“益气活血汤”药物透入治疗气虚血瘀型阿片类所致便秘的临床研究

Clinical study on the treatment of opioid-induced constipation with qi-deficiency and blood-stasis by the drug penetration of “Yiqi Huoxue Decoction”

关键词:  阿片类所致便秘  超声药物透入  临床疗效  癌痛

Key words:  opioid-induced constipation  ultrasonic drug penetration  clinical efficacy  cancer pain

摘要:

[目的] 观察足三里穴位“益气活血汤”超声药物透入治疗气虚血瘀型阿片类止痛药所致便秘的临床疗效。[方法] 符合入选标准的126例患者被随机分为超声药透组（42例）、穴位贴敷组（43例）、乳果糖治疗组（41例）。超声药透组采用超声药透“益气活血汤”作用于双侧足三里。穴位贴敷组采用艾灸贴敷“益气活血汤”作用于双侧足三里。乳果糖组口服乳果糖口服液。治疗14d后，观察3组患者的便秘治疗有效率、生活质量、癌痛改善情况以及安全性。[结果] 共122例患者完成全部试验。超声药透组的总有效率高于其余两组，且差异有统计学意义（P＜0.05）。3组患者治疗后便秘生活质量量表（PAC-QOL）评分均较治疗前均有所改善，且差异有统计学意义（P＜0.05）；治疗后，超声药透组PAC-QOL评分的改善程度大于穴位贴敷组和乳果糖组，且差异有统计学意义（P＜0.05）。超声药透组、穴位贴敷组治疗后疼痛数字模拟评分法（NRS）评分较治疗前降低，差异有统计学意义（P＜0.05）；而乳果糖组治疗前后NRS评分差异无统计学意义（P＞0.05）；治疗后NRS评分比较，超声药透组疼痛缓解率优于穴位贴敷组及乳果糖组，且差异有统计学意义（P＜0.05）。治疗后超声药透组及穴位贴敷组的不良反应发生率小于乳果糖组，且差异具有显著统计学意义（P＜0.01）。[结论] “益气活血汤”经超声药物透入作用于足三里治疗气虚血瘀型阿片药物所致便秘疗效确切，不良反应低，且可以同时改善患者疼痛症状，值得临床推广使用。

Abstract:

[Objective] To observe the clinical effect on opioid-induced constipation of qi-deficiency and blood-stasis treated with the ultrasound penetration of Yiqi Huoxue Decoction. [Methods] A total of 126 patients that were in compliance with the inclusion criteria were randomized into ultrasound penetration group (42 cases),acupoint application group (43 cases),lactulose group (41 cases). In the ultrasound penetration group,the ultrasonic penetration of Yiqi Huoxue Decoction at bilateral Zusanli (ST 36). In the acupoint application group,the use of moxibustion combined with Yiqi Huoxue Decoction acted on bilateral Zusanli. And the lactulose group was given oral lactulose liquid. After 14 days of treatment,the effective rate,the score of the patient assessment of constipation quality of life (PAC-QOL),improvement of cancer pain and safety were observed in three groups. [Results] A total of 122 cases accomplished the trial. The total effective rate of the ultrasound penetration group was higher than that of the other two groups,and the difference was statistically significant (P<0.05). After treatment,the PAC-QOL scores in all three groups were improved compared with those before treatment. And the improvement of PAC-QOL scores in the ultrasound penetration group was greater than that in the acupoint application group and the lactilose group,the difference was statistically significant (P<0.05). The NRS score of pain in ultrasound penetration group and acupoint application group was lower than that before treatment (P<0.05). But NRS scores of lactulose group before and after treatment had no statistical difference. After treatment,the pain relief rate of ultrasound penetration group was better than that of acupoint application and lactulose group,and have statistically significant (P<0.05). After treatment,the incidence of adverse reaction in ultrasound penetration group and acupoint application group was less than that in lactulose group. [Conclusion] The ultrasound penetration of Yiqi Huoxue Decoction has definite curative effect on opioid-induced constipation with qi-deficiency and blood-stasis,has low adverse reaction,and can relief the pain symptom. It is worth popularizing in clinical practice.