目的 探究参芪举陷汤联合套扎术对气虚下陷型便秘患者的治疗疗效.方法 选取2022年1月—2023年2月期间河南中医药大学附属医院收治的便秘(气虚下陷型直肠黏膜内脱垂所致便秘)患者127例,采用随机数字表法分为对照组66例和观察组61例.对照组采用套扎术治疗,观察组在对照组基础上联合参芪举陷汤.持续治疗4周后,观察比较两组患者临床疗效、不良反应情况,治疗前后中医证候评分、肛管直肠压力、黏膜5-羟色胺(5-hydroxytryptamine,5-HT)、时受体电位通道 V1(Transient receptor potentialchannel vanilloid subfamily member 1,TRPV1)、血清 D-乳酸、抑郁自评量表(Self-rating depression scale,SDS)、焦虑自评量表(Self-rating anxiety scale,SAS)、简明健康状况调查表(Short form 36 health survey questionnaire,sF-36)评分.结果 治疗后观察组临床总有效率93.44%(57/61)明显高于对照组80.30%(53/66),差异有统计学意义(P<0.05).治疗后两组患者各中医证候评分均较治疗前降低,差异有统计学意义(P<0.05);且观察组中医证候评分明显低于对照组,差异有统计学意义(P<0.05).治疗后两组患者舒张压、最大收缩压均较治疗前升高,静息压均较治疗前降低,差异有统计学意义(P<0.05);且观察组舒张压、最大收缩压均明显高于对照组,静息压明显低于对照组,差异有统计学意义(P<0.05).治疗后两组患者TRPVl、5-HT表达及血清D-乳酸浓度均较治疗前降低,差异有统计学意义(P<0.05);且观察组TRPVl、5-HT阳性表达均明显低于对照组,差异有统计学意义(P<0.05),两组间血清D-乳酸水平比较,差异无统计学意义(P>0.05).治疗后两组患者SAS、SDS评分较治疗前降低,sF-36评分较治疗前升高,差异有统计学意义(P<0.05);且观察组SDS、SAS评分低于对照组、sF-36评分高于对照组,差异有统计学意义(P<0.05).治疗期间,两组患者不良反应发生率比较,差异无统计学意义无差异(x2=0.563,P=0.453).结论 参芪举陷汤联合套扎术治疗直肠黏膜内脱垂术后气虚下陷型便秘有效,能显著改善肛管直肠压力、降低黏膜5-HT表达,减轻其抑郁焦虑程度,且具有一定的安全性.
Observation on Efficacy of Shenqi Juxian Decoction Combined with Ligation Surger-y in Treating Patients with Qi Deficiency Depression Type Constipation
Objective To explore the efficacy of Shenqi Juxian decoction combined with ligation surgery in trea-ting patients with Qi-deficiency depression type constipation.Methods 127 patients with constipation(caused by rectal mucosal prolapse with Qi-deficiency depression type)were selected from the Affiliated Hospital of Henan University of Chinese Medicine between January 2022 and February 2023.They were randomly divided into a control group(66 patients)and an observation group(61 patients)using the random number table method.The control group received ligation surgery,while the observation group received Shenqi Juxian decoction in addition to the ligation surgery.After four weeks of contin-uous treatment,clinical efficacy,adverse reactions,TCM syndrome scores,anorectal pressure,mucosal 5-hydroxytryptamine(5-HT),transient receptor potential channel vanilloid subfamily member 1(TRPV1),serum D-lactic acid,Self-Rating Depression Scale(SDS),Self-Rating Anxiety Scale(SAS),and short form-36 health survey question-naire(SF-36)scores were observed and compared between the two groups before and after treatment.Results After treatment,the overall clinical effectiveness rate in the observation group was 93.44%(57/61),significantly higher than the 80.30%(53/66)in the control group,with a statistically significant difference(P<0.05).TCM syndrome scores in both groups were significantly lower after treatment compared to before treatment,with statistically significant differences(P<0.05);the observation group showed significantly lower scores than the control group,with statistically significant differ-ences(P<0.05).After treatment,diastolic blood pressure and maximum systolic blood pressure in both groups were sig-nificantly higher,while resting pressure was significantly lower compared to pre-treatment values,with statistically signifi-cant differences(P<0.05);the observation group had significantly higher diastolic and maximum systolic pressures and lower resting pressure than the control group,with statistically significant differences(P<0.05).Expression levels of TR-PV1,5-HT,and serum D-lactic acid in both groups were significantly reduced compared to before treatment,with statisti-cally significant differences(P<0.05);the observation group had significantly lower TRPV1 and 5-HT positive expres-sion levels compared to the control group,with statistically significant differences(P<0.05),though the difference in ser-um D-lactic acid levels between the two groups was not statistically significant(P>0.05).Both SAS and SDS scores were significantly lower,and SF-36 scores were significantly higher after treatment in both groups,with statistically signifi-cant differences(P<0.05);the observation group showed lower SDS and SAS scores and higher SF-36 scores than the control group,with statistically significant differences(P<0.05).During the treatment period,there was no statistically sig-nificant difference in the incidence of adverse reactions between the two groups(x2=0.563,P=0.453).Conclusions Sh-enqi Juxian Decoction combined with ligation surgery is effective in treating constipation due to rectal mucosal prolapse with Qi-deficiency depression type.It significantly improves anorectal pressure,reduces mucosa 5-HT expression,allevi-ates depression and anxiety,and has a certain degree of safety.