effect rate of the control group 2 was 55%, the treatment group surpassed control groupl and control group 2, and the difference between two groups was significant (P<0.01).In treating the light type of RV Enteritis, the effect rate of the treatment group was 89%, the effect rate of the control group 1 was 56%, and the effect rate of the control group 2 was 57%, the treatment group surpassed control groupl and control group 2. In treating the medium type of RV Enteritis, the effect rate of the treatment group was 91%, the effect rate of the control group 1 was 54%, the effect rate of the control group 2 was 54%, and the treatment group surpassed the other two groups. The period of treatment group in treating diarrhea、arresting vomiting and resuming appetite were shorter than that of the other individual group(P<0.01).the means of the cardiackinases between the treatment group and the either control group are comparable before treating. The difference of the declines of the value in AST、CK-MB、HBDH、LDH between the treatment group and the either control group after treating was significant (P<0.05), showed that the dropdown degrees of the treatment group in AST、CK-MB、HBDH、LDH surpassed the other 2 groups. After t test, the difference is significant between the value of AST、CK-MB in the treatment group before treating and that of after treating. P<0.05. Others are no significant difference.P>0.05. it showed that the values of AST and CK-MB are decreased apparently in treated group after treating, could decrease the unconventional CK-MB, while the effect of the treated Group surpassed the control group(P<0.05).
Conclusion:
1 The pathological mechanism of IRVE is the asthenia of the spleen and dampness. So the therapy of IRVE with Tuina follows the basic rule of invigorating spleen and conditioning middle-jiao,clearing intestines and eliminating dampness.
2 In treating the IRVE, the Chinese Tuina of invigorating spleen and conditioning middle-jiao was characterized by shortening the course of the disease, improving the symptom quickly.
3 In treating the IRVE with the cardiac muscle harm, the Chinese Tuina of invigorating spleen and conditioning middle-jiao may decrease the abnormally high value of AST, CK, CK-MB, HBDH, especially the value of AST, CK-MB, that can decrease the cardiac muscle harm.
4 The Chinese Tuina of invigorating spleen and conditioning middle-jiao in treating the IRVE with the cardiac muscle harm,is internal diseases treated with external therapy features in traditional Chinese medicine.It solve the problem that children do not like to take medicine or injection.It is easy to operate and has no side effect. It is worth spreading and exploitation in clinic.
小儿轮状病毒肠炎(Infant Rotavirus enteritis, IRVE)又称秋季腹泻,是由轮状病毒(RV)感染引起的急性肠道感染。1973年在腹泻病人的十二指肠上皮细胞中首次被发现。目前认为RV感染是引起全球范围内婴幼儿急性腹泻的主要病因。该病起病急,潜伏期1-3天,以大便次数增多,粪色淡黄、质稀薄如水样或蛋花汤样为主要临床表现,常可伴有发热、鼻塞流清涕、咳嗽、呕吐等呼吸系统或消化系统症状,同时易致脱水、电解质紊乱和酸中毒。据统计全球每年因RV感染所致腹泻的婴幼儿高达1.3亿,其中1800万患儿病情严重,每年约死亡87万例,且在发展中国家死亡率较高。3岁以内的婴幼儿90%都感染过轮状病毒,轮状病毒感染每年在我国引起约3万例5岁以下儿童死亡。近年来的研究发现轮状病毒感染往往不仅仅是肠道感染,而经常是全身性感染,可导致机体多个器官和系统的感染和损伤。由RV感染引起的病毒血症是引起肠道外感染的途径。血液检测结果表明约有近90%的患儿心肌酶谱发生异常,提示轮状病毒可引起心肌损伤。心肌损伤主要表现为心肌酶谱和心电图的异常,但以心肌酶谱的异常更为显著。
西医对于本病的治疗一般采用对症和液体疗法。近年来中医对RV肠炎的治疗取得了较大进展。然而,关于RV肠炎伴发心肌损伤,中医方面的临床研究报道不多。因此发挥和研究中医对轮状病毒肠炎伴发心肌损伤的干预作用具有重要意义。
轮状病毒肠炎属于中医“泄泻”范畴,其病位在大肠,病机的根本则是脾胃虚弱、脾失健运,湿邪是主要的致病因素,即病机关键为脾虚湿困。在临床中我们以运脾调中推拿法治疗轮状病毒肠炎伴发心肌损伤,取得了较好疗效。本课题在以往研究的基础上进一步观察运脾调中推拿法对小儿轮状病毒肠炎的治疗作用,并探讨其对患儿心肌酶谱的影响。
研究方法：
采用临床病例随机入组法。将60例患儿随机分为治疗组、对照一组和对照二组,治疗组采用运脾调中推拿法,对照一组予传统推拿方法,对照二组予口服思密达,三组均根据病情在必要时予对症处理或液体疗法。观察记录治疗前后三组症状、体征、病毒转阴情况和心肌酶谱的变化,进行临床疗效分析和探讨治疗对心肌酶谱的影响。
结果：
治疗组总有效率90%,对照一组为55%,对照二组55%,治疗组与对照组比较,有非常显著性差异(P<0.01),说明治疗组临床疗效优于对照组；三组在治疗轻型RV肠炎时,治疗组的总有效率89%,对照一组56%,对照二组57%,治疗组疗效显著优于对照组；三组在治疗中型RV肠炎治疗组的总有效率91%,对照一组54%,对照二组54%,治疗组疗效显著优于对照组；治疗组在止泻及食欲恢复时间上均较对照组明显缩短。治疗前,治疗组心肌酶谱的均值与与对照组具有可比性。治疗后,治疗组与对照一组、二组之间AST、CK-MB、HBDH、LDH的下降具有显著性差异,p均<0.05。说明治疗后AST、CK-MB、HBDH、LDH下降程度治疗组优于对照组。治疗前、后AST、CK、CK-MB、HBDH、LDH组内比较,经t检验,治疗组AST、CK-MB治疗前后具有显著性差异,p均<0.05。其余无显著性差异,p均>0.05。说明治疗组治疗后AST、CK-MB均有明显下降。
结论：
1、小儿RV肠炎的病机关键是脾虚湿困,故以“运脾调中、清肠化湿”为治疗法则。
2、运脾调中推拿法用于治疗小儿RV肠炎时,在缩短病程,改善症状体征方面疗效显著。
3、运脾调中推拿法用于治疗小儿RV肠炎伴发心肌损伤时能降低异常升高的心肌酶,特别是降低AST、CK-MB,从而减轻心肌损伤。
4、运脾调中推拿法治疗小儿RV肠炎是中医内病外治特色的体现,解决了小儿服药打针不配合的难题,操作简单方便,无毒副作用,值得临床进一步推广
Objective:
Infant Rotavirus Enteritis (IRVE) is a kind of acute gastrointestinal disease that infected by Rotavirus(RV), especially prevalent in autumn. Since RV was discovered in1973 in duodenal epithelial cell from a patient with diarrhea, rotavirus has been recognized as the most important cause of acute infantile diarrhea worldwide. The onset of it is very urgent with a latency of 1-3 days. Main symptoms of rotavirus infection include increased frequency of feces, yellowish and watery stool, usually accompanied by respiratory symptoms or digestive symptoms such as fever, stuffy nose or running nose, coughing, vomiting etc.
It is also subject to dehydration, electrolyte disorder and acidosis. According to statistics, infants with diarrhea infected by rotavirus are up to 130 million every year all over the world, among those 18 million ones have severe symptoms, and 870 thousand ones died each year, and the mortalities are higher in developed countries. Almost all the infants less than 3 year old have infected to rotavirus. In our country, about 30 thousand infants less than 5 year old died from rotavirus infection every year. In the resent years, it's founded that rotavirus infect not only intestines but also all organs of the whole body. Viremia related to rotavirus infection is the path lead to parenteral infection. Abnormal results of the cardiac muscle enzymes are found in about 90% affected infants in their blood tests, as indicates that rotavirus can give rise to cardiac muscle injury, cardiac muscle injury manifests the abnormality in cardiac muscle enzyme and ECG, and especially in cardiac muscle enzyme.
Western medicine Treatment on IRVE is non-specific. The traditional Chinese medicine (TCM) treatment as well as its research has made great progress. However, there is few TCM research report about poly-organs injury (such as cardiac muscle injury) relevant to Infant Rotavirus Enteritis. Therefore, it is meaningful to study the effect of TCM intervention on IRVE.
IRVE, in the eyes of traditional Chinese medicine, falls into the category of "diarrhoea". The pathological mechanism of IRVE is the asthenia of the spleen and dampness. The therapy of IRVE with Tuina follows the basic rule of Invigorating spleen and conditioning middle-jiao, and had gained a good treatment effect in the before research. Base on it, this research observes the clinical effect of the Chinese Tuina of invigorating spleen and conditioning middle-jiao in treating IRVE, and discuss its action on cardiac muscle enzymes initially.
Methods:
Adopt randomized controlled trial. Stochastically divided 60 examples troubles into the treatment group and control groupl and control group 2. The treatment group used the Chinese Tuina of invigorating spleen and conditioning middle-jiao. The control group 1 used the traditional Chinese Tuina. The control group 2 used orally Smecta, observing its clinical curative effect and discusses their action on cardiac muscle enzymes initially.
Results:
The effect rate of the treatment group was 90%, the effect rate of the control group 1 was 55%, the effect rate of the control group 2 was 55%, the treatment group surpassed control groupl and control group 2, and the difference between two groups was significant (P<0.01).In treating the light type of RV Enteritis, the effect rate of the treatment group was 89%, the effect rate of the control group 1 was 56%, and the effect rate of the control group 2 was 57%, the treatment group surpassed control groupl and control group 2. In treating the medium type of RV Enteritis, the effect rate of the treatment group was 91%, the effect rate of the control group 1 was 54%, the effect rate of the control group 2 was 54%, and the treatment group surpassed the other two groups. The period of treatment group in treating diarrhea、arresting vomiting and resuming appetite were shorter than that of the other individual group(P<0.01).the means of the cardiackinases between the treatment group and the either control group are comparable before treating. The difference of the declines of the value in AST、CK-MB、HBDH、LDH between the treatment group and the either control group after treating was significant (P<0.05), showed that the dropdown degrees of the treatment group in AST、CK-MB、HBDH、LDH surpassed the other 2 groups. After t test, the difference is significant between the value of AST、CK-MB in the treatment group before treating and that of after treating. P<0.05. Others are no significant difference.P>0.05. it showed that the values of AST and CK-MB are decreased apparently in treated group after treating, could decrease the unconventional CK-MB, while the effect of the treated Group surpassed the control group(P<0.05).
Conclusion:
1 The pathological mechanism of IRVE is the asthenia of the spleen and dampness. So the therapy of IRVE with Tuina follows the basic rule of invigorating spleen and conditioning middle-jiao,clearing intestines and eliminating dampness.
2 In treating the IRVE, the Chinese Tuina of invigorating spleen and conditioning middle-jiao was characterized by shortening the course of the disease, improving the symptom quickly.
3 In treating the IRVE with the cardiac muscle harm, the Chinese Tuina of invigorating spleen and conditioning middle-jiao may decrease the abnormally high value of AST, CK, CK-MB, HBDH, especially the value of AST, CK-MB, that can decrease the cardiac muscle harm.
4 The Chinese Tuina of invigorating spleen and conditioning middle-jiao in treating the IRVE with the cardiac muscle harm,is internal diseases treated with external therapy features in traditional Chinese medicine.It solve the problem that children do not like to take medicine or injection.It is easy to operate and has no side effect. It is worth spreading and exploitation in clinic.
引文
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[21]展玉萍,石高举.五苓秋泻汤灌肠治疗小儿秋季腹泻的临床观察.内蒙古中医药,2008,(22)：12
[22]董善武,文蕊.思密达加黄连素保留灌肠在治疗小儿腹泻病中的应用.中国冶金工业医学杂志,2008,(4)：452
[23]王绍法,倪正伟.艾叶洗足方治疗婴幼儿腹泻300例.中医外治杂志,2000,(2)：91
[24]陈斌,李晓春.112例小儿轮状病毒肠炎合并心肌损害临床分析.安徽医学,2009,13(9)： 1097
[25]刘丽娟,刘玉琴.更昔洛韦联用西咪替丁治疗婴幼儿轮状病毒性肠炎的疗效观察[J].安徽医药,2009,13(3)：304
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[46]Kaidam I, Shif L, Keren G. Rotavirus encephalopathy evidence of centralnervous system involvementduring rotavius infection[J]. Pe-diatr InfectDis,1992,11:773
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.[20]孙利方,潘跟利,纪强.中药敷脐治疗小儿非感染性腹泻100例.光明中医,2008,23(8)：1108
[21]展玉萍,石高举.五苓秋泻汤灌肠治疗小儿秋季腹泻的临床观察.内蒙古中医药,2008,(22)：12
[22]董善武,文蕊.思密达加黄连素保留灌肠在治疗小儿腹泻病中的应用.中国冶金工业医学杂志,2008,(4)：452
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[25]刘丽娟,刘玉琴.更昔洛韦联用西咪替丁治疗婴幼儿轮状病毒性肠炎的疗效观察[J].安徽医药,2009,13(3)：304
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[27]鲍连生,姚永钢,周建明等.武汉地区婴幼儿腹泻轮状病毒型别分析.儿科临床杂志,2004,22(7)：236-237
[28]Kaidam I, Shif L, Keren G. Rotavirus encephalopathy evidence of centralnervous system involvementduring rotavius infection[J]. Pe-diatr InfectDis,1992,11:773
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[30]方鹤松,综述消化道粘膜保护剂思密达治疗腹泻病的效果.中级医刊,1994,29(4)：38-41
[31]MadkourAA, etcal.Smectite in acute diarrhea of children a double-blind Placcbo-eontrolled clinical trial.New orleans Digestive Week,1991,5:19
[32]董文岚.微生态制剂(金双歧)治疗婴幼儿腹泻60例临床观察.中国微生态学杂志,2005,17(1)：40-41
[33]江育仁.脾健不在补贵在运.中医杂志,1983,(1)：4-5
[34]江育仁.脾健不在补贵在运.上海中医药杂志,2002,(1)：4
[35]孙浩.江育仁教授“运脾法属于和法”之浅识.江苏中医药,2002,23(2)：173
[36]李江.捏脊治疗小儿厌食症100例临床观察.按摩与导引,1990,(1)：6
[37]朱佩东,推拿治疗婴儿(湿热与寒湿型)腹泻32例临床疗效.按摩与导引,1999,15(1)：39
[38]张乾忠,马沛然等.儿童病毒性心肌炎的诊断和治疗,中国实用儿科杂志,2003,18(10)：587
[40]吴又生,丁梅芳,张锡才.小儿轮状病毒肠炎366例临床分析.河北中西医结合杂志,1998,7(2)：183-184
[41]邱李华.捏脊疗法.中国中医药出版社,1994：23
[42]邵铭熙.实用推拿学.北京人民军医出版社,1998：254
[43]张乾忠,吴铁吉.专家座谈会：小儿心血管疾病的诊断与鉴别诊断.中国实用儿科杂志,2000,15(5)：264-265
[44]张传仓,李宁.轮状病毒的病毒血症及肠道外损害[J].中国实用儿科杂志,2002,17(12)：753-755.
[45]李宁.轮状病毒多系统感染二例分析.中华儿科杂志,2003,40(3)：141-143
[46]Kaidam I, Shif L, Keren G. Rotavirus encephalopathy evidence of centralnervous system involvementduring rotavius infection[J]. Pe-diatr InfectDis,1992,11:773