Clinical study of biofeedback combined with TCM on anorectal pressure, small intestinal bacterial overgrowth and emotion correlation in patients with functional constipation and Qi stagnation syndrome
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摘要: 目的 研究中药联合生物反馈对气滞型功能性便秘患者肠道压力、盆底肌协调、小肠细菌过增长及情绪相关性的影响。方法 选取气滞型功能性便秘患者61例，随机分成生物反馈组31例和生物反馈+中药组30例，2组患者在治疗前后均进行高分辨率肛肠测压检查，氢呼气试验检测小肠细菌过增长(SIBO)，并行Hamilton抑郁焦虑量表打分。结果 HAMA/HAMD评分方面，生物反馈组与生物反馈+中药组比较，差异有统计学意义(P< 0.05)；高分辨率肛肠压力测定方面，入组的气滞型功能性便秘患者均有不同程度的肛肠压力的异常，模拟排便运动时直肠压力偏低，肛门括约肌压力增高，存在排便障碍，治疗后，生物反馈组与生物反馈+中药组比较，差异有统计学意义(P< 0.05)；小肠细菌过增长测定方面，气滞型功能性便秘患者存在较高比例的SIBO，呈正相关。治疗后，生物反馈组与生物反馈+中药比较，差异有统计学意义(P< 0.05)。结论 中药配合生物反馈，能改善气滞型功能性便秘患者腹肌与盆底肌的矛盾运动，使排便时直肠压力增高，盆底肌松弛，并通过调节肠道菌群，调整肠道动力系统使SIBO发生率降低，从而治疗便秘，也能缓解其焦虑抑郁状态。Abstract: Objective To study the effects of traditional Chinese medicine combined with biofeedback on intestinal pressure, pelvic floor muscle coordination, small intestinal bacterial overgrowth and emotional correlation in patients with chronic constipation of Qi stagnation syndrome.Methods Select 61 cases of chronic constipation with Qi stagnation syndrome, randomly divided into biofeedback group(n=31) and biofeedback + TCM group(n=30). Both groups underwent high resolution anorectal manometry, hydrogen breath test for small intestinal bacterial overgrowth(SIBO), and Hamilton Depression and Anxiety Scale scores before and after treatment.Results Comparison between biofeedback group and biofeedback + TCM group on HAMA/HAMD score, the difference was statistically significant(P< 0.05); For high resolution anorectal pressure measurement, the patients with chronic constipation and Qi stagnation syndrome all had different degrees of anorectal pressure abnormalities. Low rectal pressure during simulated defecation and increased anal sphincter pressure, has the trouble of defecation. After treatment, comparison between biofeedback group and biofeedback + TCM group, the difference was statistically significant(P< 0.05); On SIBO, patients with chronic constipation and Qi stagnation syndrome have a higher proportion of SIBO, shows positive correlation. After treatment, comparison between biofeedback group and biofeedback + TCM group, the difference was statistically significant(P< 0.05).Conclusion Traditional Chinese medicine with biofeedback can improve the contradictory movement of abdominal muscle and pelvic floor muscle in patients with Qi stagnation constipation. Increase rectal pressure when defecating, increase rectal pressure when defecating, relax pelvic floor muscle. By regulating the intestinal flora and the intestinal dynamic system, the incidence of SIBO can be reduced, thus treating constipation and relieving anxiety and depression.
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Key words:
- Liumo soup /
- Sini powder /
- biofeedback /
- functional constipation /
- high resolution anorectal manometry
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表 1 2组治疗前后高分辨率测压结果比较
mmHg，X±S 肛管直肠压力 时间 生物反馈组(n=31) 生物反馈+中药组(n=30) P 模拟排便时直肠压力 治疗前 25.99±2.36 25.96±2.41 0.88 治疗后 34.30±2.37 35.81±2.37 0.05 P 0.00 0.00 模拟排便时肛门括约肌压力 治疗前 71.57±14.61 69.33±14.93 0.85 治疗后 52.69±17.45 41.73±16.89 0.06 P 0.00 0.00 直肠-门括约肌压力梯度 治疗前 -48.75±3.09 -49.47±3.45 0.65 治疗后 -29.56±2.85 -26.53±3.65 0.05 P 0.00 0.00 注：1 mmHg=0.133 kPa。 
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表 2 2组治疗前后患者SIBO阳性率比较
% SIBO阳性率 生物反馈组
(n=31)生物反馈+中药组
(n=30)P 治疗前 74.2(23/31) 73.3(22/30) 0.80 治疗后 45.2(14/31) 33.3(10/30) 0.04 P 0.02 0.01
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表 3 2组HAMA/HAMD评分比较
分，X±S 分组 时间 生物反馈组
(n=31)生物反馈+中药组
(n=30)P HAMA 治疗前 19.29±1.59 19.37±1.68 治疗后 14.81±1.52 11.50±1.47 0.02 P 0.00 0.00 HAMD 治疗前 20.97±2.55 21.07±2.54 治疗后 16.45±2.31 11.87±2.28 0.00 P 0.00 0.00
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