Effects of Bianshi heat therapy on abdominal bloating, diarrhea, and constipation during the pretreatment phase of hematopoietic stem cell transplantation patients
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摘要:
目的 探讨砭石热熨疗法对造血干细胞移植(HSCT)患者预处理期缓解腹胀、腹泻及便秘的效果，为提高患者生活质量提供新方案。 方法 选取2023年10月—2024年4月浙江中医药大学附属第一医院血液科收治的66例HSCT患者为研究对象，采用随机数字表法分为干预组(砭石热熨+常规护理)和对照组(常规护理)，各33例。2组均干预2个疗程，1个疗程为7 d，共14 d。比较2组患者14 d内腹胀、腹泻、便秘的发生率及严重程度。 结果 14 d内干预组患者的腹胀、腹泻发生率均低于对照组(P < 0.05)，便秘发生率组间差异无统计学意义(P>0.05)。干预组的腹胀严重程度低于对照组(Waldχ2=17.568, P < 0.001)，且随时间变化严重程度逐渐改善(Waldχ2=71.992, P < 0.001)；干预组的腹泻严重程度低于对照组(Waldχ2=16.149, P < 0.001)，且随时间变化严重程度逐渐改善(Waldχ2=21.409, P < 0.001)；便秘严重程度组间差异无统计学意义(Waldχ2=0.464, P=0.496)，但组别与时间有交互效应(Waldχ交互2=715.967, P交互 < 0.001)。 结论 砭石热熨疗法能显著降低HSCT患者预处理期腹胀和腹泻的发生率及严重程度，有助于提升患者的生活质量，但对便秘的作用有限。 Abstract:Objective To explore the effect of Bianshi heat therapy on abdominal bloating diarrhea, and constipation during the pretreatment phase of hematopoietic stem cell transplantation (HSCT) patients, providing a new approach to improve patient quality of life. Methods A total of 66 HSCT patients admitted to the Department of Hematology, the First Affiliated Hospital of Zhejiang Chinese Medical University from October 2023 to April 2024 were selected and divided into an intervention group (Bianshi heat therapy + routine nursing) and a control group (routine nursing) according random number table, with 33 patients in each group. The intervention was administered for 7 days over 2 consecutive treatment courses. The incidence and severity of abdominal bloating, diarrhea, and constipation were recorded and evaluated over a 14-day observation period. Results The incidence of abdominal bloating and diarrhea in the intervention group was lower than that in the control group within 14 days (P < 0.05), while no significant difference was observed in the incidence of constipation between the two groups (P>0.05). The severity of abdominal bloating was lower in the intervention group compared to the control group (Waldχ2=17.568, P < 0.001) and showed a progressive improvement over time (Waldχ2=71.992, P < 0.001). The severity of diarrhea was also lower in the intervention group than in the control group (Waldχ2=16.149, P < 0.001), with a significant time-dependent improvement over time (Waldχ2=21.409, P < 0.001). For constipation severity, no significant difference was observed between the two groups (Waldχ2=0.464, P=0.496), however, a significant interaction effect was found (Waldχinteraction2=715.967, Pinteraction < 0.001). Conclusion Bianshi heat therapy significantly reduces the incidence and severity of bloating and diarrhea during the pretreatment phase of HSCT patients, contributing to improved quality of life. Its effect on constipation appears to be limited. -
表 1 2组造血干细胞移植患者一般资料比较
Table 1. Comparison of general characteristics between two groups of patients undergoing hematopoietic stem cell transplantation
项目 干预组(n=33) 对照组(n=33) 统计量 P值 性别[例(%)] 0.061a 0.805 男性 18(54.5) 17(51.5) 女性 15(45.5) 16(48.5) 年龄(x±s, 岁) 32.58±11.63 33.94±12.35 0.462b 0.646 身高(x±s, cm) 167.39±8.42 166.30±7.51 0.556b 0.580 体重(x±s, kg) 60.16±9.86 61.66±12.29 0.547b 0.586 职业[例(%)] 0.890a 0.373 学生 5(15.2) 7(21.2) 职员 8(24.2) 10(30.3) 个体 6(18.2) 5(15.2) 务农 2(6.1) 1(3.0) 其他 12(36.3) 10(30.3) 婚姻状况[例(%)] 0.262a 0.609 已婚 20(60.6) 22(66.7) 未婚 13(39.4) 11(33.3) 疾病类型[例(%)] 1.379a 0.845 多发性骨髓瘤 2(6.1) 1(3.0) 淋巴瘤 4(12.1) 3(9.1) 白血病 4(12.1) 5(15.2) 骨髓增生异常综合征 5(15.2) 8(24.2) 再生障碍性贫血 18(54.5) 16(48.5) 移植方案[例(%)] 0.254a 0.614 含阿糖胞苷方案 19(57.6) 21(63.6) 含环磷酰胺方案 14(42.4) 12(36.4) 注：a为χ2值，b为t值。 
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表 2 2组造血干细胞移植患者腹胀严重程度情况(例)
Table 2. Severity of abdominal distension in two groups of patients undergoing hematopoietic stem cell transplantation (case)
组别 时间 无腹胀 轻度腹胀 中度腹胀 重度腹胀 干预组 第1天 32 1 0 0 第4天 26 6 1 0 第7天 22 8 3 0 第10天 13 15 4 1 第14天 29 3 1 0 对照组 第1天 32 1 0 0 第4天 19 5 6 3 第7天 6 16 11 0 第10天 6 19 8 0 第14天 19 12 2 0
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表 3 2组造血干细胞移植患者腹胀严重程度的广义估计方程分析
Table 3. Generalized estimating equation analysis of abdominal distension severity in two groups of patients undergoing hematopoietic stem cell transplantation
项目 B OR(95% CI) Waldχ2 P值 无腹胀 0.452 1.572(0.891~2.773) 2.434 0.119 轻度腹胀 2.369 10.684(5.382~21.208) 45.855 < 0.001 中度腹胀 4.904 134.878(45.204~402.440) 77.318 < 0.001 干预组 -1.324 0.266(0.143~0.494) 17.568 < 0.001 对照组 第1天 -2.551 0.078(0.016~0.381) 9.945 0.002 第4天 0.490 1.633(0.691~3.858) 1.248 0.264 第7天 1.463 4.317(2.037~9.151) 14.559 < 0.001 第10天 1.817 6.153(3.538~10.700) 41.427 < 0.001 注：腹胀分级以重度为参照，时间以第14天为参照。
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表 4 2组造血干细胞移植患者腹泻严重程度情况(例)
Table 4. Severity of diarrhea in two groups of patients undergoing hematopoietic stem cell transplantation (case)
组别 时间 腹泻0级 腹泻1级 腹泻2级 腹泻3级 腹泻4级 干预组 第1天 33 0 0 0 0 第4天 29 3 1 0 0 第7天 27 6 0 0 0 第10天 26 7 0 0 0 第14天 30 2 1 0 0 对照组 第1天 31 2 0 0 0 第4天 23 8 2 0 0 第7天 17 10 4 2 0 第10天 17 14 1 1 0 第14天 20 10 1 2 0
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表 5 2组造血干细胞移植患者腹泻严重程度的广义估计方程分析
Table 5. Generalized estimating equation analysis of diarrhea severity in two groups of patients undergoing hematopoietic stem cell transplantation
项目 B OR(95% CI) Waldχ2 P值 无腹泻 0.512 1.669(0.864~3.222) 2.329 0.127 腹泻分级1级 2.545 12.749(6.109~26.605) 45.984 < 0.001 腹泻分级2级 3.706 40.701(11.759~140.870) 34.230 < 0.001 干预组 -1.484 0.227(0.110~0.468) 16.149 < 0.001 对照组 第1天 -2.460 0.085(0.019~0.378) 10.502 0.001 第4天 -0.211 0.810(0.344~1.904) 0.234 0.629 第7天 0.539 1.715(0.809~3.632) 1.982 0.159 第10天 0.469 1.599(0.831~3.077) 1.974 0.160 注：腹泻分级以3级为参照，时间以第14天为参照。
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表 6 2组造血干细胞移植患者便秘严重程度情况(例)
Table 6. Severity of constipation in two groups of patients undergoing hematopoietic stem cell transplantation (case)
组别 时间 便秘0级 便秘1级 便秘2级 便秘3级 便秘4级 干预组 第1天 30 3 0 0 0 第4天 31 2 0 0 0 第7天 31 2 0 0 0 第10天 32 1 0 0 0 第14天 33 0 0 0 0 对照组 第1天 32 1 0 0 0 第4天 30 2 1 0 0 第7天 32 1 0 0 0 第10天 28 5 0 0 0 第14天 31 1 1 0 0
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表 7 2组造血干细胞移植患者便秘严重程度的广义估计方程分析
Table 7. Generalized estimating equation analysis of constipation severity in two groups of patients undergoing hematopoietic stem cell transplantation
项目 B OR(95% CI) Waldχ2 P值 无便秘 3.252 25.842(4.619~144.582) 13.703 < 0.001 便秘分级1级 5.622 276.480(25.350~3 015.419) 21.269 < 0.001 干预组 -0.442 0.643(0.180~2.294) 0.464 0.496 对照组 第1天 0.705 2.024(0.345~11.875) 0.610 0.435 第4天 0.962 2.618(0.612~11.198) 1.684 0.194 第7天 0.402 1.495(0.358~6.241) 0.304 0.581 第10天 1.139 3.124(0.971~10.043) 3.653 0.056 注：便秘分级以2级为参照，时间以第14天为参照。
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