辨证论治结合生物反馈治疗功能性排便障碍临床研究

目的 观察中医辨证分型结合生物反馈治疗功能性排便障碍（functional defecation disorders，FDD）的临床疗效。方法 选取90例符合FDD诊断标准的患者，根据随机分组方法分为生物反馈组30例、中医辨证组30例、综合治疗组30例。生物反馈组患者接受盆底生物反馈治疗，中医辨证组患者在中医辨证分型基础上给予中药口服，综合治疗组患者在口服中药的基础上联合盆底生物反馈治疗，10 d为1个疗程，共治疗3个疗程。观察治疗前后3组患者的临床症状积分、便质积分、肛管直肠压力、直肠感觉值、盆底Glazer评估及球囊逼出试验情况并作前后对比，观察不同治疗方法的临床疗效。结果 综合治疗组在肛门坠胀、排便间隔时间、排便方式、便质的改善程度上优于生物反馈组（P<0.05），在肛门坠胀、便感的改善程度上优于中医辨证组（P<0.05）。综合治疗组治疗后肛管静息压、肛管收缩压、直肠排便压改善程度与其他两组比较，差异具有统计学意义（P<0.05），直肠静息压低于中医辨证组（P<0.05）。综合治疗组治疗后初始感觉阈值、疼痛阈值改善程度均优于生物反馈组和中医辨证组，差异具有统计学意义（P<0.05），排便阈值改善程度优于中医辨证组（P<0.05）。综合治疗组治疗后快速收缩值、耐久收缩值改善程度优于其他两组，差异均有统计学意义（P<0.05），持续收缩值改善程度优于中医辨证组（P<0.05）。3组治疗后球囊逼出试验转阴率比较，差异具有统计学意义(P<0.05)，以综合治疗组转阴率为最高。结论 中医辨证论治结合生物反馈治疗FDD的临床效果优于单纯中医辨证治疗或者生物反馈治疗。

A Clinical Study of Syndrome Differentiation based Treatment Combined with Biofeedback Therapy in Treatment of Functional Defecation Disorder

Objective To investigate the clinical efficacy of traditional Chinese medicine (TCM) syndrome differentiation combined with biofeedback therapy over TCM syndrome differentiation or biofeedback therapy alone in the treatment of functional defecation disorder (FDD). Methods A total of 90 patients who met the diagnostic criteria for FDD were enrolled and randomly divided into biofeedback group, TCM syndrome differentiation group, and multimodality therapy group, with 30 patients in each group. The patients in biofeedback group received pelvic floor biofeedback therapy, those in the TCM syndrome differentiation group were given symptomatic treatment with oral TCM based on TCM syndrome differentiation, and those in the multimodality therapy group were given pelvic floor biofeedback therapy in addition to the symptomatic treatment with oral TCM. Ten days was one course of treatment and there were three courses of treatment for each group. The clinical symptom score, stool quality score, anorectal pressure, rectal sensation, Glazer pelvic floor assessment, and results of balloon expulsion test were compared between the three groups before and after treatment to observe the clinical effects of these therapies. Results The multimodality therapy group had significantly better improvements in anal pendant expansion, defecation interval, defecation pattern, and stool quality compared with the biofeedback group (P<0.05), as well as significantly better improvements in anal pendant expansion and feeling of defecation compared with the TCM syndrome differentiation group (P<0.05). The multimodality therapy group had significantly better improvements in anal canal resting pressure, anal canal systolic pressure, and rectal defecation pressure compared with the other two groups (P<0.05), as well as a significantly lower rectal resting pressure than the TCM syndrome differentiation group (P<0.05). The multimodality therapy group had significantly lower initial sensory threshold and pain threshold after treatment than the other two groups (P<0.05), as well as a significantly better improvements in defecation threshold than the TCM syndrome differentiation group (P<0.05). The multimodality therapy group had significantly better improvements in fast contraction and sustained contraction values than the other two groups (P<0.05), as well as a significantly better improvements in continued contraction value than the TCM syndrome differentiation group (P<0.05). There were significant differences in the negative conversion rate of balloon expulsion test between the three groups (P<0.05), and the multimodality therapy group had the highest negative conversion rate. Conclusion TCM syndrome differentiation based treatment combined with biofeedback therapy has a better clinical effect than TCM syndrome differentiation or biofeedback therapy alone in the treatment of FDD.