Investigation On Physical And Mental Health And Quality Of Life Of Patients With Functional Constipation In Anorectal Department And The Clinical Research Of Treatment Plan

Part ?:Investigation on the physical and mental status and quality of life of functional constipation in anorectal departmentObjective: To investigate the general information,constipation-related indicators,psychosocial quality of life and clinical significance of patients with functional constipation(FC)in anorectal department.Methods: 113 patients with functional constipation in anorectal department and40 healthy controls matched by gender and age were investigated by questionnaire.Between the two groups of gender,age,level of education,body mass index(BMI),Spontaneous Bowel Movements(SBM),Bristol Stool Form Score(BSFS),Symptom Checklist 90(SCL-90),Wexner constipation score(WCS),Patient Assesment of Constipation Quality of Life(PAC-QOL)are compared.Correlation analysis was also carried out on constipation related indicators,WCS,SCL-90 and PAC-QOL in the FC group.Results:(1)There was no statistically significant difference in age and gender between FC patients and controls.The differences in body weight,BMI and education level were statistically significant.(2)FC group has more psychological problems than healthy people.The proportion of psychological disorder in FC group was 59.29%.The scores of 9 factors including somatization,compulsive state,interpersonal relationship sensitivity,depression,anxiety,hostility,fear,paranoia and psychosis in FC group all higher than that of the control group(P<0.001).Among them,psychosis was the factor with the biggest difference between FC group and control group.(3)The PAC-QOL score of FC group was significantly higher than that of control group(P<0.001),and the life quality of FC group was worse than that of healthy people.The scores of emotional mood,satisfaction,worry,life independence,diet and physiology in the FC group were significantly higher than those in the control group(P<0.001).Satisfaction was the biggest difference between the two groups.(4)WCS in FC group was low correlated with PAC-QOL(r=0.477,P<0.001).The course of constipation was weakly correlated with PAC-QOL(r=0.223,P=0.017),and the time of defecation was weakly correlated with PAC-QOL(r=0.305,P=0.001).(5)WCS was weakly correlated with SCL-90(r=0.200,P<0.05).(6)scl-90 was moderately correlated with pac-qol(r=0.507,P<0.05).Conclusion: There was difference in BMI and educational level between FC patients and controls.Compared with healthy people,FC group has obvious mental and psychological problems,and the quality of life is significantly reduced.The severity of constipation in FC patients is correlated with the psychosocial status and quality of life.Part ?:Clinical study on the optimal treatment of trifunctional constipationObjective: To investigate the efficacy and safety of Xuanshen Decoctions combined with psychological intervention in the treatment of functional constipation.Methods: A randomized,controlled clinical study was designed.105 patients with functional constipation were prospectively included and divided into experimental group ?(Xuanshen Decoction),experimental group ?(Xuanshen Decoction combined with psychological intervention)and control group(procapride).The following indicators were recorded before and after 4 weeks of medication:Traditional Chinese Syndrome Score Scale(TCMSSS),Spontaneous Bowel Movements(SBM),Bristol Stool Form Score(BSFS),Wexner Constipation Score(WCS),Hamilton Depression Scale(HAMD),Hamilton Anxiety Scale(HAMA)and Patient Assesment of Constipation Quality of Life(PAC-QOL),evaluation Xuanshen Decoction,Xuanshen Decoction combined mental intervention in the treatment of functional constipation curative effect.Results:(1)There was no statistically significant difference in baseline data between the three groups(P>0.05).(2)after 4 weeks of treatment,the scores of TCM symptoms in the three groups were improved compared with those before treatment(P<0.05),with no statistically significant difference between the groups(P>0.05).The total effective rate of TCM symptoms was 90.0% in the experimental group,97.1% in the experimental group and 90.3% in the control group,but there was no statistically significant difference between the three groups(P>0.05).(3)after 4 weeks of treatment,SBM,BSFS,Wexner constipation score and pac-qol score all improved compared with those before treatment(P<0.05),with no statistically significant difference between the three groups(P>0.05).(4)after 4 weeks of treatment,HAMA and HAMD scores in the experimental group 1 and the control group showed no statistically significant difference from those before treatment(P>0.05).The total effective rate of HAMA score in the experimental group was 33.3%,that of the experimental group was 70.6%,and that of the control group was 25.8%.The difference was statistically significant(P<0.05).The total effective rate of HAMD score after treatment was 40.0% in the experimental group,76.5% in the experimental group and 16.1% in the control group,with statistically significant differences(P<0.05).(1)There was no statistically significant difference in baseline data between the three groups(P>0.05).(2)After 4 weeks' treatment,TCMSSS in the three groups decreased(P<0.05),and no statistically significant difference between the three groups(P>0.05).The total effective rate of TCM syndromes was 90.0% in the experimental group I,97.1% in the experimental group ? and 90.3% in the control group,and no statistically significant difference between the three groups(P>0.05).(3)After 4 weeks of treatment,SBM,BSFS,Wexner constipation score and PAC-QOL score all improved compared with those before treatment(P<0.05),with no statistically significant difference between the three groups(P>0.05).(4)HAMA and HAMD scores in the experimental group ? and the control group showed no statistically significant difference from those before treatment(P>0.05).The total effective rate of HAMA score was 33.3% in the experimental group I,70.6% in the experimental group ? and that of the control group was 25.8%,with statistically significant differences(P<0.05).The total effective rate of HAMD score after treatment was 40.0% in the experimental group ?,76.5% in the experimental group ? and that was 16.1% of the control group,statistically significant differences(P<0.05).Conclusion: After 4 weeks of treatment with Xuanshen Decoction and purucapril,the efficacy of TCM syndromes,defecation frequency,stool characteristics,constipation severity and quality of life were improved.The combination of Xuanshen Decoction and psychological intervention in the treatment of functional constipation can not only improve the curative effect of TCM syndromes,constipation symptoms and quality of life,but also improve the mental and psychological conditions of patients.