针刺治疗孤独症谱系障碍儿童便秘的效果

doi:10.3969/j.issn.1006-9771.2021.10.012

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (10): 1211-1217.doi: 10.3969/j.issn.1006-9771.2021.10.012

针刺治疗孤独症谱系障碍儿童便秘的效果

张春艳^1,²,王艳^1,²,李宏玉^1,²,庄亚楠^1,²,朱淑伟^1,²,徐丹双^1,²,张雪薇^1,³,陈慧杰^1,²()

1.黑龙江中医药大学,黑龙江哈尔滨市 150040
2.黑龙江中医药大学附属第二医院,黑龙江哈尔滨市 150001
3.黑龙江中医药大学研究生院,黑龙江哈尔滨市 150040

收稿日期:2021-02-04 修回日期:2021-08-26 出版日期:2021-10-25 发布日期:2021-10-29
通讯作者: 陈慧杰 E-mail:chenhuijie2010@163.com
作者简介:张春艳(1980-),女,汉族,黑龙江哈尔滨市人,博士,主治医师,主要研究方向：儿童神经系统疾病中医康复基础及临床研究。
基金资助:
黑龙江省中医药科研项目(ZHY2020-138);黑龙江中医药大学科研基金项目(201517)

Effect of Acupuncture on Constipation in Children with Autism Spectrum Disorder

ZHANG Chun-yan^1,²,WANG Yan^1,²,LI Hong-yu^1,²,ZHUANG Ya-nan^1,²,ZHU Shu-wei^1,²,XU Dan-shuang^1,²,ZHANG Xue-wei^1,³,CHEN Hui-jie^1,²()

1. Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150040, China
2. Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150001, China
3. Graduate School of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150040, China

Received:2021-02-04 Revised:2021-08-26 Published:2021-10-25 Online:2021-10-29
Contact: CHEN Hui-jie E-mail:chenhuijie2010@163.com
Supported by:
Heilongjiang Province Traditional Chinese Medicine Research Project(ZHY2020-138);Heilongjiang University of Chinese Medicine Project(201517)

摘要/Abstract

摘要：

目的观察针刺对孤独症谱系障碍(ASD)儿童便秘问题及核心症状的治疗效果。方法 2019年1月至2020年11月,黑龙江中医药大学附属第二医院康复中心收治50例ASD并发便秘患儿,随机分为针康组(n = 25)和药康组(n = 25)。针康组采用头针、体针结合康复训练法;药康组采用口服益生菌结合康复训练法;两组均进行便秘和核心症状的康复训练。便秘治疗8周,核心症状治疗12周。治疗前,治疗8周、12周后进行便秘疗效判定和便秘主症评分,并采用孤独症儿童行为量表(ABC)和孤独症治疗评估表(ATEC)对核心症状进行评估。结果治疗前两组便秘主症评分、ABC评分和ATEC总分比较均无显著性差异(P > 0.05)。治疗8周,两组主症评分均显著降低(t > 5.473, P < 0.001);治疗12周,针康组便秘疗效和主症评分均优于药康组(Z = 2.848, t = -2.139, P < 0.05)。治疗8周后,两组ABC评分和ATEC总分均较治疗前显著降低(t > 7.139, P < 0.001),两组间比较均无显著性差异(P > 0.05);针康组ATEC行为评分明显降低(t = 3.849, P < 0.01),优于药康组(t = -2.643, P < 0.05),两组间其他项评分无显著性差异(P > 0.05);治疗12周,针康组ABC评分、ATEC总分及各项评分均低于药康组(|t| > 2.156, P < 0.05)。结论针刺结合康复训练法可改善ASD儿童便秘问题,疗效较持久,也可改善孤独症的核心症状,均优于药物结合康复训练法。

关键词: 孤独症谱系障碍, 针刺, 益生菌, 便秘

Abstract:

Objective To observe the effect of acupuncture on constipation in children with autism spectrum disorder (ASD).Methods From January, 2019 to November, 2020, 50 ASD children with constipation from Rehabilitation Center of the Second Affiliated Hospital of Heilongjiang University of Chinese Medicine were admitted and randomly divided into acupuncture-rehabilitation group (n = 25) and medicine-rehabilitation group (n = 25). For constipation, the acupuncture-rehabilitation group used scalp acupuncture, body acupuncture combined with rehabilitation; the medicine-rehabilitation group took probiotics orally combined with rehabilitation. Both groups received conventional rehabilitation for constipation and the core symptoms. Constipation was treated for eight weeks, and ASD symptoms was treated for twelve weeks. After eight weeks and twelve weeks, the efficacy of constipation and the scores of main symptoms of constipation were compared, and they were also evaluated with Autism Child Behavior Scale (ABC) and Autism Treatment Evaluation Scale (ATEC).Results Before treatment, there was no significant difference in the main symptoms of constipation, nor the scores of ABC and ATEC between two groups (P > 0.05). Eight weeks after treatment, the main symptoms of constipation significantly improved (t > 5.473, P < 0.001); twelve weeks after treatment, the efficacy of constipation and the main symptoms of constipation were better in the acupuncture-rehabilitation group than in the medicine-rehabilitation group (Z = 2.848, t = -2.139, P < 0.05). Eight weeks after treatment, the scores of ABC and ATEC significantly decreased (t > 7.139, P < 0.001), and there was no significant difference between two groups (P > 0.05); the score of behavior of ATEC significantly decreased in the acupuncture-rehabilitation group (t = 3.849, P < 0.01), and was lower than that of the medicine-rehabilitation group (t = -2.643, P < 0.05), and no significant difference in other items was found between two groups (P > 0.05); twelve weeks after treatment, the scores of ABC and ATEC were lower in the acupuncture-rehabilitation group than in the medicine-rehabilitation group (|t| > 2.156, P < 0.05).Conclusion Acupuncture-rehabilitation can improve the longer-lasting effect of constipation, and also improve the core symptoms of ASD, which is superior to medicine-rehabilitation.

Key words: autism spectrum disorder, acupuncture, probiotics, constipation

中图分类号:

R749.94

张春艳,王艳,李宏玉,庄亚楠,朱淑伟,徐丹双,张雪薇,陈慧杰. 针刺治疗孤独症谱系障碍儿童便秘的效果[J]. 《中国康复理论与实践》, 2021, 27(10): 1211-1217.

ZHANG Chun-yan,WANG Yan,LI Hong-yu,ZHUANG Ya-nan,ZHU Shu-wei,XU Dan-shuang,ZHANG Xue-wei,CHEN Hui-jie. Effect of Acupuncture on Constipation in Children with Autism Spectrum Disorder[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(10): 1211-1217.

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参考文献 30

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组别	n	性别(n)		年龄(岁)	ASD病程(年)	ASD病情(n)
组别	n	男	女	年龄(岁)	ASD病程(年)	轻中度	重度
针康组	24	19	5	4.06±1.04	1.23±0.63	19	5
药康组	23	19	4	4.13±1.03	1.22±0.61	19	4
χ²/t值		0.764		0.213	0.026	0.764
P值		0.090		0.832	0.980	0.090

主症	正常(0分)	轻度(2分)	中度(4分)	重度(6分)
大便性状	4型、5型	3型或先3型后4型、5型	2型或先2型后4型、5型	1型
排便情况	正常	排便费力	排便努挣方出	排便努挣难出
排便频次	1~2 d 1次	3 d 1次	4~5 d 1次	每周< 1次

组别	n	治疗前	治疗8周	治疗12周	t值^a	P值^a	t值^b	P值^b
针康组	24	11.76±3.05	8.75±2.97	9.05±3.15	7.901	< 0.001	8.782	< 0.001
药康组	23	12.41±3.28	10.75±3.22	11.15±2.77	5.473	< 0.001	1.187	0.253
t值		-0.697	-0.502	-2.319
P值		0.491	0.048	0.026

组别	n	治疗前	治疗8周	治疗12周	t值^a	P值^a	t值^b	P值^b
针康组	24	82.45±9.00	77.55±8.89	67.95±8.91	11.640	< 0.001	13.976	< 0.001
药康组	23	83.95±8.34	78.25±9.25	74.21±9.42	7.139	< 0.001	13.566	< 0.001
t值		-0.546	-0.244	-2.156
P值		0.588	0.809	0.038

组别	n	治疗前	治疗8周	治疗12周	t值	P值	t值^b	P值^b
针康组	24	98.16±5.99	88.47±5.57	79.86±5.77	63.364	< 0.001	82.758	< 0.001
药康组	23	98.48±6.08	90.39±5.89	86.56±5.69	58.032	< 0.001	30.774	< 0.001
t值		-0.240	-0.982	-3.960
P值		0.981	0.331	< 0.001

针刺治疗孤独症谱系障碍儿童便秘的效果

Effect of Acupuncture on Constipation in Children with Autism Spectrum Disorder

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组别	n		语言	社交	认知	行为
针康组	24	治疗前	15.71±3.32	23.80±3.54	13.65±1.30	33.21±4.13
		治疗8周	12.74±3.35	19.73±3.13	11.55±1.61	28.95±3.51
		治疗12周	10.12±2.31	17.25±2.79	10.15±1.66	26.61±3.58
药康组	23	治疗前	16.05±3.33	23.75±3.74	13.55±1.46	33.42±3.69
		治疗8周	13.15±3.43	21.84±3.65	12.30±1.63	31.85±3.31
		治疗12周	12.55±2.78	19.85±3.73	11.51±1.76	29.42±3.47
t值^a			2.972	4.040	2.748	3.849
P值^a			< 0.001	0.001	0.013	0.001
t值^b			13.958	7.050	6.281	30.252
P值^b			< 0.001	< 0.001	< 0.001	< 0.001
t值^c			17.105	3.368	3.651	15.158
P值^c			< 0.001	0.003	0.002	< 0.001
t值^d			4.543	6.324	5.454	4.108
P值^d			< 0.001	< 0.001	< 0.001	< 0.001
t值^e			-0.422	-1.951	-1.473	-2.643
P值^e			0.681	0.063	0.151	0.012
t值^f			-3.028	-2.496	-2.492	-2.508
P值^f			0.004	0.017	0.017	0.017

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组别	n	治愈	显效	有效	无效
针康组	24	7	10	5	2
药康组	23	3	5	8	7

组别	n	治愈	显效	有效	无效
针康组	24	6	7	8	3
药康组	23	1	3	10	9