【摘要】 目的 观察中医技术对尿毒症维持性血液透析(MHD)并血液灌流治疗患者便秘及心理状况的影响。方法纳入2021年1月至2024年9月扬州大学建湖临床医学院血液净化中心接受血液灌流和MHD的尿毒症患者98例为研究对象，按照随机抽签法分为2组，对照组49例患者接受常规干预，观察组49例患者在常规干预基础上应用中医技术(推拿按摩、大承气汤灌肠、揿针疗法)干预方案，2组均干预2周。比较2组干预前后排便情况、肠道菌群、胃肠激素[胃动素(MTL)、胃泌素(GAS)、血管活性肠肽(VIP)及胆囊收缩素(CCK)水平]、生活质量、心理状况[焦虑自评量表(SAS)、抑郁自评量表(SDS)]变化。结果 干预后，2组排便次数增加(P<0.05)，便秘症状及生活质量评分降低(P<0.05)，且观察组排便次数多于对照组(P<0.05)，便秘症状及生活质量评分低于对照组(P<0.05)。干预后2组双歧杆菌、乳酸杆菌数量均较干预前增加(P<0.05)，且观察组多于对照组(P<0.05);干预后2组大肠杆菌、肠球菌数量均较干预前减少(P<0.05)，且观察组少于对照组(P<0.05)。干预后2组MTL、GAS及CCK水平均较干预前升高(P<0.05)，且观察组高于对照组(P<0.05);干预后2组VIP水平均较干预前下降(P<0.05)，且观察组低于对照组(P<0.05)。干预后2组SAS、SDS评分均较干预前下降(P<0.05)，且观察组低于对照组(P<0.05)。结论 中医技术能够改善尿毒症MHD并血液灌流患者的便秘症状，调节胃肠激素表达水平和肠道菌群分布，减轻焦虑、抑郁程度，提升生活质量。更多还原

【Abstract】 Objective To observe the effect of traditional Chinese medicine( TCM) techniques for treating constipation in uremia patients undergoing maintenance hemodialysis( MHD) and hemoperfusion, and its influence on psychological conditions of the patients. Methods Ninety-eight MHD patients who received hemoperfusion in the Hemodialysis Center,Jianhu Clinical College of Yangzhou University from January 2021 to September 2024 were included as the study subjects. They were randomly divided into the observation group( n = 49) and the control group( n = 49) by drawing lots. All patients received routine intervention,those in the observation group additionally received TCM techniques including massage,Large Chengqi Decoction enema,press needle therapy. After 2 weeks of intervention,the aim was to compare the improvement of constipation symptoms,gut microbiota,gastrointestinal hormones,such as motilin( MTL),gastrin( GAS),vasoactive intestinal peptide( VIP),and cholecystokinin( CCK) levels,quality of life,and psychological status including the self rating anxiety scale( SAS) and Self Rating Depression Scale( SDS) between two groups. Results After intervention,the both groups showed significantly increased bowel movement frequency( P<0.05),decreased constipation symptoms and quality of life( P<0.05),which were significantly pronounced in observation group( all P<0.05). After intervention,the numbers of Bifidobacterium and Lactobacillus in the both groups were significantly increased compared to before intervention( P < 0. 05),which were significantly higher in the observation group than in the control group( P < 0. 05). The numbers of Escherichia coli and Enterococcus in the both groups were significantly decreased compared to before intervention( P< 0.05),which were more lower in the observation group than in the control group( P < 0. 05). After intervention,the levels of MTL,GAS,and CCK in the both groups increased significantly compared to those before intervention( P<0.05),which were more higher in the observation group than the control group( P<0.05); VIP levels decreased significantly compared to before intervention( P<0.05),which were more lower in the observation group than the control group( P< 0.05). After intervention,the scores of SAS and SDS in both groups decreased significantly compared to those before intervention( P< 0.05),which were more lower in the observation group than the control group( P<0.05). Conclusion TCM techniques can improve constipation symptoms in uremia patients undergoing MHD and hemoperfusion,regulate the expression levels of gastrointestinal hormones and the distribution of gut microbiota,alleviate anxiety and depression,and improve the quality of life of patients.更多还原