1、170中国现代药物应用2024年4月第18卷第8期Chin J Mod Drug Appl,Apr 2024,Vol.18,No.8直肠功能训练配合穴位敷贴治疗脑卒中便秘患者的 疗效观察凌福茂刘菁蓉何叶青叶翠河【摘要】目的探讨直肠功能训练配合穴位敷贴治疗脑卒中便秘患者的疗效。方法选取脑卒中便秘患者 80 例,随机分为观察组与对照组,每组 40 例。对照组患者予以穴位敷贴、饮食指导等常规治疗,观察组患者在对照组的基础上给予直肠功能训练。比较两组患者自主排便起效时间、临床疗效、复发情况、护理满意度。结果观察组患者自主排便起效时间早于对照组,差异具有统计学意义(P0.05)。观察组患者的治疗总有效率
2、为 97.50%,高于对照组患者的 82.50%,差异具有统计学意义(P0.05)。观察组患者复发率为 15.00%,低于对照组患者的 37.50%,差异具有统计学意义(P0.05)。观察组患者对护理工作的满意率为 100.00%,高于对照组患者的 85.00%,差异具有统计学意义(P0.05)。结论对脑卒中便秘患者进行穴位敷贴配合直肠功能训练,能够有效促进排便功能,改善便秘情况,且降低便秘的复发风险,对提升患者生命质量具有意义,值得推广应用。【关键词】脑卒中；便秘；穴位敷贴；直肠功能训练；康复DOI：10.14164/11-5581/r.2024.08.046Observation on t
3、he therapeutic effect of rectal function training combined with acupoint application on constipation in stroke patients LING Fu-mao,LIU Jing-rong,HE Ye-qing,et al.Department of Traditional Chinese Medicine Rehabilitation,Xinxing County Peoples Hospital,Yunfu 527400,China【Abstract】Objective To explor
4、e the therapeutic effect of rectal function training combined with acupoint application on constipation in stroke patients.Methods 80 stroke patients with constipation were randomly divided into an observation group and a control group,with 40 cases in each group.The control group was given routine
5、treatment of acupoint application and dietary guidance,and the observation group was given rectal function training on the basis of the control group.The onset time of spontaneous defecation,clinical efficacy,recurrence,and nursing satisfaction were compared between the two groups.Results The onset
6、time of spontaneous defecation in the observation group was earlier than that in the control group,and the difference was statistically significant(P0.05).The total effective rate of the observation group was 97.50%,which was higher than 82.50%of the control group,and the difference was statisticall
7、y significant(P0.05).The recurrence rate of the observation group was 15.00%,which was lower than 37.50%of the control group,and the difference was statistically significant(P0.05).The rate of satisfaction with nursing work in the observation group was 100.00%,which was higher than 85.00%in the cont
8、rol group,and the difference was statistically significant(P0.05),具有可比性。1.2方法对照组采用穴位敷贴、饮食指导等常规治疗。穴位敷贴：将中药大黄、三棱、莪术研成粉末,再加上适量蜂蜜混合成糊状物,置于清洁的空白敷贴上；清洁相应穴位皮肤,将敷贴贴在双侧天枢、关元、气海、大肠腧、上巨虚等穴位,1 次/d,于上午 9:00 敷贴,敷贴 46 h；共持续 2 周。饮食指导：注意粗、细纤维食物搭配,鼓励患者进食维生素丰富的食物,如豆类、瘦肉、苹果和动物肝脏以及产气食物萝卜、豆类,刺激肠道蠕动；应避免高热量食物,如油炸、肥肉、甜点、蛋糕、
9、红茶饮料等,禁忌辛辣刺激之物；每日清晨空腹饮用 300 ml 淡盐水,摄入 1500 ml/d 左右温开水。观察组患者在对照组基础上给予直肠功能训练,患者取平卧位,进行腹式呼吸 1520 次；腹部顺时针按摩 510 次；直腿抬高 510 次；桥式运动 510 次；提捏脊柱两侧 2 次；盆底肌力训练、夹臀动作 1015 次；横向及纵向牵拉肛门括约肌各 5 次；手指直肠刺激并环形按摩 23 圈；模拟排便；排便时注意保护隐私,选取合适的体位,通过训练让患者养成定期排便的习惯,每日早晨 1 次,共持续 2 周。1.3观察指标及判定标准自主排便起效时间:患者治疗结束后首次自主排便的时间。临床疗效:疗效判
10、定标准：在治疗结束后第 7 天患者能自主排便,排便时间间隔3 d,且无明显腹胀感为显效；在治疗结束后第 7 天患者能自主排便,排便时间间隔在 35 d,稍有腹胀感为有效；在治疗结束后第 7 天患者无法自主排便,或排便时间 5 d,腹胀感明显为无效。总有效率=(显效+有效)/总例数 100%。复发情况：观察起效后 1 个月内再次发生便秘的情况。护理满意度：使用自制护理满意度问卷表进行调查,分为满意、基本满意和不满意。满意率=(满意+基本满意)/总例数 100%。1.4统计学方法采用 SPSS22.0 统计学软件进行数据统计分析。计量资料以均数 标准差(x-s)表示,采用 t 检验；计数资料以率(
11、%)表示,采用2 检验,等级资料使用秩和检验。P0.05 表示差异具有统计学意义。2结果2.1两组患者自主排便起效时间比较观察组患者自主排便起效时间早于对照组,差异具有统计学意义(P0.05)。见表 1。2.2两组患者临床疗效比较观察组患者的治疗总有效率为 97.50%,高于对照组患者的 82.50%,差异具有统计学意义(P0.05)。见表 2。2.3两组患者复发情况比较观察组患者复发率为15.00%,低于对照组患者的 37.50%,差异具有统计学意义(P0.05)。见表 3。2.4两组患者护理满意度比较观察组患者对护理工作的满意率为 100.00%,高于对照组患者的 85.00%,差异具有统
12、计学意义(P0.05)。见表 4。表 1两组患者自主排便起效时间比较(n)组别例数第 1 天第 2 天第 3 天第 4 天第 5 天第 6 天第 7 天观察组4020754310对照组4024128554Z4.758P0.000注：两组比较,P0.05表 2两组患者临床疗效比较n(%)组别例数显效有效无效总有效观察组4032(80.00)7(17.50)1(2.50)39(97.50)a对照组4018(45.00)15(37.50)7(17.50)33(82.50)25.000P0.025注：与对照组比较,aP0.05172中国现代药物应用2024年4月第18卷第8期Chin J Mod Dr
13、ug Appl,Apr 2024,Vol.18,No.8表 3两组患者复发情况比较n(%)组别例数未复发复发观察组4034(85.00)6(15.00)a对照组4025(62.50)15(37.50)25.230P0.022注：与对照组比较,aP0.05表 4两组患者护理满意度比较n(%),%组别例数满意基本满意不满意满意率观察组4025(62.50)15(37.50)0100.00a对照组4010(25.00)24(60.00)6(15.00)85.0026.486P0.011注：与对照组比较,aP0.05)；康复训练后,观察组患者 Barthel 指数(78.891.46)分显著高于对照组
14、的(42.421.79)分,具有显著差异(P0.05)。观察组患者对康复训练的总满意度 98.00%显著高于对照组的 80.00%,具有显著差异(P0.05)。观察组患者不良事件发生率 4.00%显著低于对照组的 16.00%,具有显著差异(P0.05).After rehabilitation training,the observation group had significantly higher Barthel index of(78.891.46)points than(42.421.79)points in the control group,and there was a si
15、gnificant difference between the two groups(P0.05).The total satisfaction with rehabilitation training in the observation group was 98.00%,which was significantly higher than 80.00%in the control group,and there was a significant difference between the two groups(P0.05).The incidence of adverse even
16、ts in the observation group was 4.00%,which was significantly lower than 16.00%in the control group(P0.05).Conclusion Early systematic rehabilitation training has a significant positive impact on the activities of daily living of post-stroke hemiplegic patients,which can improve a series of adverse reactions caused by low activity 作者单位：362500德化县医院