【作者】 樊冬梅；

【导师】 罗云坚；

【作者基本信息】 广州中医药大学 ， 中医内科学， 2005， 博士

【摘要】 目的、意义 慢性功能性便秘(CFC)属中医便秘的范畴,气秘证是CFC的主要证型,调肠理气法是其主要治疗方法但其疗效需进一步证实。CFC的发病机制尚未完全阐明。目前研究表明,肛门直肠动力异常与其发病密切相关。肛门直肠测压是近年来肛门直肠动力学检查较先进的方法。不少学者认为肛门直肠动力异常可表现为肛门直肠压力、感觉及排便功能的异常,因此研究调肠理气法治疗前后CFC疗效以及直肠压力、感觉、排便功能变化,有助于阐明CFC气秘证的实质及调肠理气法治疗CFC气秘证可能作用途径。 研究方法 本课题分文献研究、临床研究二部分。文献研究主要从中西医两方面对CFC的概念、发病机理、中医药作用机理及肛门直肠动力学研究现状进行阐述。临床研究主要分疗效观察及气秘证肛门直肠动力学研究二部分,临床观察主要采用随机、对照的原则,以调肠理气复方-调肠理气片为观察药,主要对CFC气秘证患者的症状、体征、病情程度、生活质量、远期疗效等方面进行观察。疗程包括2周基线期和4周治疗期。肛门直肠动力学研究主要采用肛门直肠测压法,对CFC气秘证患者直肠压力、感觉、排便功能进行检测,并观察调肠理气法对直肠压力、感觉阈值及排便功能的影响,并设立正常对照组进行对照分析。 研究结果 文献研究结果阐明了CFC及肛门直肠动力学的研究现状,为本课题研究找到了思路。临床观察结果:(1) 从总体疗效看,观察组35例,总有效率为91.4%,。其中痊愈率17.1%,显效率48.6%,有效率25.7%无效率8.6%;对照组总有效率80.7%,其中痊愈率6.5%,显效率29.1%,有效率45.2%,无效率19.3%,两组间经统计学处理,P<0.05,有显著性差异,说明观察组疗效优于对照组。(2) 从证候疗效看观察组与对照组在治疗前后均有改善,但观察组的改善优于对照组,经统计学处理P<0.05,有显著性差异。从具体指征看:(1) 在临床主要症状改善方面,两组经治疗后均可使大便性状改善、大便次数增多、每次排便时间缩短,经统计学处理有显著性意义,P<0.05-0.01,但观察组对主要症状的改善优于对照组,经统计学处理P<0.05,有显著性差异。(2) 从便秘伴随症状观察,观察组和对照组对气秘证各项兼症均有不同程度的改善,尤其观察组对嗳气、肠鸣、矢气症状的改善明显优于对照组,经统计学处理,P<0.05。(3) 在舌苔、脉象客观指标改善方面,观察组对舌、脉异常改善明显优于对照组,经统计学处理P<0.05,经统计学处理P<0.05,有显著性差异。(4) 在病情程度改善方面,观察组治疗更多还原

【Abstract】 Objective and Significance:Chronic functional constipation (CFC ) belongs to the category of the constipation of TCM. QI stagnation is most common in CFC, so transferring function of intestines and regulatting the flow of vital energy are the main therapeutic method. but the curative effect of the therapeutic method of TCLQ needs verifying further . The mechanism of happenning on CFC has not been totally expounded yet. Research indicates at present , changes of anorectal manometry is closely related to happenning. Anorectal manometry is more advanced method in recent years to check unusual change of annrectal motility. Many scholar think unusual change of annrectal motility can show changes of rectal sentation functions, annrectal defecate function ,so comparing the curative effect and the change of anorectal manometry is useful to clarify the essence of the syndrome of Qi stagnation and the mechanism of the recipe of DCLQ on treating CFC. Methods:This thesis includes two parts:the literature review and clinical research. Literature review explained from two respects of traditional Chinese and western medicine about concept , pathogenesis , traditionalfunctional mechanism of TCM and annrectal motility of CFC mainly. Clinical research divided into two parts mainly:clinical observing and the reseach of intervention on annrectal motility. Clinical observation adopted at random, by the contrasting principle . The recipe of DCLQ-TiaoChangLiQiTablets(TCLQT) was observing medicine.Maren Capsule(MRC) is contrasting medicine. We divided two groups:35 cases in the observing group was treated by TCLQT and 31 cases in the controlling one was treated by MRC. We mainly observed such respects as symptoms , signs , conditional degree of disease , long-term curative effect before and after treatment of the therapeutic method of TCLQ. The intervening reseach on annrectal motility adopted anorectal manometry to examine the change of rectal sentation functions, annrectal and defecate function of Qi stagtation type of CFC before and after treatment of TCLQT, contrasting by 20 healthy peason. Results:The literature review clarified the present condition of CFC and annrectal motility reseach and found the clue to study the disease.Clinical observation indicated: (1)By the look of overall curative effect, among 35 cases in observing groups, it was 91. 4% to be always effective. Fully the recovering rate was 17.1% among them. The Significantly effective rate was 48.6%. The effective rate was 25. 7%. The ineffective rate was 8.6%; Among Contrasting groups the overall curative effective rate was 80.7%, fully the recovering rate was 6.5% among them. The Significantly effective rate was 29.1%; The effective rate was 45. 2%. The ineffective rate was 19.3%. Dealt with by statistics between two groups(P<0. 05), it had significance difference. Observing group’s curative effect was superior to contrasting group’s. (2)By the look of the curative effect of the syndromes: Observing group and contrasting group’s effect had improvement before and after treating. But the difference of scores for symptoms and signs before and after treatment was also significantly obvious in the observing group than in the contrasting one. The observing group is superior to the contrasting group, dealt with by statistics(P<0.05), there were significance differences. From pointing and solicitting seeing concretly: (1) On respects of clinical main symptom, two groups all made stool properties improve ,Stool number of times increase , defecate time shorten each time after treating, dealt with by statistics, there were significant difference( P <0.05-0. 01). But the observing group was superior to the contrasting group in the improvement of the main symptom, dealt with by statistics (P<0. 05), there were significant differences. (2) By the look from following symptom of constipation , both the observing group and the contrasting one had improvement in various degree in the every following symptom of Qi stagnation syndrome. But the observing group was obviously superior to contrasting the group especially in the well improvement of symptom, such as belchN intestines .Dealt with by statistics (P <0.05), there were significant differences. (3)By the look of respects of these objective index, such as tongue coating and pulse, the observing group was is obviously superior to the contrasting group in the improvement of unusual tongue^ pulse. Dealt with them by statistics (P<0. 05), there were significant differences. (4)On the respect of mprovemeht in the conditional degree of disease, there were significant differences before and after treatment between two groups. Dealt with them by statistics, P<0.05. The observing group was superior to the contrasting group to improve the conditional degree of disease . Dealt with them by statistics (P<0. 05), there were significant differences. (5)In addition, the lighter the conditional degree of disease was, the better the curative effect was; The shorter the course of disease was, the better curative effect was. It showed that annrectal motility intervenes the result of study: these patients of Qi stagnation type of CFC had no unusual anorectal and sphincter pressure, had unusual rectal sentation functions and poor coordination of rectal sphincter of threshold value. It showed that rectal sensation volume thresholds were higher , and rectal maximum tolerable volume thresholds were higher and defecate function was unusal than healthy person. The recipe ofDCLQ-TiaoChangLiQiTablets(TCLQT) could degrade rectal sensation volume thresholds and rectal maximum tolerable volume thresholds after treatment, and could raise harmony of rectal sphincter of threshold value. Dealt with them by statistics (P<0. 05), there were significant differences. Cone I us i ons:Clinical observation is pointed out: the observing group and the更多还原