摘要：Objective To create a dinical slow-transit constipation pathway, and based on patient reported outocomes to assess the characteristic and effect of aeuptmcture. Methods After create the slow-transit constipation treatment team and database, according to Rome Ⅲ criteria and colon transit test from Feb.2007 to Aug. 30 cases,9 males and 21 females,aged 18-80(49.3± 17.6)years,duration of disease 2-40(10.9 ±9.6)years were enrolled. All of the 30 cases had depended upon irritative laxafives or glycerine enema for a long time. In 30 cases of slow transit constipation 12 cases were pancolon type,and 18 cases were decending colon type. Twelve of the 30 cases associated with psychological disorder and 15 cases with insomnia. Acoording to the classification in traditional medicine,the main types of syndrome were qi asthenia and liver depression, asthenia of both qi and yin, and spleen qi deficiency. The acupoints defined as group 1 including TIANSHU, DAHENG, FUJIE, QIHAI, GUANYUAN, ZUSANLI and SHANGJUXU, and group 2 including DACHANGSHU SHENSHU, BALIAO and SISHENODNG. Deep stab to the aeupoints on abdomen and back,and moxibustion over the SISHENCONG acupoint were performed. The assessment of effectiveness was based on patient reported outcomes. Evaluations of the Bristol score, times of defecation, sense of distention and PAC-QOL at pretreatment and 1,2 and 3 weeks after treatment were completed. Results Compared the differences in pretreatment and 1 2 and 3-week post-treatment, the number of patients using irritant laxative or glycerine enema reduced,and those with normal Bristol score rised, awareness of defecation and times of defecation ineresed, and feeling of abdominal distension lessened. (all P< 0.0001). After treatment PAC-QOL scores of malaise, psyehosocial complaint,anxiety and interest related to constipation and satisfaction were obviously reduced and the difference of total score values reduced too. The results of assessment at the end of treatment,and after 1 month,3 months were cure in 13,10,and 7 cases; improved in 9,7 and 8 cases; and failed in 8, 13, 16 cases respectively. Conclusions The establishment of clinical pathway is merit to the coperation among the patients,doctors (researchers) and regulators for the continuous in diagnosis and treatment,and by using of Patient Reported Outcomes method to reveal clearly the superiority of acupuncture in improving symptoms and quality of life, and deeply concerned about patients' psychological abnormality,out-let malfunction and poor life quality. These are helpful in regulating the treatment protocol and improving the therapeutic results.%目的 通过建立结肠慢传输性便秘的临床路径,以病人报告结果(patient reported Outcomes,PROs)为疗效评估的主要方法,评估针灸治疗结肠慢传输性便秘的疗效及作用特点.方法 建立该疾病临床路径,根据罗马Ⅲ标准及结肠传输试验结果,自2007年2月-8月纳入患者30例,男9例,女21例,年龄18～80(49.3±17.6)岁,病程2～40(10.9±9.6)年,30例患者均长期依赖刺激性泻药或开塞露排便.30例患者中12例为全结肠运输迟缓型,18例为左半结肠运输迟缓型.30例患者中12例合并心理障碍,15例合并睡眠障碍.中医证候类型,以气虚肝郁证、气阴两虚证和脾气虚证为主要证型.穴位分成两组,第一组:天枢、大横、腹结、气海、关元、足三里、上巨虚;第二组:大肠俞、肾俞、八髂、四神聪,对腹部和背部穴位深刺,灸四神聪,两组穴位交替使用,20次为一疗程.采用PROs疗效评估法,比较治疗前、治疗后1周、2周、3周Bristol便质评分、便意感次数、排便次数、腹胀程度和生活质量(PAC-QOL).结果 治疗前与治疗后1周、2周、3周比较,患者开塞露或泻药使用人数减少,Bristol便质评分正常人数比例呈上升趋势;便意感次数上升;排便次数上升;腹胀减轻.(各项P值均<0.0001).治疗前后生活质量(PAC-QOL)比较,患者身体不适、心理不适、便秘相关的焦虑和关心、满意度四方面分值及总分差值均明显下降.治疗期间未发生不良事件.治疗结束时痊愈13例,好转9例,无效8例;治疗后1月痊愈10例,好转7例,无效13例.治疗后3月痊愈7例,好转8例,无效15例.结论 诊治路径的建立有利于患者、医者(研究者)、管理者三位一体,使诊治连续;采用PROs疗效评估法,凸显了针灸治疗结肠慢传输性便秘的特点是改善便秘症状和提高患者生活质量;对患者合并心理异常、出口处功能异常、体质异常、生活质量差等症状特点的重视,有利于结肠慢传输性便秘临床治疗方案的调整和疗效的提高.
