调中益气汤治疗老年气虚型慢传输便秘的疗效研究

doi:10.12114/j.issn.1007-9572.2023.0515

摘要/Abstract

摘要： 背景调中益气汤最早用来治疗脾虚湿滞所导致的胃肠病。多年临证经验发现，调中益气汤加减可治疗老年慢传输型便秘（STC）。目的评价调中益气汤治疗老年气虚型STC临床疗效及对肠动力的影响。方法选取银川市中医医院2022年5月—2023年4月肛肠科、治未病中心就诊的中医辨证为气虚型STC患者100例，选用1∶1随机数字表法将患者随机分为观察组50例和对照组50例。观察组采用调中益气汤煎汤口服，对照组50例口服琥珀酸普芦卡必利片，各治疗4周。分别于治疗前、治疗4周后记录并比较每周完全自主排便次数（CSBM）积分、中医证候积分、临床症状积分和48、72 h标记物排出率，检测胃肠激素水平，观察不良反应发生情况。随访3个月，观察两组患者便秘复发情况。结果治疗4周后，观察组每周CSBM积分、中医证候积分和临床症状各积分均低于对照组（P<0.05），48、72 h标记物排出率高于对照组（P<0.05）；观察组血清5-羟色胺、血管活性肽、生长抑素低于对照组，而胃泌素高于对照组（P<0.05）。治疗4周后观察组临床总有效率高于对照组（χ2=4.031，P=0.046）；随访3个月，观察组复发率低于对照组（χ2=5.134，P=0.023）。研究过程中观察组有2例服用调中益气汤后出现腹胀，对照组4例口服琥珀酸普芦卡必利片出现口干、恶心、头晕等，均未进行对症治疗，试验终止后症状自行消失。结论调中益气汤能够改善老年STC患者中医证候、胃肠传输时间和临床症状，调节胃肠神经激素水平，促进胃肠动力，且临床复发率较低，值得临床推广。

关键词: 便秘, 慢传输便秘, 老年人, 气虚型, 促胃肠动力药（中药）, 胃肠激素类

Abstract:

Background

Tiaozhong Yiqi Soup was first used to treat gastrointestinal diseases caused by spleen deficiency and dampness stagnation. Years of experience in treating slow transit constipation (STC) in the elderly through the addition or subtraction of this formula has been found can treat elderly slow transit constipation.

Objective

To evaluate the clinical effect of Tiaozhong Yiqi Soup on elderly Qi deficiency type STC and intestinal motility.

Methods

A total of 100 cases of Qi deficiency type STC patients were selected from the Proctology Department and the Prevention and Treatment Center of Traditional Chinese Medicine Hospital of Yinchuan City from May 2022 to April 2023, and randomly divided into the observation group of 50 cases and control group of 50 cases using a 1∶1 randomized numerical table method. The observation group was orally treated with Tiaozhong Yiqi Soup decoction, the control group of 50 patients was orally treated with Prukapril Succinate Tablets, each group was treated for 4 weeks. The score of weekly Complete Spontaneous Bowel Movement (CSBM), traditional Chinese medicine (TCM) syndrome score, clinical symptom score, exclusion rates of markers at 48 and 72 hours before and after 4 weeks of treatment were recorded and compared, gastrointestinal hormone levels were detected and the occurrence of adverse reactions was observed. Follow up for 3 months to observe the recurrence of constipation in both groups of patients.

Results

After 4 weeks of treatment, the weekly CSBM score, TCM syndrome score, and clinical symptom score of the observation group were lower than those of the control group (P<0.05), and the exclusion rates of markers at 48 and 72 hours were significantly higher than those of the control group (P<0.05). The serum 5-HT, VIP, and SS of the observation group were lower than those of the control group, while the GAS higher than the control group, with statistical significant difference (P<0.05). The total clinical effective rate of the observation group was higher than that of the control group after 4 weeks of treatment (χ²=4.031, P=0.046). Following up for 3 months, the recurrence rate of the observation group was higher than that of the control group, and the difference was statistically significant (χ²=5.134, P=0.023). In the course of the study, 2 cases in the observation group developed abdominal distension after taking Tiaozhong Yiqi Soup, while 4 cases in the control group developed dry mouth, nausea, dizziness, and other symptoms after taking Prukapril Succinate Tablets orally, all of which were not treated symptomatically, and the symptoms disappeared on their own after the termination of the trial.

Conclusion

Self formulated Tiaozhong Yiqi Soup can improve TCM syndrome, weekly CSBM, and clinical symptoms in elderly STC patients, regulate gastrointestinal neurohormone levels, promote gastrointestinal motility, with a low clinical recurrence rate, which is worthy of clinical promotion.

Key words: Constipation, Slow transmission constipation, Aged, Qi deficiency type, Prokinetic agents (TCD), Gastrointestinal hormones

赵红波,吴晓晶,杨云,等. 调中益气汤治疗老年气虚型慢传输便秘的疗效研究[J]. 中国全科医学, 2024, 27(12): 1487-1492. DOI: 10.12114/j.issn.1007-9572.2023.0515.
ZHAO Hongbo,WU Xiaojing,YANG Yun, et al. Analysis of the Efficacy of Tiaozhong Yiqi Soup on Elderly Qi Deficiency Type Slow Transit Constipation[J]. Chinese General Practice, 2024, 27(12): 1487-1492. DOI: 10.12114/j.issn.1007-9572.2023.0515.

图/表 4

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组别	例数	每周CSBM积分（分）		中医证候积分（分）		标记物排出率（%）
		治疗前	治疗4周后	治疗前	治疗4周后	48 h		72 h
		治疗前	治疗4周后	治疗前	治疗4周后	治疗前	治疗4周后	治疗前	治疗4周后
对照组	50	2.71±0.32	1.53±0.20^a	24.97±4.15	22.65±3.73	19.31±4.87	45.90±6.96^a	26.85±5.72	60.42±8.31^a
观察组	50	2.84±0.26	0.89±0.17^a	23.63±4.09	13.87±2.28^a	20.28±5.43	62.65±8.75^a	25.59±5.64	77.18±10.62^a
t值		0.139	5.910	0.703	5.528	0.619	11.316	1.074	13.192
P值		0.359	0.032	0.448	0.027	0.380	0.011	0.625	0.006

组别	例数	每周CSBM积分（分）		中医证候积分（分）		标记物排出率（%）
		治疗前	治疗4周后	治疗前	治疗4周后	48 h		72 h
		治疗前	治疗4周后	治疗前	治疗4周后	治疗前	治疗4周后	治疗前	治疗4周后
对照组	50	2.71±0.32	1.53±0.20^a	24.97±4.15	22.65±3.73	19.31±4.87	45.90±6.96^a	26.85±5.72	60.42±8.31^a
观察组	50	2.84±0.26	0.89±0.17^a	23.63±4.09	13.87±2.28^a	20.28±5.43	62.65±8.75^a	25.59±5.64	77.18±10.62^a
t值		0.139	5.910	0.703	5.528	0.619	11.316	1.074	13.192
P值		0.359	0.032	0.448	0.027	0.380	0.011	0.625	0.006

组别	例数	5-HT（μg/L）		GAS（ng/L）		VIP（ng/L）		SS（ng/L）
组别	例数	治疗前	治疗4周后	治疗前	治疗4周后	治疗前	治疗4周后	治疗前	治疗4周后
对照组	50	51.70±10.14	78.86±14.35^a	21.77±6.34	23.95±7.87	82.99±8.92	70.04±8.04^a	59.34±10.02	46.98±7.51^a
观察组	50	50.94±8.25	67.19±11.28^a	20.69±5.28	47.19±8.29^a	81.38±7.50	47.10±6.82^a	58.28±9.39	33.19±5.25^a
t值		0.639	10.711	0.811	13.528	1.168	15.306	0.807	9.192
P值		0.250	0.014	0.375	<0.001	0.497	<0.001	0.526	0.027

组别	例数	5-HT（μg/L）		GAS（ng/L）		VIP（ng/L）		SS（ng/L）
组别	例数	治疗前	治疗4周后	治疗前	治疗4周后	治疗前	治疗4周后	治疗前	治疗4周后
对照组	50	51.70±10.14	78.86±14.35^a	21.77±6.34	23.95±7.87	82.99±8.92	70.04±8.04^a	59.34±10.02	46.98±7.51^a
观察组	50	50.94±8.25	67.19±11.28^a	20.69±5.28	47.19±8.29^a	81.38±7.50	47.10±6.82^a	58.28±9.39	33.19±5.25^a
t值		0.639	10.711	0.811	13.528	1.168	15.306	0.807	9.192
P值		0.250	0.014	0.375	<0.001	0.497	<0.001	0.526	0.027

组别	例数	便意感		粪便性状		排便时长		排便不尽		排便无力		腹胀
组别	例数	治疗前	治疗4周后	治疗前	治疗4周后	治疗前	治疗4周后	治疗前	治疗4周后	治疗前	治疗4周后	治疗前	治疗4周后
对照组	50	3.02±1.42	2.29±0.53^a	4.61±1.04	4.37±1.12	3.09±0.95	2.41±0.65^a	2.84±0.79	2.29±0.35^a	3.11±0.58	2.99±0.56	2.90±0.62	2.28±0.49^a
观察组	50	3.08±1.31	1.76±0.44^a	4.53±0.92	2.65±0.58^a	3.04±0.77	1.52±0.26^a	2.95±0.85	1.38±0.31^a	3.07±0.66	1.58±0.39^a	2.86±0.63	1.69±0.37^a
t值		0.539	4.910	0.672	3.528	0.912	5.214	1.639	7.910	2.073	4.328	3.169	5.822
P值		0.406	0.036	0.187	0.029	0.634	0.017	0.312	0.014	0.264	0.025	0.187	0.029