【摘要】：目的：生物反饋是目前治療盆底失弛緩所致便秘的一線療法,但情志因素會制約生物反饋的臨床療效,本課題是觀察導(dǎo)師經(jīng)驗(yàn)方解郁通幽湯結(jié)合生物反饋這一雙聯(lián)療法治療盆底失弛緩所致便秘(APFS),中醫(yī)辨證為肝脾不調(diào)型的臨床療效。探討兩種療法結(jié)合應(yīng)用的可行性、有效性以及優(yōu)勢,為其臨床推廣應(yīng)用提供依據(jù)。 方法：選擇2013年01月—2014年01月在福建中醫(yī)藥大學(xué)附屬人民醫(yī)院肛腸科病人,符合納入標(biāo)準(zhǔn)的40例便秘患者,隨機(jī)分成治療組20例和對照組20例兩組。治療組用口服解郁通幽湯結(jié)合生物反饋療法,對照組單純采用生物反饋療法。10天為一療程。觀察患者治療后便秘主癥、心理狀態(tài)、盆底表面肌電水平的改變情況,記錄觀察指標(biāo),進(jìn)行統(tǒng)計(jì)學(xué)分析,分析療效,得出結(jié)論。 結(jié)果：1.經(jīng)過2個療程的治療,試驗(yàn)組臨床痊愈2例,顯效14例,有效2例,無效2例,愈顯率80%,總有效率90%。對照組臨床痊愈0例,顯效4例,有效8例,無效8例,愈顯率20%,總有效率60%。兩組有統(tǒng)計(jì)學(xué)意義(愈顯率P0.01,總有效率P0.01)。 2.治療組在改善腹脹、善嘆息、噯氣、心中煩悶、納差方面顯著優(yōu)于對照組(P0.01),在改善便質(zhì)、便意感、排便費(fèi)力程度、排便時間、排便頻率、排便不盡感、肛門墜脹感上等其余各項(xiàng)臨床癥狀方面均優(yōu)于對照組(P0.05)。 3.經(jīng)統(tǒng)計(jì)處理,盆底表面肌電評估結(jié)果與治療前相比,治療后Glazer盆底肌電評估中前后基線收縮波幅均明顯降低,快速收縮階段最大收縮波幅明顯升高,持續(xù)收縮階段、耐受收縮階段變異系數(shù)明顯降低,差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。 4.治療組在改善焦慮、抑郁方面方面顯著優(yōu)于對照組(P0.01)。 5.隨訪2個月后,治療組1例復(fù)發(fā),對照組3例復(fù)發(fā)。有效率分別為85%,45%。治療組顯著優(yōu)于對照組(P0.01)。 結(jié)論：1.生物反饋治療盆底失弛緩型便秘是有效的。 2.解郁通幽湯結(jié)合生物反饋可顯著改善患者臨床癥狀、焦慮抑郁情緒。 3.解郁通幽湯結(jié)合生物反饋療法是一種臨床療效好、療效穩(wěn)定的治療方法,在解除主癥的同時,以疏肝理脾為根本,彌補(bǔ)了單純采用生物反饋治療儀進(jìn)行生物反饋訓(xùn)練治療盆底失弛緩型便秘的不足。在臨床值得推廣應(yīng)用。
[Abstract]:Objective: biofeedback is a first-line therapy for constipation caused by pelvic floor achalasia, but emotional factors will restrict the clinical efficacy of biofeedback. This subject is to observe the clinical curative effect of the tutors' experience prescription Jieyu Tongyou decoction combined with biofeedback in treating constipation caused by pelvic floor achalasia and constipation caused by (APFS), syndrome differentiation of liver and spleen. To explore the feasibility, effectiveness and advantages of the combination of the two therapies, and to provide the basis for its clinical application. Methods: from January 2013 to January 2014, 40 patients with constipation were randomly divided into two groups: treatment group (n = 20) and control group (n = 20). The treatment group was treated with oral Jieyu Tongyou decoction combined with biofeedback therapy, while the control group was treated with biofeedback therapy for 10 days. To observe the changes of main constipation, psychological state and surface myoelectric level of pelvic floor after treatment, to record the observation index, to make statistical analysis, to analyze the curative effect, and to draw a conclusion. The result is 1: 1. After two courses of treatment, 2 cases were cured, 14 cases were effective, 2 cases were ineffective, the effective rate was 80% and the total effective rate was 90%. In the control group, there were 0 cases of clinical cure, 4 cases of remarkable effect, 8 cases of effective and 8 cases of ineffective. The effective rate was 20 and the total effective rate was 60. The two groups had statistical significance (callus rate P0.01, total effective rate P0.01). The treatment group was significantly better than the control group in improving abdominal distension, sighing, belching, boredom, anorexia (P0.01), improving fecal quality, fecal feeling, defecation effort, defecation time, defecation frequency, defecation inexhaustible feeling. The other clinical symptoms were better than the control group (P0.05). After statistical treatment, compared with before treatment, the baseline systolic amplitude of Glazer pelvic floor electromyography was significantly decreased, the maximum systolic amplitude of rapid contraction phase was significantly increased, and the sustained contraction stage was observed. The coefficient of variation in the period of tolerance to contraction was significantly decreased, and the difference was statistically significant (P0.05). The treatment group was superior to the control group in improving anxiety and depression (P0.01). After 2 months follow-up, 1 case recurred in the treatment group and 3 cases in the control group. The effective rate is 85 and 45, respectively. The treatment group was significantly better than the control group (P0.01). Conclusion 1. Biofeedback treatment of pelvic floor flaccid constipation is effective. 2. 2. Jieyu Tongyou decoction combined with biofeedback can significantly improve the clinical symptoms of patients, anxiety and depression. 3. Jieyu Tongyou decoction combined with biofeedback therapy is a kind of treatment method with good clinical effect and stable curative effect. At the same time, it is essential to soothe the liver and regulate the spleen. It makes up for the deficiency of biofeedback training in the treatment of pelvic floor flaccid constipation. It is worth popularizing in clinic.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R574.62

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