Observation on the therapeutic effect of deep needling at Baliao acupoint combined with biofeedback therapy on functional defecation disorder
-
摘要: 目的 观察八髎穴深刺联合生物反馈(biofeedback，BF)治疗功能性排便障碍(functional defecation disorder，FDD)的临床疗效。方法 研究对象为2021年2月—2022年12月期间诊治的84例FDD患者，将其随机分为对照组(单纯BF治疗)和治疗组(八髎穴深刺联合BF治疗)，其中对照组43例，治疗组41例。所有患者每周治疗3次，10次为1个疗程。治疗2个疗程后，分别比较两组患者治疗前后的临床疗效、便秘症状评分、生活质量、心理状态评分、肛管直肠压力和心率变异性指标，并对两组患者治疗后的效果进行组间比较。结果 治疗组总有效率为73.17%，高于对照组的51.16%。两组患者治疗后便秘症状评分、肛管直肠压力及生活质量评分较治疗前均显著改善(P＜0.05)，但治疗组改善幅度大于对照组(P＜0.05)。治疗组焦虑自评量表、抑郁自评量表评分和心率变异性指标较治疗前显著优化(P＜0.05)，而对照组治疗前后差异无统计学意义。结论 八髎穴深刺联合BF治疗FDD的总体疗效优于单纯BF治疗，可显著改善患者的自主神经功能及情绪状态。Abstract: Objective To observe the clinical efficacy of deep needling at Baliao point combined with biofeedback in the treatment of functional defecation disorder.Methods The research subjects were 84 functional defecation disorder patients diagnosed and treated from February 2021 to December 2022. The patients were randomly divided into a control group(treated with biofeedback alone) and a treatment group(treated with deep needling of Baliao acupoint combined with biofeedback), with 43 cases in each control group and 41 cases in the treatment group. All patients were treated 3 times a week, with 10 times being a course of treatment. After two courses of treatment, the clinical efficacy, constipation symptom score, quality of life, psychological state score, anorectal pressure, and heart rate variability(HRV) of the two groups of patients were compared before and after treatment, and the results of the two groups of patients were compared between groups.Results The total effective rate of the treatment group was 73.17%, higher than the 51.16% of the control group. The scores of constipation symptoms, anorectal pressure, and quality of life in both groups of patients after treatment were significantly improved compared to before treatment(P < 0.05), but the improvement in the treatment group was greater than that in the control group(P < 0.05). The self-rating anxiety scales, self-rating depression scale scores, and HRV indicators in the treatment group were significantly optimized compared to before treatment(P < 0.05), while there was no statistically significant difference in the control group before and after treatment.Conclusion The overall efficacy of deep needling at Baliao acupoint combined with biofeedback treatment for functional defecation disorders is better than that of simple biofeedback treatment, which can significantly improve patients' autonomic nervous function and emotional state.
-
-
表 1 两组患者的疗效比较
例 组别 例数 痊愈 显效 有效 无效 总有效 对照组 43 3 6 13 21 22 治疗组 41 5 10 15 11 30 χ2 5.210 P 0.022 
下载: 导出CSV
表 2 两组患者的便秘症状评分比较
分，M(Q1，Q3) 组别 例数 粪便性状 排便费力 排粪时间 下坠、不尽、胀感 排粪频率 腹胀 对照组 43 治疗前 2(1，3) 3(2，3) 3(2，3) 2(2，3) 3(2，3) 2(2，3) 治疗后 1(0，1)1) 2(1，2)1) 2(1，2)1) 1(1，2)1) 1(1，2)1) 1(1，2)1) 治疗组 41 治疗前 2(1，2) 3(2，3) 3(2，3) 2(2，3) 3(2，3) 2(2，3) 治疗后 1(0，1)1) 1(0，1)1)2) 1(0，1)1)2) 0(0，1)1)2) 1(0，1)1) 1(0，1)1)2) 与治疗前比较，1)P＜0.05；与对照组比较，2)P＜0.05。
下载: 导出CSV
表 3 两组患者的肛管直肠压力比较
X±S 组别 例数 肛管静息压/mmHga) 肛管残余压/mmHg 肛管松弛率/% 初始感觉阈值/mL 排粪感觉阈值/mL 对照组 43 治疗前 102.34±13.70 89.37±10.91 15.98±5.82 46.65±9.36 81.95±15.64 治疗后 90.05±10.401) 79.95±7.501) 22.28±6.101) 42.95±9.021) 66.44±11.751) 治疗组 41 治疗前 101.30±14.43 87.41±12.65 15.63±5.68 46.92±8.99 80.37±16.18 治疗后 80.76±9.071)2) 75.34±8.131)2) 25.73±6.341)2) 39.09±7.321)2) 59.85±11.401)2) 注：a)1 mmHg=0.133 kPa。
与治疗前比较，1)P＜0.05；与对照组比较，2)P＜0.05。
下载: 导出CSV
表 4 两组患者的PAC-QOL、SAS、SDS评分比较
分，X±S 组别 例数 PAC-QOL SAS SDS 治疗前 治疗后 治疗前 治疗后 治疗前 治疗后 对照组 43 95.31±10.92 82.51±8.271) 44.33±8.25 42.21±6.03 44.63±7.87 43.07±6.01 治疗组 41 94.85±11.19 71.83±8.191)2) 44.08±8.73 31.69±5.021)2) 46.05±7.53 32.34±5.181)2) 与治疗前比较，1)P＜0.05；与对照组比较，2)P＜0.05。
下载: 导出CSV
表 5 两组患者的心率变异性指标比较
X±S 组别 例数 LF/ms2 HF/ms2 LF/HF SDANN/ms RMSSD/ms 对照组 43 治疗前 166.42±39.09 116.86±33.41 1.48±0.39 54.81±9.94 21.48±5.45 治疗后 171.25±47.31 119.63±32.95 1.50±0.46 56.83±10.12 23.04±8.61 治疗组 41 治疗前 168.78±37.64 119.68±25.53 1.44±0.35 55.39±9.80 22.21±5.25 治疗后 214.27±45.871)2) 133.98±23.861)2) 1.64±0.441) 64.90±9.091)2) 27.61±7.751)2) 与治疗前比较，1)P＜0.05；与对照组比较，2)P＜0.05。
下载: 导出CSV
-
[1] Desprez C, Bridoux V, Leroi AM. Disorders of anorectal motility: functional defecation disorders and fecal incontinence[J]. J Visc Surg, 2022, 159(1): S40-S50. doi: 10.1016/j.jviscsurg.2021.12.004
[2] Serra J, Pohl D, Azpiroz F, et al. European society of neurogastroenterology and motility guidelines on functional constipation in adults[J]. Neurogastroenterol Motil, 2020, 32(2): e13762. doi: 10.1111/nmo.13762
[3] Lee HJ, Boo SJ, Jung KW, et al. Long-term efficacy of biofeedback therapy in patients with dyssynergic defecation: results of a Median 44 months follow-up[J]. Neurogastroenterol Motil, 2015, 27(6): 787-795. doi: 10.1111/nmo.12552
[4] Iovino P, Neri MC, D'Alba L, et al. Pelvic floor biofeedback is an effective treatment for severe bloating in disorders of gut-brain interaction with outlet dysfunction[J]. Neurogastroenterol Motil, 2022, 34(5): e14264. doi: 10.1111/nmo.14264
[5] (明)李时珍. 柳长华, 校注. 奇经八脉考[M]. 北京: 中国中医药出版社, 2007: 89-89.
[6] 王斌华, 吴新贵. 八髎穴的临床应用研究进展[J]. 广西中医药大学学报, 2021, 24(4): 77-80. doi: 10.3969/j.issn.2095-4441.2021.04.021
[7] 罗宏标, 彭昌能, 李国民, 等. 电针八髎穴对不协调型功能性排便障碍患者的肛管直肠动力学影响[J]. 中国中西医结合消化杂志, 2020, 28(9): 705-708. https://zxyxh.whuhzzs.com/article/doi/10.3969/j.issn.1671-038X.2020.09.12
[8] 方秀才. 罗马Ⅳ功能性胃肠病: 肠-脑互动异常(中文翻译版)[M]. 北京: 科学出版社, 2016.
[9] 蔡海红, 王玲玲. 王玲玲教授八髎穴深刺法及临床应用[J]. 中国针灸, 2014, 34(3): 285-288. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZE201403034.htm
[10] 中华中医药学会脾胃病分会. 便秘中医诊疗专家共识意见(2017)[J]. 北京中医药, 2017, 36(9): 771-776, 784. https://www.cnki.com.cn/Article/CJFDTOTAL-BJZO201709001.htm
[11] 中华医学会外科学分会肛肠外科学组. 便秘症状及疗效评估[J]. 中华胃肠外科杂志, 2005, 8(4): 355-357. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWCW200504027.htm
[12] Marquis P, De La Loge C, Dubois D, et al. Development and validation of the Patient Assessment of Constipation Quality of Life questionnaire[J]. Scand J Gastroenterol, 2005, 40(5): 540-551. doi: 10.1080/00365520510012208
[13] 汪向东, 王希林, 马弘. 心理卫生评定量表手册[M]. 北京: 中国心理卫生杂志社, 1999: 194-235.
[14] 中华医学会消化病学分会胃肠动力学组, 中华医学会外科学分会结直肠肛门外科学组. 中国慢性便秘诊治指南(2013年, 武汉)[J]. 中华消化杂志, 2013, 33(5): 291-297. doi: 10.3760/cma.j.issn.0254-1432.2013.05.002
[15] Rao SS, Bharucha AE, Chiarioni G, et al. Functional anorectal disorders[J]. Gastroenterology, 2016: S0016-S5085(16)00175-X10.
[16] Park MI. Can electrical stimulation therapy be helpful for patients with chronic constipation refractory to biofeedback therapy?[J]. J Neurogastroenterol Motil, 2013, 19(3): 279-280. doi: 10.5056/jnm.2013.19.3.279
[17] 邹洋洋, 丁曙晴, 周惠芬, 等. 八髎穴治疗出口梗阻型便秘的机制探讨[J]. 针刺研究, 2015, 40(5): 427-430. https://www.cnki.com.cn/Article/CJFDTOTAL-XCYJ201505020.htm
[18] Chan AO, Cheng C, Hui WM, et al. Differing coping mechanisms, stress level and anorectal physiology in patients with functional constipation[J]. World J Gastroenterol, 2005, 11(34): 5362-5366.
[19] 陈照, 宋佳, 刘汶. 北京中医医院消化中心对慢性便秘患者生存质量的调查报告[J]. 中国中西医结合消化杂志, 2009, 17(5): 322-325. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXPW200905013.htm
[20] Guo MQ, Yao JF, Yang F, et al. The composition of intestinal microbiota and its association with functional constipation of the elderly patients[J]. Future Microbiol, 2020, 15(3): 163-175.
[21] 张东铭. 盆源型出口梗阻性便秘的神经病因学[J]. 结直肠肛门外科, 2007, 13(6): 341-343. https://www.cnki.com.cn/Article/CJFDTOTAL-DCGM200706001.htm
[22] 高祥悦, 姜亚, 李飞, 等. 自主神经功能与功能性便秘患者临床症状的相关性分析[J]. 南京医科大学学报(自然科学版), 2023, 43(4): 510-517. https://www.cnki.com.cn/Article/CJFDTOTAL-NJYK202304009.htm
[23] Zhou LR, Lin Z, Lin L, et al. Functional constipation: implications for nursing interventions[J]. J Clin Nurs, 2010, 19(13-14): 1838-1843.
[24] Liu TT, Yi CH, Chen CL, et al. Impact of sleep dysfunction on anorectal motility in healthy humans[J]. J Neurogastroenterol Motil, 2011, 17(2): 180-184.
[25] Patel HC, Rosen SD, Lindsay A, et al. Targeting the autonomic nervous system: measuring autonomic function and novel devices for heart failure management[J]. Int J Cardiol, 2013, 170(2): 107-117.
-