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目的:探讨四逆汤加味联合普芦卡必利治疗阳虚型慢性便秘患者的临床疗效,为进一步提高阳虚型慢性便秘的治疗效果,减少药物不良反应提供新的治疗方案。方法:以本院2012年10月—2014年11月收治的278例阳虚型便秘患者作为研究对象,随机分为西药组和中西药结合组,每组各139例。西药组患者采用口服普芦卡必利治疗,中西药结合组采用口服普芦卡必利联合中药汤剂四逆汤加味治疗,两组均持续治疗12周。观察两组患者治疗前后临床症状积分、中医证候积分和结肠传输试验积分变化,并对治疗过程中的不良反应进行比较分析。结果:治疗后两组患者各项症状积分均较治疗前明显降低(P<0.05),组间比较中西药结合组患者各项临床症状积分及中医临床证候积分均明显低于西药组(P<0.05);结肠传输试验中西药结合组相比西药组其正常患者明显增加,中度患者明显减少(P<0.05);治疗后中西药结合组在肛管静息压、肛管最大收缩压、肛门括约肌长度以及持续挤压时间方面的改善均明显优于西药组(P<0.05);治疗后与西药组相比,中西药结合组患者痊愈率明显增加,无效率明显降低(P<0.05);治疗过程中中西药结合组患者不良反应发生率明显低于对照组(P<0.05),差异均具有统计学意义。结论:联合四逆汤加味治疗阳虚型慢性便秘能有效提高普芦卡必利对患者临床症状的改善作用,提高临床疗效,并显著减少患者不良反应的发生。
Objective: To explore the clinical curative effect of Sini Decoction combined with propafasulpride on chronic constipation in patients with Yang deficiency type, and to provide a new treatment plan to further improve the therapeutic effect of chronic constipation on Yang deficiency type and reduce the adverse drug reactions. Methods: A total of 278 cases of Yang-type constipation admitted from October 2012 to November 2014 in our hospital were randomly divided into western medicine group and Chinese-western medicine combination group, with 139 cases in each group. The patients in western medicine group were treated with prucalopride orally, and the combination of traditional Chinese medicine and western medicine was treated with oral propafacal in combination with decoction of Sini Decoction. Both groups were treated for 12 weeks. Before and after treatment, the scores of clinical symptom score, TCM syndrome score and colonic transit test score were observed, and the adverse reactions in the course of treatment were compared and analyzed. Results: After treatment, the symptom scores of two groups were significantly lower than those before treatment (P <0.05). The scores of clinical symptom scores and TCM clinical syndromes in the two groups were significantly lower than those in western medicine group (P <0.05). Compared with the western medicine group, the colon-transmitted test showed that the western medicine combined group showed a significant increase in normal patients and a moderate decrease in patients (P <0.05). After the treatment, the static pressure at the anal canal, the maximum systolic pressure of the anal canal , Anal sphincter length and sustained compression time were significantly better than western medicine group (P <0.05). Compared with western medicine group, the cure rate of Chinese traditional medicine combined with western medicine group increased significantly and the inefficiency decreased significantly after treatment (P <0.05) ). During the course of treatment, the incidence of adverse reactions in the combined Chinese and western medicine group was significantly lower than that in the control group (P <0.05), and the differences were statistically significant. Conclusion: The combination of Sini Decoction with yang deficiency chronic constipation can effectively improve the effect of purarpill on the clinical symptoms, improve the clinical curative effect and significantly reduce the incidence of adverse reactions in patients.