针药结合改善慢性功能性便秘患者心理状态及生活质量的临床研究
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摘要
研究背景：
慢性功能性便秘(CFC)是一种常见的消化道慢性疾病,随着饮食结构的改变及精神心理和社会因素的影响,患病率逐渐升高。在北美洲便秘发病率为1.9%到27.2%,在北京地区进行的随机、分层调查表明,慢性便秘患病率6.07%。CFC病程漫长,医疗成本高,社会成本庞大,在美国,每年因便秘就诊人次超过七百万,购买非处方缓泻剂的的金额高达八亿美元,平均每名病人花费在便秘的诊断费用为3000美元,治疗费用为4500美元。近年来的研究发现CFC发病与精神心理有密切关系,CFC患者心理状态较差,生活质量降低,而低质量的心理状态及生活质量给家庭甚至社会带来了负担,但鲜少有治疗前后心理状态及生活质量改善的研究。
现今对治疗的要求与以往不同,不仅仅是症状改善,心理状态及生活质量的改善也成为评价疗效的重要指标。世界卫生组织(WHO)对“健康”下的定义为“健康不仅是没有疾病和虚弱,而应是躯体、心理和社会适应的完好状态”。这意味着人们逐渐认识到医学最终的目的不仅仅是去延长人的生命长度,还要关注其生活质量。
针药结合治疗CFC,有其独特的优势,不仅安全有效且不良反应少。禀承以人为本的观念,以中医理论为指导,藉由“治神”和“治身”进行整体性调整,可同时改善便秘症状、心理状态及生活质量,起到身心同治的作用。
目的：
本课题以中医理论为指导,以临床实践为依据,采用针药结合治疗CFC,以精神量表(SCL-90.SAS.SDS)及便秘生活质量量表(PAC-QOL)作为评量工具,探讨针药结合干预对CFC患者心理状态及生活质量的影响,突出针药结合治疗的优势,提高中医在治疗CFC中的作用与地位,拓宽临床治疗思路,为提高临床疗效提供更为确切的方法。方法：
根据罗马Ⅲ标准及实验室检查结果,收集自2010年3月至2011年3月南京中医药大学第三附属医院(南京市中医院)盆底疾病中心慢性功能性便秘患者90例,随机分为二组,其中治疗组60例,对照组30例。治疗组给予针刺加中药治疗,对照组仅予单纯中药治疗。10次为一个疗程,共观察2个疗程。在治疗前后各以精神量表(SCL-90.SAS. SDS)及便秘生活质量量表(PAC-QOL)作为评量工具,在治疗两个疗程后进行患者治疗前后的疗效观察。
结果：
1.治疗前CFC患者心理状态、生活质量较正常人低下,有统计学差异(P<0.05),治疗后心理状态、生活质量较前改善,治疗前后有显著统计学差异(P<0.01)。
2.针药结合及单纯中药治疗均能改善CFC患者心理状态,针药结合组在抑郁、焦虑、恐怖、饮食、睡眠五个方面改善优于单纯中药组,有统计学差异(P<0.05)。
3.针药结合治疗CFC患者生活质量改善优于单纯中药,有显著统计学差异(P<0.01)。
结论：
应用针药结合治疗CFC安全有效,患者心理状态及生活质量改善优于单纯中药治疗。对于心理状态或生活质量明显低下的CFC患者,可优先考虑针药结合治疗。
Background:
Chronic functional constipation (CFC) is a common diagnose of gastrointestinal diseases, with the impact of diet changes and psychological and social factors, the prevalence rate is gradually increasing. In general, the prevalence of constipation among the general population in North America has been quoted as1.9%to27.2%, a random, stratified survey carried out in Beijing showed that6.07%of the prevalence of chronic functional constipation.
CFC's course is long with high medical costs and huge social spending. In the United States, constipation accounts for7million physician visits per year and over US$800million is spent for over-the-counter (OTC) laxatives, and diagnostic workup for constipation averages US$3000per patient, and it takes another US$4500per person to provide treatment.
Recent researches discovered that the CFC morbidity and the stress disorder have the close relation. Psychological state of CFC patient is bad, and the quality of life reduces, but fewer researches about the improvement of psychological state and quality of life after treatment.
The CFC treated by acupuncture combined with Chinese herbs has its unique superiority not only safe, effective but the untoward effect is few. Treatment of CFC based on TCM theory mainly to human nature, makes an adjustment of the whole body adjustment, and cures both physically and mentally. Nowadays treatment is not only the improvement of symptoms, but the psychological state and the quality of life has utilized gradually takes the curative effect as the evaluating indicators. Acupuncture combined with Chinese herbs treat CFC, by the rule of treating body and mind to be a whole body adjustment, makes the body and mind cured together.
Objective:
This research takes the Chinese medicine theory as the instruction, takes the clinical practice as the basis and uses acupuncture combined with Chinese herbs to treat CFC. The valuation tools are the psychological scales (SCL-90, SAS, and SDS) and the constipation quality of life (PAC-QOL) to inquire into the influence of psychological state and the quality of life of CFC patients by the intervenes of acupuncture combined with Chinese herbs. It highlights the superiority of acupuncture combined with Chinese herbs, enhances the function and the status of the traditional Chinese medicine in treating CFC, expands the clinical care mentality, and provides a more accurate method to enhance the clinical curative effect.
Method:
According to Rome Ⅲ criteria and the laboratory test results, collected90cases of CFC from March,2010to March,2011in the pelvic floor center of Nanjing Chinese medicine University third affiliated hospital (the Nanjing Chinese medicine hospital). They are divided into two groups randomly,60cases in the treatment group and30cases in the control group. The treatment group is given with the acupuncture combined with Chinese herbs; and the control group is only given with the treatment of traditional Chinese herbs. Ten times treatments as a course of treatment and two treatment courses are observed altogether. Around the treatment, the psychological scales (SCL-90, SAS and SDS) and the constipation quality of life (PAC-QOL) are used as assessment tools respectively to be self-comparison after two treatment courses.
Result:
1. Before the treatment the psychological state and life quality of CFC patient is lower compared with the normal people.(P<0.05) After the treatment, the psychological state and the quality of life have improved a lot.(P<0.01)
2. The psychological state of CFC can be improved by the treatment of acupuncture combined with Chinese herbs and the traditional Chinese herbs, but in the parts of depression, anxious, terror, diet, sleep, the group of acupuncture combined with Chinese herbs is superior to the traditional Chinese herbs group.(P<0.05)
3. The quality of life can be ameliorated by the acupuncture combined with Chinese herbs obviously than the traditional Chinese herbs.(P<0.01)
Conclusion:
It is safe and effective by treating CFC with acupuncture combined with Chinese herbs, and the improvement of the psychological state and the quality of life is better than the traditional Chinese herbs. The CFC patients who obviously have the lower psychological state or the quality of life may be treated first by acupuncture combined with Chinese herbs.
慢性功能性便秘(CFC)是一种常见的消化道慢性疾病,随着饮食结构的改变及精神心理和社会因素的影响,患病率逐渐升高。在北美洲便秘发病率为1.9%到27.2%,在北京地区进行的随机、分层调查表明,慢性便秘患病率6.07%。CFC病程漫长,医疗成本高,社会成本庞大,在美国,每年因便秘就诊人次超过七百万,购买非处方缓泻剂的的金额高达八亿美元,平均每名病人花费在便秘的诊断费用为3000美元,治疗费用为4500美元。近年来的研究发现CFC发病与精神心理有密切关系,CFC患者心理状态较差,生活质量降低,而低质量的心理状态及生活质量给家庭甚至社会带来了负担,但鲜少有治疗前后心理状态及生活质量改善的研究。
现今对治疗的要求与以往不同,不仅仅是症状改善,心理状态及生活质量的改善也成为评价疗效的重要指标。世界卫生组织(WHO)对“健康”下的定义为“健康不仅是没有疾病和虚弱,而应是躯体、心理和社会适应的完好状态”。这意味着人们逐渐认识到医学最终的目的不仅仅是去延长人的生命长度,还要关注其生活质量。
针药结合治疗CFC,有其独特的优势,不仅安全有效且不良反应少。禀承以人为本的观念,以中医理论为指导,藉由“治神”和“治身”进行整体性调整,可同时改善便秘症状、心理状态及生活质量,起到身心同治的作用。
目的：
本课题以中医理论为指导,以临床实践为依据,采用针药结合治疗CFC,以精神量表(SCL-90.SAS.SDS)及便秘生活质量量表(PAC-QOL)作为评量工具,探讨针药结合干预对CFC患者心理状态及生活质量的影响,突出针药结合治疗的优势,提高中医在治疗CFC中的作用与地位,拓宽临床治疗思路,为提高临床疗效提供更为确切的方法。方法：
根据罗马Ⅲ标准及实验室检查结果,收集自2010年3月至2011年3月南京中医药大学第三附属医院(南京市中医院)盆底疾病中心慢性功能性便秘患者90例,随机分为二组,其中治疗组60例,对照组30例。治疗组给予针刺加中药治疗,对照组仅予单纯中药治疗。10次为一个疗程,共观察2个疗程。在治疗前后各以精神量表(SCL-90.SAS. SDS)及便秘生活质量量表(PAC-QOL)作为评量工具,在治疗两个疗程后进行患者治疗前后的疗效观察。
结果：
1.治疗前CFC患者心理状态、生活质量较正常人低下,有统计学差异(P<0.05),治疗后心理状态、生活质量较前改善,治疗前后有显著统计学差异(P<0.01)。
2.针药结合及单纯中药治疗均能改善CFC患者心理状态,针药结合组在抑郁、焦虑、恐怖、饮食、睡眠五个方面改善优于单纯中药组,有统计学差异(P<0.05)。
3.针药结合治疗CFC患者生活质量改善优于单纯中药,有显著统计学差异(P<0.01)。
结论：
应用针药结合治疗CFC安全有效,患者心理状态及生活质量改善优于单纯中药治疗。对于心理状态或生活质量明显低下的CFC患者,可优先考虑针药结合治疗。
Background:
Chronic functional constipation (CFC) is a common diagnose of gastrointestinal diseases, with the impact of diet changes and psychological and social factors, the prevalence rate is gradually increasing. In general, the prevalence of constipation among the general population in North America has been quoted as1.9%to27.2%, a random, stratified survey carried out in Beijing showed that6.07%of the prevalence of chronic functional constipation.
CFC's course is long with high medical costs and huge social spending. In the United States, constipation accounts for7million physician visits per year and over US$800million is spent for over-the-counter (OTC) laxatives, and diagnostic workup for constipation averages US$3000per patient, and it takes another US$4500per person to provide treatment.
Recent researches discovered that the CFC morbidity and the stress disorder have the close relation. Psychological state of CFC patient is bad, and the quality of life reduces, but fewer researches about the improvement of psychological state and quality of life after treatment.
The CFC treated by acupuncture combined with Chinese herbs has its unique superiority not only safe, effective but the untoward effect is few. Treatment of CFC based on TCM theory mainly to human nature, makes an adjustment of the whole body adjustment, and cures both physically and mentally. Nowadays treatment is not only the improvement of symptoms, but the psychological state and the quality of life has utilized gradually takes the curative effect as the evaluating indicators. Acupuncture combined with Chinese herbs treat CFC, by the rule of treating body and mind to be a whole body adjustment, makes the body and mind cured together.
Objective:
This research takes the Chinese medicine theory as the instruction, takes the clinical practice as the basis and uses acupuncture combined with Chinese herbs to treat CFC. The valuation tools are the psychological scales (SCL-90, SAS, and SDS) and the constipation quality of life (PAC-QOL) to inquire into the influence of psychological state and the quality of life of CFC patients by the intervenes of acupuncture combined with Chinese herbs. It highlights the superiority of acupuncture combined with Chinese herbs, enhances the function and the status of the traditional Chinese medicine in treating CFC, expands the clinical care mentality, and provides a more accurate method to enhance the clinical curative effect.
Method:
According to Rome Ⅲ criteria and the laboratory test results, collected90cases of CFC from March,2010to March,2011in the pelvic floor center of Nanjing Chinese medicine University third affiliated hospital (the Nanjing Chinese medicine hospital). They are divided into two groups randomly,60cases in the treatment group and30cases in the control group. The treatment group is given with the acupuncture combined with Chinese herbs; and the control group is only given with the treatment of traditional Chinese herbs. Ten times treatments as a course of treatment and two treatment courses are observed altogether. Around the treatment, the psychological scales (SCL-90, SAS and SDS) and the constipation quality of life (PAC-QOL) are used as assessment tools respectively to be self-comparison after two treatment courses.
Result:
1. Before the treatment the psychological state and life quality of CFC patient is lower compared with the normal people.(P<0.05) After the treatment, the psychological state and the quality of life have improved a lot.(P<0.01)
2. The psychological state of CFC can be improved by the treatment of acupuncture combined with Chinese herbs and the traditional Chinese herbs, but in the parts of depression, anxious, terror, diet, sleep, the group of acupuncture combined with Chinese herbs is superior to the traditional Chinese herbs group.(P<0.05)
3. The quality of life can be ameliorated by the acupuncture combined with Chinese herbs obviously than the traditional Chinese herbs.(P<0.01)
Conclusion:
It is safe and effective by treating CFC with acupuncture combined with Chinese herbs, and the improvement of the psychological state and the quality of life is better than the traditional Chinese herbs. The CFC patients who obviously have the lower psychological state or the quality of life may be treated first by acupuncture combined with Chinese herbs.
引文
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