龙贵梅 杨新 黄佳

【摘 要】 目的：观察土家药通肠散穴位贴敷改善心衰患者便秘的临床疗效。方法：选取将120例心衰便秘的患者随机分为观察组和对照组各60例。两组患者均给予利尿、强心、扩血管等心衰的常规治疗。对照组采用护理干预与手法腹部按摩，观察组在对照组的基础上给予土家药通肠散外敷于神阙穴，每日1次，每次6h，7d为1个疗程，连续治疗两个疗程后观察比较两组患者的临床疗效，治疗前后便秘症状评分的变化、满意度及不良反应情况。结果：观察组总有效率91.67%，对照组总有效率78.33%，两组差异有统计学意义（P<0.05）；观察组治疗后的便秘症状评分、满意度评价均优于对照组（P<0.05）；两组不良反应发生率无明显差异（P>0.05）。结论：土家药通肠散穴位贴敷治疗心衰患者便秘的疗效确切，操作简单、方便、安全。

【关键词】 土家药通肠散；穴位贴敷；便秘；心力衰竭

【中图分类号】R541.6 【文献标志码】 A 【文章编号】1007-8517（2018）14-0092-04

Abstract：Objective To observe the clinical effect of the application of Tujia Tongchang powder on the improvement of constipation caused by heart failure.Methods 120 patients with heart failure constipation were allocated randomly into observation group and control group.Both groups of patients were given routine treatment of heart failure such as diuretic， cardiac， and vasodilator. The control group was treated with nursing intervention and abdominal massage. Besides the routine medical therapy，observation group was given the application of Tujia Tongchang powder on acupoint Shenque（CV 8）.1 time per day， 6 hours per time， 7 days for one course of treatment.Clinical effects，the changes of constipation symptom scores，satisfaction and adverse reactions were observed after two courses of continuous treatment.Results The total effective rate of the observation group was 91.67%， and the total effective rate of the control group was 78.33%， and the difference between the two groups was statistically significant （P<0.01）. There were significant differences in the scores of constipation symptoms before and after treatment （P<0.05）. The satisfaction evaluation of observation group was better than that of the control group （P<0.05）.The incidence of adverse reaction was5% in the control group and was6.67% in the observation group， the difference being insignificant（P>0.05）.Conclusion The application of Tujia Tongchang powder on acupoint Shenque（CV 8） is a effective treatment which is simple， convenient and safe for the heart failure constipation.

Keywords：TujiaTongchang Powder； Acupoint Application； Constipation； Heart Failure

心力衰竭（簡称心衰）是各种心血管疾病发展至终末期的临床状态，是由心脏结构或功能异常导致心室充盈或射血功能受损的一组复杂临床综合征。心力衰竭已成为对患者伤害最大的心血管疾病，其症状的反复发作导致患者生活质量逐渐下降，且住院率及病死率均增高[1]。心衰患者由于胃肠道瘀血导致不思饮食，病情危重、恐惧、卧床，以及药物、环境等因素常导致患者发生便秘[2]。便秘后患者用力排便的憋气动作，会使胸腔压力和腹腔压力同时增加，加重心脏负荷，甚至诱发呼吸衰竭、猝死等严重不良事件[3]。据文献[2]报道，心内科急性大面积心肌梗死、重度心力衰竭等高危患者排便过程猝死的发生率约占心性猝死的50%～60%。……