养阴理气汤治疗阿片性便秘的临床研究

目的:评价养阴理气汤治疗阿片性便秘的疗效,探讨养阴理气汤治疗阿片性便秘的作用机制。方法:将66例服用美施康定后产生便秘,且中医辨证分型为气秘型和阴虚热结型的癌痛患者分为治疗组和对照组各33例。治疗组给予养阴理气汤治疗,对照组给予杜秘克治疗。观察两组治疗前后的便秘评分(CCS评分)、血浆脑肠肽水平(胃动素、血管活性肠肽)、疼痛评分、不良反应,比较两组治疗阿片性便秘的疗效,并从人体内分泌(脑肠肽)角度初步探讨养阴理气汤治疗阿片性便秘的机制。结果:治疗组总有效率90.9%,对照组69.7%,治疗组总有效率明显高于对照组,差异有统计学意义(P=0.03);治疗后治疗组CCS评分低于对照组,差异有高度统计学意义(P=0.0003);治疗后治疗组血浆胃动素水平明显高于对照组,差异有高度统计学意义(P=0.0005),治疗组血浆血管活性肠肽水平低于对照组,差异有高度统计学意义(P=0.006);治疗后两组疼痛评分比较,差异无统计学意义(P=0.645);两组在观察过程中均未发生由实验药物引起的严重不良反应。结论:养阴理气汤可有效改善气秘型和阴虚热结型阿片性便秘,疗效优于口服杜秘克,且安全可靠,不影响美施康定的止痛效果。养阴理气汤治疗阿片性便秘的机制可能与调节体内胃动素和血管活性肠肽等脑肠肽分泌有关。

Clinical Study of Yangyin Liqi Decoction in the Treatment of Opioid-Induced Constipation

Objective:To evaluate the efficacy of Yangyin Liqi decoction in the treatment of opioid-induced constipation,and to explore the mechanism of therapeutic effect of Yangyin Liqi decoction on treating the opioid-induced constipation. Methods:According to randomized controlled methods,66 patients with opioid-induced constipation,who met the inclusion criteria of qi stagnation or yin deficiency with accumulated heat,were divided into two groups,with 33 cases in treatment group and 33 cases in control group. The treatment group was given Yangyin Liqi decoction,and the control group was given duphalac. Constipation score(CCS score),constipation curative effect evaluation,plasma brain gut peptide(motilin,vasoactive intestinal peptide)were observed before and after treatment. The effects on opioid constipation were compared to explore the mechanism of Yangyin Liqi decoction in the treatment of opioid-induced constipation. Results:After treatment,the treatment group's total efficiency was 90.9%,while the control group's total efficiency was 69.7%;the treatment group's total efficiency was higher than the control group's,with significant difference(P=0.03).There was significant difference between the CCS scores of treatment group and control group at post-treatment(P=0.0003). The treatment group's plasma motilin level at post-treatment was higher than the control group 's,with significant difference(P=0.0005). The treatment group 's plasma vasoactive intestinal peptide level at post-treatment was lower than the control group 's,with significant difference(P=0.006). After treat ment,there was no significant difference between the number relating scale scores of the two groups(P=0.645).There was no adverse reaction caused by the medicine during the experiment in each group. Conclusion:Yangyin Liqi decoction could effectively relieve the opioid-induced constipation of qi stagnation syndrome or yin deficiency with accumulated heat syndrome,and is more effective than duphalac,without interfering the effect of morphine. The effect of Yangyin Liqi decoction on the treatment of opioid-induced constipation may be related to regulating secretion of motilin and vasoactive intestinal peptideghrelin.