慢性便秘患者的循证治疗

    Evidence-Based Treatment for Chronic Constipation Patients

    • 摘要: 目的 针对慢性便秘患者,检索当前最佳证据,为患者选择治疗方案提供依据,控制患者症状,提高生活质量。 方法 在充分评估病人的情况后,提出临床问题,从Cochrane 图书馆(2009第2期)、MEDLINE(1990年12月至2009年)、EMBASE(1999年12月至2009年)、SCIE(2000年12月至2009年)、CBM中分别检索治疗慢性便秘的随机对照试验和系统评价,对所获证据进行评价,并结合患者意愿制定治疗方案。 结果 共检出与不同问题相关的随机对照试验52篇,系统评价/Meta分析31篇。分析证据并结合患者意愿,为患者制定了合理的治疗方案: ①聚乙二醇,每天20 g,空腹冲服。②嘱早餐增加谷类摄入,同时保证每天水果及蔬菜总摄入量至少20~25 g,并适当进行体育锻炼。③建议患者进行专业的心理测评,进行必要的心理辅导或者治疗。治疗1个月后,患者的便秘症状显著改善,生活质量明显提高。 结论 采用循证治疗的方法,为患者确定合理的治疗方案,控制了症状,提高了生活质量。

       

      Abstract: Objective To make individualized treatment for patients with chronic constipation by means of evidence-based medicine. Methods After clinical problems were put forward, systematic reviews and randomized controlled trials were collected from the Cochrane Library (Issue2, 2009), MEDLINE(1990.12 to 2009.12), EMBASE (1999.12 to 2009.12), SCIE(2000.12 to 2009.12) and CBM(2000.12 to 2009.12). Treatment protocol was produced by combining the evidence and the values of the patient. Results A total of 52 RCTs and 31 systematic reviews were identified. A rational treatment plan was made upon a serious evaluation of the data and wishes of patients: ① polyethylene glycol, 20 g/d, Po Chongfu, before meal. ② Increasing breakfast with cereal intake and ensuring that daily intake of fruits and vegetables was 20~25 g at least. Appropriate physical exerciseis also needed. ③ We recommend patients undergo some specialized psychological evaluation and get necessary psychological counseling or treatment. After 1 month of treatment, the symptoms and quality of life for the patients were improved significantly. Conclusion The treatment efficacy in diagnosed chronic constipation has been improved by determining an individualized treatment plan according to evidence-based methods.

       

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