Ding Shu-qing, Ding Yi-jiang, Wang Xiao-feng
Third Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, National Traditional Chinese Medicine Therapeutic Center of Anorectal Diseases, Nanjing.
Zhongguo Zhong Xi Yi Jie He Za Zhi. 2009 Nov;29(11):1031-4.
To assess the therapeutic effects and acting specialty of acupuncture and moxibustion for treatment of slow-transmission constipation (STC).
A clinical pathway was created and Patient-Reported Outcomes (PROs) method was taken for efficacy evaluation dominantly. Acupuncture and moxibustion were applied to 30 STC patients on two groups of acupoints in alternation, with acupoints of Tianshu (ST25), Daheng (SP15), Fujie (SP14), Qihai (RN6), Guanyuan (RN4), Zusanli (ST36), and Shangjuxu (ST37) as group 1; Dachangshu (BL25), Shenshu (BL23), Baliao (BL31, BL32, BL33, BL34), and Sishencong (Ex-HN1) as group 2. Deep needling was applied on acupoints of abdominal and back region and moxibustion was put on Sishencong, 20 times as one course. The therapeutic effect was assessed based on the Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL) method by comparing the Bristol scoring on quality of stool, awareness and frequency of defecation, degree of abdominal fullness sensation, and patients' quality of life (QOL) at different time points, i.e., pre-treatment, after 1, 2 and 3 weeks of treatment.
Compared with the condition of pre-treatment, after 1, 2 and 3 weeks of treatment, cases using irritant laxative or glycerin enema reduced, with quality of stool normalized, scores for awareness and frequency of defecation increased, and abdominal fullness sensation lessened (all P < 0.01); both the total score and scores on the 4 domains of QOL (malaise, psychosocial complaint, anxiety and interest related to constipation, and satisfaction) were obviously reduced. No adverse event occurred during the treatment course. Therapeutic effectiveness assessment at the end of treatment showed that 13 patients were cured, 9 improved and 8 treated in vain; the corresponding cases assessed at 1 month after treatment were 10, 7, 13; and those at 3 months after were 7, 8, 15, respectively.
Establishing a clinical pathway is helpful to patients in their continuous diagnosis and treatment. Using PROs method to evaluate the therapeutic effect could clearly reveal the superiority of acupuncture and moxibustion in improving symptoms and QOL in patients of STC.
评估针灸治疗慢传输型便秘（STC）的疗效及作用特点。
制定临床路径，主要采用患者报告结局（PROs）方法进行疗效评估。将30例STC患者交替应用两组穴位进行针灸治疗，第一组穴位为天枢（ST25）、大横（SP15）、腹结（SP14）、气海（RN6）、关元（RN4）、足三里（ST36）、上巨虚（ST37）；第二组穴位为大肠俞（BL25）、肾俞（BL23）、八髎（BL31、BL32、BL33、BL34）、四神聪（Ex-HN1）。腹部和背部穴位采用深刺，四神聪进行艾灸，20次为一个疗程。采用便秘生活质量患者评估问卷（PAC-QOL）方法，通过比较治疗前、治疗1周、2周和3周不同时间点的布里斯托粪便评分、排便意识和频率、腹部胀满感程度以及患者生活质量（QOL）来评估治疗效果。
与治疗前相比，治疗1周、2周和3周后，使用刺激性泻药或甘油灌肠的病例减少，粪便质量恢复正常，排便意识和频率评分增加，腹部胀满感减轻（均P<0.01）；QOL的总分及4个领域（不适、心理社会抱怨、与便秘相关的焦虑和兴趣、满意度）的评分均明显降低。治疗过程中未发生不良事件。治疗结束时疗效评估显示，治愈13例，好转9例，无效8例；治疗后1个月评估相应病例分别为10例、7例、13例；治疗后3个月分别为7例、8例、15例。
建立临床路径有助于患者的持续诊疗。采用PROs方法评估治疗效果能够清晰揭示针灸在改善STC患者症状和生活质量方面的优势。
