| Background: With the increasing number of patients with functional constipation,the incidence of outlet obstructive constipation（OOC）is also increasing.At present,among the many treatment measures for functional constipation,drug treatment is still the first choice for the treatment.However,the effectiveness is not satisfactory for some patients,which needs to be maintained by continuous administration for a long time.The constipation symptom is easy to occur repeatedly after drug withdrawal,and even some patients have a prolonged course of disease and aggravation of the disease.At the same time,the constipation symptoms will also affect patients’ quality of life.The long-term coexistence of multiple pathogenic adverse factors will lead to the vicious circle of aggravating constipation symptoms and declining quality of life.Therefore,exploring non-drug treatment methods in the diagnosis and treatment of functional constipation has become a hot spot in the research of constipation diseases.The purpose of this study are: 1)to compare treatment effects of transcutaneous electrical acupoint stimulation（TEAS）and oral polyethylene glycol 4000 powder on OOC patients,II)to explore the changes of relevant characteristic indexes of rectal and anal motility and the changes of serum brain intestinal peptides such as vasoactive intestinal peptide（VIP）and nitric oxide（NO）in patients with OOC before and after treatment,as well as the improvement of symptoms and quality of life in patients with constipation before and after treatment,and iii)to evaluate the value of percutaneous acupoint electrical stimulation in the treatment of outlet obstructive constipation.Methods: According to the Rome IV diagnostic criteria of functional constipation,90 patients with OOC were randomly divided into two groups: observation group and control group.All patients in the observation group were treated with TEAS combined with oral polyethylene glycol 4000 powder.The stimulation acupoints were Tianshu point（ST25）and dongdashu point（BL25）,once a day for 15 minutes each time;the drug is polyethylene glycol 4000 powder,10 g each time,twice a day;Patients with OOC in the control group were treated with sham-TEAS combined with oral drugs.Sham-TEAS is considered as sham electroacupuncture,which is a common control method of TEAS and sham TEAS was performed at non meridians and non acupoints about 2 cm away from ST25 and BL25 acupoints with the same parameters;Polyethylene glycol 4000 powder was also selected,10 g each time,twice a day;Before treatment,4 weeks and 6 weeks after treatment,the patients in the two groups were measured by high-resolution anorectal manometry instrument to detect the changes of anorectal dynamics before and after treatment;Elasa method was used to detect the changes of VIP and no in fasting serum before treatment,4 weeks and 6 weeks after treatment;The symptom questionnaire for patients with constipation（PAC-SYM）and the quality of life scale for patients with constipation（PAC-QOL）were used to quantitatively score the symptoms of constipation and the impact of long-term constipation on the quality of life of patients,evaluate the degree of illness,and count the treatment effect according to the improvement of clinical symptoms of patients with constipation after treatment.Results: 1.Changes of anorectal motility characteristics: 1)before treatment,there was no significant difference between the observation group and the control group in anal resting pressure,maximum rectal tolerance capacity,defecation sensory threshold and anorectal pressure difference during simulated defecation（P > 0.05）.After 4 weeks of treatment,there was significant difference in anorectal pressure between the observation group and the control group（P = 0.012）;There was significant difference in defecation sensory threshold between the observation group and the control group（P = 0.037）;There was significant difference in rectal maximum tolerance capacity between the observation group and the control group（P < 0.001）;After 6 weeks of treatment,there was significant difference in anorectal pressure between the observation group and the control group（P < 0.001）;There was significant difference in defecation sensory threshold between the observation group and the control group（P < 0.001）;There was significant difference in rectal maximum tolerance capacity between the observation group and the control group（P < 0.001）.At the same time,the comparison between 6weeks of treatment and 4 weeks of treatment: there was no significant difference in anal resting pressure between 6 weeks of treatment and 4 weeks of treatment in the observation group（P > 0.05）,and there were significant differences in rectal maximum tolerance capacity（P < 0.001）,defecation sensation threshold（P < 0.001）and rectal anal pressure difference（P < 0.001）,It shows that the anorectal dynamic indexes in the observation group improved more significantly after 6 weeks of treatment.2.The content of serum VIP and no: there was no significant difference in the content of serum VIP and no between the observation group and the control group before treatment（P > 0.05）.After 4 weeks of treatment,there was significant difference in serum VIP between the observation group and before treatment（P = 0.009）,and there was significant difference in serum VIP between the control group and before treatment（P =0.016）;After 6 weeks of treatment,there was significant difference in serum VIP between the observation group and before treatment（P < 0.001）,there was significant difference in serum VIP between the control group and before treatment（P < 0.001）,and there was significant difference in serum VIP between the observation group and the control group（P < 0.001）.Similarly,after 4 weeks of treatment,there was significant difference in serum NO between the observation group and before treatment（P < 0.001）,and there was significant difference in serum NO between the control group and before treatment（P < 0.001）,but there was no significant difference in serum NO between the observation group and the control group（P = 0.442）;After 6 weeks of treatment,there was significant difference in serum NO between the observation group and before treatment（P < 0.001）,there was significant difference in serum NO between the control group and before treatment（P < 0.001）,and there was significant difference in serum NO between the observation group and the control group（P < 0.001）.It shows that the improvement of serum VIP and no indexes in the observation group after 6weeks of treatment is more obvious.3.Scale score: there was no significant difference in PAC-SYM and PAC-QOL scores between the observation group and the control group before treatment（all P > 0.05）.After 4 weeks of treatment,there was significant difference in PAC-SYM between the observation group and before treatment（P = 0.002）,and there was significant difference in PAC-SYM between the control group and before treatment（P = 0.028）,but there was no significant difference in PAC-SYM between the observation group and the control group（P = 0.173）;After 6 weeks of treatment,there was significant difference between the observation group and PAC-SYM before treatment（P < 0.001）,the control group and PAC-SYM before treatment（P < 0.001）,and there was significant difference between the observation group and the control group（P < 0.001）.After 4 weeks of treatment,there was significant difference in PAC-QOL between the observation group and before treatment（P < 0.001）,and there was significant difference in PAC-QOL between the control group and before treatment（P < 0.001）,but there was no significant difference in PAC-QOL between the observation group and the control group（P =0.226）;After 6 weeks of treatment,there was significant difference between the observation group and PAC-QOL before treatment（P < 0.001）,the control group and PAC-QOL before treatment（P < 0.001）,and there was significant difference between the observation group and the control group（P < 0.001）.It shows that the constipation symptoms and quality of life of patients in the observation group improved more significantly after 6 weeks of treatment.4.Treatment effect:The total number of effective patients in the observation group was31 and that in the control group was 24.The effective rate in the observation group was significantly higher than that in the control group（31 vs.24,2 = 2.291,P = 0.130）.2)After 6 weeks of treatment with different schemes,the total number of effective patients in the observation group was 38 and that in the control group was 26.The effective rate of the observation group was significantly higher than that of the control group（38 vs.26,2 = 7.788,P = 0.005）.It can be seen that the observation group after 6 weeks of acupoint electrical stimulation combined with drugs has a higher total effective rate.Conclusion: Percutaneous Acupoint Electrical Stimulation and polyethylene glycol4000 powder can coordinate the contraction of abdominal and pelvic muscles during defecation by increasing the pressure gradient of rectal and anal canal,and improve the sensitivity of rectal receptivity at the same time;It can also improve the defecation symptoms of patients with outlet obstructive constipation,improve the quality of life of patients and improve the treatment effect by regulating the secretion level of relevant neurotransmitters such as VIP and NO。... |
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