【作者】 王芳；

【导师】 王旭慧；

【作者基本信息】 天津中医药大学 ， 针灸推拿学（专业学位）， 2022， 硕士

【摘要】 目的:通过调神法针刺治疗腹泻型肠易激综合征,观察调神法针刺治疗在肠道症状和情绪症状两方面的改善情况,并与特定穴针刺组作比较,探讨何种治疗方法更具有优效性,以期为临床医生提供更佳的治疗思路,达到最佳疗效,并且为进一步的科研设计提供思路。方法:共纳入符合纳排标准的受试者61例,根据随机数字表法将所有受试者分为调神组、特定穴组,调神组受试者31例,特定穴组受试者30例。特定穴组选取中脘、天枢、关元、足三里、上巨虚,并根据中医辩证分型选取不同的配穴,肝郁脾虚证加太冲、脾虚湿阻证加三阴交、脾胃湿热证加内庭,调神组在特定穴组基础上增加百会、印堂、神庭、本神4个穴位。医者手消毒及患者皮肤消毒后,百会向上平刺0.5-0.8寸,本神向上平刺1寸,神庭向上平刺1寸,印堂向下斜刺0.3-0.5寸,中脘直刺0.5-1寸,关元、天枢、足三里、上巨虚直刺1-1.5寸,所有穴位针刺得气,患者自觉针刺部位有酸、麻、重、胀等反应,留针30分钟。所有患者共治疗6周,1-3周每周治疗3次,4-6周每周治疗2次,随访8周。受试者需要在试验全程每天填写排便日记卡,记录每日排便及腹痛等症状。通过视觉模拟量表(VAS量表)评价患者过去24h最严重腹痛评分并计算每周平均值;记录每日粪便性状与次数,稀便天数指出现了至少1次6型或7型粪便性状的天数。对所有患者完成PHQ9量表、HAMA量表、IBS-SSS量表的评分。并将有效应答率作为主要结局指标,即第6周时最严重腹痛平均值较基线改善30%,且稀便天数较基线减少50%的患者百分比,将治疗期每周的有效应答率、基线期、2周、4周、6周、10周、14周的PHQ9量表、HAMA量表以及IBS-SSS量表评分作为次要结局指标,收集相关数据及评分进行统计学分析。结果:1.研究共纳入61例受试者,试验过程中调神组脱落2例,特定穴组脱落2例,共57例受试者完成试验。2.一般资料分析:在性别、年龄、BMI值、病程、是否为在校学生、IBS-SSS评分、PHQ9评分、HAMA评分、中医辨证分型方面两组受试者的差异无统计意义(P>0.05)。3.主要结局指标:调神组总有效应答率为65.50%,特定穴组总有效应答率为53.6%,调神组总体有效应答率优于特定穴组,差异不具有统计意义(P>0.05);调神组稀便天数有效应答率为62.10%,特定穴组稀便天数有效应答率为60.70%,调神组稀便天数有效应答率优于特定穴组,差异不具有统计意义(P>0.05);调神组腹痛评分有效应答率为75.90%,特定穴组腹痛评分有效应答率为50.00%,调神组腹痛评分有效应答率优于特定穴组,且差异具有统计学意义(P<0.05)。4.次要结局指标:治疗期1、3、4、5、6周调神组总有效应答率均高于特定穴组,第2周调神组有效应答率低于特定穴组,差异均无统计学意义(P>0.05);通过PHQ9量表评价受试者抑郁症状,两组受试者治疗第6周PHQ9评分均较基线明显降低(P<0.001),治疗第6周调神组与特定穴组PHQ9评分差异无统计学意义(P>0.05);随访期第10周调神组受试者PHQ9评分低于特定穴组,且差异有统计学意义(P<0.05);随访期第14周调神组受试者PHQ9评分低于特定穴组,且差异有统计学意义(P<0.05);表明两种针刺方法均可降低受试者PHQ9评分,缓解受试者抑郁症状,但在治疗第6周两组疗效差异不明显,在随访期第10周、第14周调神组治疗效果较特定穴组更加显著;通过HAMA量表评价受试者焦虑症状,两组受试者治疗第6周HAMA评分均较基线明显降低(P<0.001),但两组在治疗第6周、随访期第10周、随访期第14周HAMA评分无统计学差异(P>0.05);表明两种针刺方法均可降低受试者HAMA评分,减轻受试者焦虑症状,但两组治疗效果在治疗期及随访期均无明显区别,提示可能由于治疗疗程较短,未能充分改善患者存在已久的焦虑症状,需要后期专业医生介入及自我干预调节;通过IBS-SSS量表评价两组受试者症状严重程度改善状况,治疗第6周两组受试者IBS-SSS评分均较基线明显降低(P<0.001),差异具有统计学意义,治疗第6周、随访期第10周调神组与特定穴组IBS-SSS量表评分差异不具有统计学意义(P>0.05);随访期第14周调神组受试者IBS-SSS评分低于特定穴组,且差异有统计学意义(P<0.05),表明两种针刺方法均可降低受试者IBS-SSS评分,提高患者整体生活质量,但在随访期第14周调神组治疗效果更加明显。结论:1.调神法与特定穴针刺治疗腹泻型肠易激综合征均有较好的整体疗效;2.调神法针刺较特定穴针刺治疗腹泻型肠易激综合征在减轻受试者腹痛评分方面有更好的效果;3.调神法针刺较特定穴针刺治疗腹泻型肠易激综合征在改善受试者抑郁情绪以及症状严重程度方面疗效更佳;4.调神法针刺是在特定穴针刺的基础上进行优化的治疗方法,对于患者肠道症状及抑郁症状均有更好的疗效,且在抑郁症状方面的优效性提示调神法针刺可作为抑郁症状较为明显的肠易激综合征患者群体的治疗方案,故值得进一步大样本的临床研究以及临床推广应用。更多还原

【Abstract】 Objective:Through the Tiaoshen of acupuncture treatment of diarrhea type irritable bowel syndrome,observe the Tiaoshen of acupuncture treatment in the two aspects of intestinal symptoms and mood symptoms improve the situation.And comparing with the specific point acupuncture group,we will discuss which kind of treatment is more superior effect,so that it can guide the clinical doctors according to the clinical manifestations of patients to treat and achieve the best curative effect and provide ideas for further scientific research design.Method:A total of 61 subjects that met the criteria were included.According to the table of random numbers,all subjects were divided into the spirit conditioning group and the specific acupoint group,with 31 subjects in the Tiaoshen group and 30 subjects in the specific acupoint group.Zhongwan,Tianshu,Guanyuan,Zusanli and Shangjuxu were selected for the specific point group,and different points were selected according to the dialectical classification of troditional Chinese medicine,such as the syndrome of liver stagnation and spleen deficiency plus Taichong,the syndrome of dampness resistance of spleen deficiency plus Sanyinjiao,the syndrome of dampness and heat of spleen and stomach plus Neiting,Baihui,Yintang,Shenting and Benshen were added to the specific point group in Tiaoshen group.After hand disinfection and skin disinfection,Baihui flat acupuncture 0.5-0.8 inch,Benshen upward flat acupuncture 1 inch,Shenting upward flat acupuncture 1 inch,Yintang downward oblique acupuncture 0.3-0.5 inche,Tianshu,Guanyuan,Zusanli and Shangjuxu straight acupuncture 1-1.5 inches,Zhongwan straight acupuncture 0.5-1 inch.Patients with local numbness and acid swelling as a degree,the needle for 30 mins.All patients received treatment for 6 weeks,3 times a week for 1-3 weeks and 2 times a week for 4-6 weeks,and followed up for 8 weeks.Subjects were required to fill in a defecation diary card every day throughout the trial to record their daily symptoms such as defecation and abdominal pain.The visual analog scale(VAS scale)was used to evaluate the score of the most severe abdominal pain in the past 24 hours and calculate the weekly average.Daily fecal traits and frequency were recorded,and the number of days with loose stools indicated the number of days with at least one fecal trait of type 6 or 7.PHQ9 scale,HAMA scale and IBS-SSS scale were scored for all patients.And effective response rate as the primary outcome indicators,namely average 6 weeks the most severe abdominal pain from baseline to improve by 30%,and the percentage of patients in loose days fell 50% baseline.The weekly effective response rate of the treatment period,the baseline period,week2,week4,week6,week10,week14 of PHQ9 scale,HAMA scale and IBS-SSS scale score as a secondary outcome indicators,and collect relevant data.Result:1.A total of 61 subjects were intaked in this experiment.During the experiment,2subjects in the Tiaoshen group and 2 subjects in the specific acupoint group fell off.A total of57 subjects completed the experiment.2.General data analysis: there are no statistical significance of differences(P > 0.05)in the two groups of gender,age,BMI,course of diseases,whether for college students,IBS-SSS score,PHQ9 score,HAMA scores and syndrome differentiation of traditional Chinese medicine.3.The main outcome indicators: the Tiaoshen group total effective response rate was65.50%,the specific point group total effective response rate was 53.6%,total effective response rates of the Tiaoshen group is better than that of specific acupoint group,there was no statistically significant difference(P > 0.05);The effective response rate was 62.10% in the Tiaoshen group on the days of sparse defecation,and 60.70% in the specific point group on the days of sparse defecation.The overall effective response rate in the Tiaoshen group was better than that in the specific point group,and the difference was not statistically significant(P>0.05).The effective response rate of abdominal pain score in the spirit adjustment group was 75.90%,and the effective response rate of abdominal pain score in the specific point group was 50.00%.The overall effective response rate of abdominal pain score in the Tiaoshen group was better than that in the specific point group,and the difference was statistically significant(P<0.05).4.Secondary outcome indicators: At week 1,3,4,5 and 6 of the treatment period,the total effective response rates of the Tiaoshen group were higher than the total effective response rates of the specific acupoint group,at the second week,the effective response rate of the Tiaoshen group was lower than that of the specific acupoint group,with no statistical significance(P>0.05);The PHQ9 scale was used to evaluate the depressive symptoms of the subjects.At the 6th week of treatment,the PHQ9 scores of the two groups were lower than baseline(P<0.001)significantly,and there wasn’t statistical significance in the PHQ9 scores between the Tiaoshen group and the specific acupoint group at the 6th week of treatment(P>0.05).At the 10 th week of follow-up period,PHQ9 score in the Tiaoshen group was lower than that in the specific acupoint group,and the difference was statistically significant(P<0.05).At the 14 th week of follow-up period,PHQ9 score in the Tiaoshen group was lower than PHQ9 score in the specific acupoint group,and the difference was significant statistically(P<0.05).The results showed that both acupuncture methods could reduce PHQ9 score and relieve depressive symptoms of the subjects,but there was no significant difference between the two groups in the 6th week of treatment,and the treatment effect of the Tiaoshen adjustment group was more obvious than that of the specific point group in the 10 th and 14 th week of follow-up period.HAMA scale was used to evaluate the anxiety symptoms of the subjects,and in the two groups,HAMA scores at week 6 of treatment were both lower than baseline(P<0.001)significantly,but there were no significant differences in HAMA scores between the 2 groups at week 6 of treatment,week 10 of follow-up period and week 14 of follow-up period(P>0.05).The results showed that both acupuncture methods could reduce HAMA scores and relieve anxiety symptoms of the subjects,but there was no significant difference in the treatment effect between the two groups in the treatment period and the follow-up period,suggesting that the long-term anxiety symptoms of the patients could not be fully improved due to the short treatment course,and professional doctors’ intervention and self-intervention regulation were needed in the later stage.The IBS-SSS scale was used to evaluate the improvement of the severity of symptoms in the two groups.The IBS-SSS score of the two groups was significantly lower than that of baseline at the 6th week of treatment(P<0.001),and there was no statistically significant difference between the IBS-SSS scale score of the Tiaoshen group and the specific point group at the 6th week of treatment and the10 th week of follow-up period(P>0.05).The IBS-SSS score of subjects in the Tiaoshen group at the 14 th week of follow-up period was lower than the score in the specific point group,and the imparities was significant statistically(P<0.05),demonstating both acupuncture methods could reduce the IBS-SSS score of subjects and improve the overall quality of life of patients,but the treatment effect of Tiaoshen group at the 14 th week of follow-up period was more obvious.Conclusion:1.The treatment of diarrhea type irritable bowel syndrome by Tiaoshen acupuncture and specific point acupuncture both has good overall efficacy;2.Comparing with specific point acupuncture,the treatment of diarrhea type irritable bowel syndrome has a better effect on reducing the abdominal pain score of subjects.3.The Tiaoshen of acupuncture is a specific point acupuncture treatment of diarrhea type irritable bowel syndrome severity to improve the symptoms of depression and subjects in curative effect is better;4.The Tiaoshen of acupuncture is based on a specific point acupuncture optimized treatment,for patients with intestinal symptoms and depressive symptoms have better curative effect,and optimum effect in depressive symptoms suggest the Tiaoshen of acupuncture can be used as a group of patients with depressive symptoms evident in the treatment,so it is worth further large sample clinical research and clinical application.更多还原