目的 探討六味能消膠囊聯(lián)合雙歧桿菌三聯(lián)活菌膠囊治療兒童功能性便秘的臨床效果。方法 選取2019年6月—2021年9月鄭州市金水區(qū)總醫(yī)院收治的82例功能性便秘患兒，使用隨機數(shù)字表法將82例患兒隨機分成對照組和治療組，每組各41例。對照組口服雙歧桿菌三聯(lián)活菌膠囊，1粒/次（1～6歲），2粒/次（7～14歲），3次/d，以溫牛奶或溫開水沖服。治療組在對照組基礎(chǔ)上口服六味能消膠囊，1/3粒/次（1～3歲）、1/2粒/次（4～5歲）、2/3粒/次（6～10歲）、1粒/次（11～14歲），2次/d。兩組均連續(xù)治療2周。觀察兩組的臨床療效，比較治療前后兩組主要癥狀評分、肛門直腸動力學參數(shù)值、腸道菌群數(shù)量及血清P物質(zhì)（SP）、血管活性腸肽（VIP）水平。結(jié)果 治療后，治療組總有效率為95.1%，顯著高于對照組的80.5%（P<0.05）。治療后，兩組糞便性狀評分、排便頻率評分、排便時間評分、腹脹評分均較治療前顯著降低（P<0.05）；且均以治療組下降更顯著（P<0.05）。治療后，兩組直腸最低敏感量、最大耐受量和肛門括約肌最大收縮壓較治療前均顯著降低（P<0.05）；但均以治療組的改善更顯著（P<0.05）。兩組治療前后肛門括約肌靜息壓組內(nèi)及組間比較差異均無統(tǒng)計學意義。治療后，兩組患者糞便中雙歧桿菌、乳酸桿菌數(shù)量較治療前均顯著增加，而梭桿菌、腸球菌數(shù)量則均顯著減少（P<0.05）；且治療后，治療組腸道菌群數(shù)量改善優(yōu)于對照組（P<0.05）。治療后，兩組血清SP水平均顯著升高，而血清VIP水平均顯著降低（P<0.05）；且治療后，治療組血清SP、VIP水平改善優(yōu)于對照組（P<0.05）。結(jié)論 六味能消膠囊聯(lián)合雙歧桿菌三聯(lián)活菌膠囊治療兒童功能性便秘的整體療效確切，能安全有效地緩解患兒癥狀，改善肛門直腸動力學異常，恢復腸道內(nèi)環(huán)境穩(wěn)態(tài)，糾正腦腸肽分泌異常，值得臨床推廣應用。

Objective To explore the clinical effect of Liuwei Nengxiao Capsules combined with live combined bifidobacterium, lactobacillus and enterococcus in treatment of children with functional constipation. Methods A total of 82 children with functional constipation admitted to the General Hospital of Jinshui District Zhengzhou City from June 2019 to September 2021 were selected. The 82 children were randomly divided into control group and treatment group by random number table method, with 41 cases in each group. Patients in the control group were po administered with Live Combined Bifidobacterium, Lactobacillus and Enterococcus Capsules, 1 grain/time (1 to 6 years old), two grains/time (7 to 14 years old), three times daily, with warm milk or warm water. Patients in the treatment group were po administered with Liuwei Nengxiao Capsules on the basis of the control group, 1/3 grain/time (1-3 years old), 1/2 grain/time (4-5 years old), 2/3 grain/time (6-10 years old), 1 grain/time (11-14 years old), twice daily. Both groups were treated for 2 weeks. The clinical efficacy of the two groups were observed, and the scores of main symptoms, anorectal kinetic parameters, intestinal flora number and serum substance P (SP) and vasoactive intestinal peptide (VIP) levels were compared before and after treatment. Results After treatment, the total effective rate in the treatment group was 95.1%, significantly higher than that in the control group (80.5%) (P < 0.05). After treatment, the scores of fecal traits, defecation frequency, defecation time and abdominal distension in two groups were significantly lower than those before treatment (P < 0.05). The decrease was more significant in the treatment group (P < 0.05). After treatment, the minimum sensitive volume of rectum, the maximum tolerated volume and the maximum systolic pressure of anal sphincter in two groups were significantly decreased compared with before treatment (P < 0.05). However, the improvement in treatment group was more significant (P < 0.05). There was no significant difference in the anal sphincter resting pressure between the two groups before and after treatment. After treatment, the numbers of bifidobacteriaand lactobacillus in feces in two groups were significantly increased compared with before treatment, while the numbers of Clostridium and enterococcus were significantly decreased (P < 0.05). After treatment, the number of intestinal flora in the treatment group was better than that in the control group (P < 0.05). After treatment, serum SP level was significantly increased, while serum VIP level was significantly decreased in both groups (P < 0.05). After treatment, the serum SP and VIP levels in the treatment group were better than those in the control group (P < 0.05). Conclusion Liuwei Nengxiao Capsules combined with live combined bifidobacterium,lactobacillus and enterococcus has a definite overall effect in treatment of children with functional constipation, and can safely and effectively relieve the symptoms of children, improve anorectal dynamic abnormalities, restore intestinal environmental homeostasis and correct brain-gut peptide secretion abnormalities, which is worthy of clinical application

R975

鄭州市科技攻關(guān)項目（20190038）