2023 年第 11 期 第 18 卷

卯刻燮理术联合生物反馈治疗出口梗阻型便秘的临床效果观察

Clinical effect observation of Maokexieli practice combined with biofeedback in the treatment of outlet obstruction constipation

作者：路越张洋

英文作者：Lu Yue Zhang Yang

单位：辽宁中医药大学附属第三医院盆底科，沈阳110003

英文单位：Department of Pelvic Floor the Third Affiliated Hospital of Liaoning University of Traditional Chinese Medicine Shenyang 110003 China

关键词：出口梗阻型便秘；卯刻燮理术；胃动素；血管活性肠肽；盆底Glazer评估

英文关键词：Outletobstructiveconstipation;Maokexielipractice;Motilin;Vasoactiveintestinalpeptide;PelvicfloorGlazerassessment

• 摘要：

• 目的  探讨卯刻燮理术联合生物反馈治疗对出口梗阻型便秘（OOC）的临床效果。方法  选取辽宁中医药大学附属第三医院2020年5月至2022年5月治疗的OOC患者90例，按随机数字表法分为功法组、生物反馈组及联合组，每组30例。功法组予卯刻燮理术功法锻炼治疗，生物反馈组予生物反馈治疗，联合组予卯刻燮理术功法锻炼联合生物反馈治疗，4周为1个疗程，治疗2个疗程。比较3组治疗前后便秘临床症状评分、肛门直肠压力测定指标、盆底Glazer评估指标、血清胃动素和血管活性肠肽（VIP）水平。结果  治疗后，3组便秘临床症状评分、肛管静息压、肛门括约肌最大收缩力均低于治疗前，且联合组均低于功法组、生物反馈组；联合组最大耐受觉低于治疗前，且低于功法组、生物反馈组（均P＜0.05）。治疗后，3组前基线和后基线波幅、快速收缩最大波幅、持续收缩平均波幅、耐力收缩平均波幅均高于治疗前、且联合组高于功法组和生物反馈组，3组前基线和后基线变异系数均低于治疗前，且联合组低于功法组和生物反馈组（均P＜0.05）。治疗后，3组血清胃动素、VIP水平均高于治疗前，且联合组均高于功法组和生物反馈组［（261±43）ng/L比（241±37）、（219±34）ng/L，（81±15）ng/L比（60±19）、（69±11）ng/L］（均P＜0.05）。联合组总有效率高于功法组和生物反馈组（均P＜0.05）。结论  卯刻燮理术联合生物反馈治疗OOC效果较好，可能是通过调节胃动素及VIP水平影响肠道蠕动从而发挥辅助治疗作用。

• Objective  To investigate the clinical effect of Maokexieli practice combined with biofeedback in the treatment of outlet obstruction constipation (OOC). Methods  From May 2020 to May 2022, 90 patients with OOC admitted to the Third Affiliated Hospital of Liaoning University of Traditional Chinese Medicine were enrolled. They were divided into practice group, biofeedback group and combined group, with 30 cases in each group. Practice group were treated with Maokexieli practice, biofeedback group was treated with biofeedback, combined group was treated with Maokexieli practice combined with biofeedback, and all were treated for 2 courses, with 4 weeks as a course. The clinical symptom scores for constipation, anorectal manometry index, pelvic floor Glaser assessment index and serum levels of motilin and vasoactive intestinal peptide (VIP) were compared in the three groups before and after treatment. Results  After treatment, clinical symptom scores for constipation, anal resting pressure, maximum contraction force of anal sphincter in the three groups were lower than those before treatment, the combined group was lower than the practice group and the biofeedback group, and maximum tolerable sensation in the combined group was lower than those in the practice group and the biofeedback group (all P<0.05). After treatment, the amplitudes of before and after baselines, maximum amplitudes of rapid contraction, average amplitudes of continuous contraction and average amplitudes of endurance contraction in the three groups were higher than those before treatment, the combined group was higher than the practice group and the biofeedback group, the coefficients of variation of before and after baselines in the three groups were lower than those before treatment, and the combined group was lower than the practice group and the biofeedback group (all P<0.05). After treatment, serum levels of motilin and VIP in the three groups were higher than those before treatment, and the combined group was higher than the practice group and the biofeedback group［（261±43）ng/L vs （241±37）,（219±34）ng/L;（81±15）ng/L vs （60±19）,（69±11）ng/L］(all P<0.05). The total effective rate in the combined group was higher than those in the practice group and the biofeedback group(both P<0.05). Conclusion  Maokexieli practice combined with biofeedback has better curative effect on OOC, possibly by regulating levels of motilin and VIP to affect intestinal peristalsis and enhance treatment outcomes as an adjunct therapy.