大肠水疗配合解秘散保留灌肠治疗功能性便秘临床研究

【作者】 王洋；

【导师】 周建华；

【作者基本信息】 长春中医药大学 ， 中医外科学， 2007， 硕士

【摘要】 目的：功能性便秘(Functional Constipation，FC)是指排除了肠道和全身器质性疾病和药物导致的便秘，以排便困难，排便次数少，或排便未尽感为主要症状的一类疾病。近年来，该病的患病率有逐年上升的趋势，已成为严重影响现代人生活质量的重要原因之一，且与结肠癌、肝性脑病、乳腺疾病、早老性痴呆、衰老等疾病的发生有密切关系，因此早期预防和合理治疗，非常必要。就目前治疗现状来看，无论是以口服药物为主的保守治疗，还是外科手术治疗均不是十分满意，或者有较大的副作用，或者容易产生耐药性，或者出现不可接受的并发症，因此研究新的、更为有效的治疗FC的方法和药物仍然是目前临床的一个重要课题。中药灌肠用于治疗便秘以及防病健身、延长寿命，在我国已有数千年的历史。大肠水疗是灌肠疗法的发展，借助现代科技、仪器以清洁的水进行灌洗肠道以治病、健身的一种治疗方法，目前在临床上已广泛用于便秘、肾功能衰竭等多种疾病的治疗。但对于大肠水疗治疗FC的疗效、其疗效与中、西医各种分型的关系及其与中药灌肠联合应用的疗效尚无系统和深入的研究报道。为了评价大肠水疗结合中药灌肠治疗便秘的疗效，及其疗效与西医亚型、中医证型之间的关系，从而发挥传统中医药和先进科技二者联合的优势，寻求一种治疗便秘的有效方法，而设计了该课题。方法：本研究共收集符合要求的FC患者120例(男性40例，女性80例)，随机分为：大肠水疗结合解秘散保留灌肠组(Ⅰ组)，单纯大肠水疗(Ⅱ组)。两组均为3天治疗1次，共5次。治疗前后行症状评分，观察其总有效率及对中、西医亚型的疗效，对兼症的治疗作用。结果：Ⅰ组对FC的总有效率为87％，对西医亚型的总有效率分别为：慢传输型100％，出口梗阻型81％，混合型78％；对于中医各证型的治疗结果：热秘100％、气秘100％、虚秘91％、冷秘25％；Ⅱ组FC总有效率为65％，对西医亚型的总有效率分别为：慢传输型80％，出口梗阻型60％，混合型43％；对于中医各证型总有效率分别为：热秘80％、气秘63％、虚秘56％、冷秘33％。Ⅰ、Ⅱ两组总的治疗结果经统计学分析，显示出显著性差异(P＜0.05)，Ⅰ组的总有效以及对热秘、气秘虚秘的疗效优于Ⅱ组；对心烦、失眠、食欲不振等兼症的缓解，较Ⅱ组具有明显的优势，但对冷秘的疗效则有下降趋势。结论：单纯大肠水疗对于FC具有较好的治疗作用，对热秘或慢传输型便秘疗效显著。大肠水疗结合解秘散灌肠对FC的整体疗效有明显的增强，表明FC存在血瘀机理，FC从血瘀论治是合理的。大肠水疗结合解秘散灌肠对热秘、气秘、虚秘或慢传输型便秘疗效显著，尤其对气秘、虚秘的疗效明显优于单纯大肠水疗。二者对阳虚冷秘者疗效均较差，但联合治疗组的疗效有降低趋势。大肠水疗结合解秘散灌肠可提高对心烦、失眠、食欲不振等伴随症状的改善。大肠水疗结合解秘散灌肠及单纯大肠水疗安全性好，均无不良事件发生。大肠水疗结合解秘散灌肠值得临床推广应用，尤其在热秘、气秘、虚秘方面，效果非常满意。更多还原

【Abstract】 Objective: Constipation is a very common disease. The main symptoms of constipation include straining, sensation of anorectal blockage, sensation of incomplete evacuation, lumpy or hard stools and reduced stool frequency.Functional constipation (FC)can be diagnosed when structural abnormalityand medical conditions have been excluded. More and more people complain of one or more symptoms associated with chronic constipation. It have become an important factor that have an serious impact on people’s life quality. It may indicate a higher risk of colon malignancy and may be related to the incidence of hepatic encephalopathy, mammary diseases, Alzheimer’s disease,caducity,and other diseases. So appropriate prevention and treatment of chronic constipation means a lot to the therapeutic efficacy of many diseases. Whereas, current approaches to FC often fail to control the patient’s symptoms adequately, produce problematic side effects, or loss effectiveness with time,thus new therapies are needed.There has been a long history for clysis with Traditional Chinese Medicine(TCM)to be used for treatment of constipation, prevention of diseases,keeping fit and lengthening life-span in China. Colon hydrotherapy is a method which is developed on the basis of clysis. It is easier and can scour the enteric cavity more adequately. It has been widely used in treatment of constipation,deficiency of kidney fuction and some other fields. However, it is scarce ofsystemic research on the therapeutic effect of colon hydrotherapy on FC’s different subtypes of TCM and Western Medicine. The reports on the therapeutic effect of combining colon hydrotherapy with clysis of herbs solution are few as well. In order to evaluate the therapeutic effect of combination of colon hydrotherapy and clysis of herbs solution, we designed this research.Methods: In this research, 120 cases(including 40 males and 80 females) with FC were included which were divided into two groups. Group I, was treated with combination of colonrectal hydrotherapy and clysis with solution of disengage constipation powder for injection and group II was treated with colorectal hydrotherapy alone. Both groups are treated once every three days for five times. Evaluate the total effective rate and effects of both therapies on the subtypes of TCM and western medicine according to the improvement of symptoms.Results:The total effective rate of group I is 87%, and the efficiency on slow transit constipation (100%)is higher than that on outlet obstructed constipation (81%) and mixed constipation (78%).The results of the effects on the subtypes of TCM indicate that it is more efficient on cases with marked symptoms of pathogenic heat (100%) and stagnation of Qi (100%) than on those caused by deficiency of Yang (25%) or Qi and blood (91%).Though there is no statistic significance between the results of the two groups with or without clysis (the total effective rate of group II is 65%, the effective rates on STC, OOC and MC are 80%, 60%, 43% respectively and on cases caused by pathogenic heat, stagnation of Qi, deficiency of Yang or Qi and blood are 80%, 63%, 33%and 56% respectively).The uptrend indicates that the therapeutic efficiency with clysis is better than without clysis, especially in the treatment of cases with more symptoms of deficiency of Yin and blood or stagnation of Qi and the improving of such concomitant symptoms as irritation and insomnia and anorexia.There are statistic significance between the two groups in above aspects. But to those whose symptoms were caused by deficiency of Yang, the effect is reduced by combining with clysis.Conclusion:Colon hydrotherapy has a good effect on FC and better effects appear in cases caused by pathogenic heat or concerned to the type of STC.Clysis with solution of disengage constipation powder for injection appears a synergetic effect with colon hydrotherapy on FC, which indicates that hemostasis is of mechanisms of FC and it’s reasonable to treat FC with the method of activating blood circulation and dispelling thrombi. Significant effects appeared in the cases with marked symptoms of pathogenic heat,stagnation of Qi and deficiency of Qi and blood treated by combining colon hydrotherapy and clysis. Especially to the cases caused by stagnation of Qi and deficiency of Qi and blood, combining therapy is markedly better than treatment only with colon hydrotherapy. The effects both with and without clysis on cases caused by deficiency of Yang are unideal. But the downtrend appeared in the group I which was treated with combination of both therapies.Besides, combining the two therapies can get better effect in improving the following symptoms such as irritation, insomnia and anorexia. Colon hydrotherapy and clysis with solution of disengage constipation powder for injection is safe. No side-effects were found in both colon hydrotherapy combining clysis of groups. As a result,disengage constipation powder for treat those deficiency injection is worthy to be with solution introduced to treat FC, especially towhich are concerned with pathogenic heat, stagnation of Qi of Qi and blood.更多还原