2.148 慢传输型便秘结肠动力学研究

目的本研究通过对结肠慢传输型便秘结肠动力学特点的评估,旨在为这类病人的诊断和治疗策略的选择提供理论和实验依据.方法 50例功能性慢性便秘(Chronic Functional Constipation,CFC)年龄20 ～70岁,钡剂灌肠造影或结肠镜检查除外结肠解剖学及形态学病变.符合慢性便秘的诊断, 病程≥3月.均行肛门、直肠测压检查排除功能出口型便秘.对照组20例为健康受试者.应用不透X线标志物法,检测50例慢性功能性便秘(CFC)患者的胃肠传输功能(4h胃排空,24h,4 8h,及72h的结肠传输率).结果便秘患者胃肠传输动力学评估与正常组比较,便秘患者4h胃排空(79. 10±3.56% vs 93.57±6.38%),48h结肠排出率(50.30±3.20% vs 85.19±4 .28)及72h结肠排出率(94.17±1.45% vs 98.33±1.95%)均明显降低(P＜0.0 1)差异有非常显著性.50例便秘患者其中32例72h全结肠排空率低于正常组x-2s(94.43%), 计算其传输指数(TI)48h为0.34±0.05,72h为0.46±0.08,提示为结肠慢传输.1.慢传输型便秘结肠各区传输及传输指数STC组标记物在结肠各区段残留数均高于正常对照,比较STC结肠各段残留48h RC(6.26±3.20)多于LC(2.44±1.40)(P＜0.01)和SR(2.2 0±1.42)(P＜0.01).72h则标记物残留于LC、SR多于RC.提示结肠各段均存在传输缓慢,48h RC慢传输型,而72h表现为LC及SR慢传输.2.运动指数便秘患者的乙状结肠及直肠运动指数与正常组比较差异无显著性.结论 TC是CFC常见的类型,结肠传输试验及传输指数的测算有助于结肠动力障碍的病理生理学评估及分型诊断并为治疗策略选择提供依据.     

2.74不同类型功能性便秘的心理状态研究

目的旨在探讨功能性便秘及其不同亚型与心理障碍关系. 方法1.对全部功能性便秘患者进行结肠通过时间测定(Colonic transit test,CTT),参照AGA诊断标准,将FC分为正常通过型便秘(NTC)、慢通过型便秘(STC)、混合型便秘(MC)及出口梗阻性便秘(OOC)4组,对结肠通过时间检查和临床表现可疑出口梗阻性便秘的患者进行了肛直肠测压和排粪造影检查.     

结肠通过时间和盆底肌电图检测对功能性便秘分型的探讨

目的　探讨结肠通过时间和盆底肌电图检测对功能性便秘分型的临床意义。方法　选择符合功能性便秘罗马Ⅱ诊断标准的患者 32例 ,男性 8例 ,女性 2 4结结肠排出率 (排出率 =2 0 -残量数 2 0× 10 0 )和传输指数 (TI)。同时进行盆底肌电图检查记录盆底肌和腹部肌群的肌电活动情况并观察两者有无矛盾运动的存在。结合两项检查结果最终对患者做出分型并选择相应的治疗方法。结果　 1 结肠通过时间检查显示 2 0例患者为出口梗阻型便秘 (TI:4 8h为 0 5 5± 0 0 7,72h为 0 85± 0 39) ;12例为慢传输型便秘 (TI :4 8h为 0 17±0 15 ,72h为 0…     

肠道Cajal间质细胞与慢性便秘发生和治疗的关系

正慢性便秘(chronic constipation,CC)是一种以腹胀、排便困难、肛门梗阻感、排便不尽感或排便干硬为主要表现的消化系统功能性疾病[1],按其病理生理主要分为慢传输型便秘(slow transit constipation,STC)、出口梗阻型便秘(outlet obstructive constipa-tion,OOC)、正常传输型便秘(normal transit constipa-tion,NTC)及混合型便秘(mixed constipation,MC)[2]。CC在普通人群中发病率从3%到27%不等[3],并随着老龄化的进展有逐年上升趋势,     

针刺治疗慢传输型功能性便秘的临床研究

目的　研究针刺合谷、曲池、大肠俞、天枢、中脘对慢传输型功能性便秘的确切临床疗效及其机理。方法　选取 4 5例慢传输型功能性便秘患者 ,分为三组 :针刺治疗组、生物反馈治疗组和针刺联合生物反馈治疗组 ,从患者的自觉症状、体征 (如粪便量、及硬度等 )、助排方法的使用 (如泄剂或灌肠等 )、结肠传输时间、直肠肛管压力检查和胃电图、核素扫描胃排空试验等多角度研究。结果　针刺疗法治疗慢传输型功能性便秘的有效率为 5 3 3% ,针刺联合生物反馈治疗组的有效率为 6 6 7% ;针刺疗法可以明显改善慢传输型功能性便秘患者的排便困难、粪便太…     

2.128 生物反馈治疗慢性顽固性功能性便秘的临床研究

目的评价生物反馈治疗各种类型慢性顽固性功能性便秘和疗效及其作用机理.方法选择40例慢性顽固性功能性便秘病人(诊断标准与疗效判定标准遵循19 99年全国便秘学术研讨会制定的标准),其中慢传输型3例,出口梗阻型31例,慢传输与出口梗阻混合型2例,肠易激综合症型4例.所有入组病人发病时间皆超过2年,都经过一般正规的保守治疗,有4例还经过手术治疗,治疗无效.40例病人皆进行了一个疗程的生物反馈治疗(2次/周,共10周),治疗方式有两种肌电图介导和压力介导的生物反馈.治疗前后以及治疗期间所有病人要在医生的指导下填写症状问卷表、治疗日记、心理症状自评表(SCL-90 ).所有病人在治疗结束后都进行了至少一年的随访(随访方式为电话与门诊相结合).数据统计采用x2检验方法(使用SAS10.0软件包).结果所有40例病人皆为自愿入组,其中大部分病人为女性.每个病人都接受了一个疗程的物生反馈治疗.生物反馈疗法可以明显改善便秘病人的排便困难、粪便太硬等症状,可以明显减少便秘病人口服泻药和灌肠的次数,其总有效率为62.5%;出口梗阻型便秘患者的肛管直肠压力在行生物反馈治疗前后变化,结果经统计学处理无显著性差异;在本研究中,生物反馈疗法的成功与否与病人的一般状况(如年龄、性别等)、便秘分型和生物反馈的方式等均无关,唯一的影响因素是病人心理状态,心理状况高症状组的病人接受治疗失败的比率明显升高(P＜0.05);出口梗阻型便秘病人接受生物反馈治疗的成功率明显升高(P＜0.01).Hopkins心理症状自评量表结果显示总分由治疗前42.80±31.27减少为治疗后24.05±20.62(P＜0.01);所有行生物反馈治疗的病人在治疗过程中无1 例出现副作用.结论本研究充分证明生物反馈疗法是一种治疗慢性顽固性功能性便秘的行之有效、而且有确切长期疗效、无副作用的方法,值得在临床上广泛推广.     

不同类型功能性便秘的心理状态研究

目的　旨在探讨功能性便秘及其不同亚型与心理障碍关系。方法　 1 对全部功能性便秘患者进行结肠通过时间测定 (Colonictransittest,CTT) ,参照AGA诊断标准 ,将FC分为正常通过型便秘 (NTC)、慢通过型便秘 (STC)、混合型便秘 (MC)及出口梗阻性便秘(OOC) 4组 ,对结肠通过时间检查和临床表现可疑出口梗阻性便秘的患者进行了肛直肠测压和排粪造影检查。 2 采用Zung抑郁自评量表 (Self ratingDe pressionScale ,SDS)、焦虑自评量表 (Self ratingAnxietyScale ,SAS)和综合医院焦虑抑郁量表 (thehospitalanxietyanddepressionscale …     

莫沙比利联合乳果糖治疗功能性便秘疗效观察

目的 评价莫沙比利联合乳果糖治疗功能性便秘疗效.方法 84例功能性便秘患者随机分为三组,每组28例.A组给予口服莫沙比利5mg/次,3次/d,乳果糖10ml/次,3次/d;B组单用莫沙比利;C组单用乳果糖.疗程均为4周.记录病人服药前后大便间隔天数、大便性状的改变、排便困难程度改变及副反应.结果 治疗4周后,三组有效率分别为96.4%、46.4%和85.7%.结论 莫沙比利联合乳果糖治疗功能性便秘疗效优于两药单用.     

2.149 功能性出口梗阻型便秘排便动力学研究

目的探讨了解功能性出口梗阻型便秘排便动力学特点,为诊断和治疗提供依据.方法 40例便秘患者,男性16例,女性24例,年龄(43.40±14.13)岁,范围18～68岁.正常对照20例.40例结肠传输功能正常的功能性出口梗阻型便秘(FOOC)患者进行肛肠动力和排便动力学的检查.使用多导灌注式测压法,按标准程序进行肛肠测压,分析其肛肠动力参数,运动指数(MI),排便反射,直肠感知性,以及肛管肌电图EMG)测定并与20 例自愿受试者对照.结果静息状态下肛门内括约肌压力FOOC组(83.90±23.40)高于正常对照组(32.40±15.20)(P＜0.05),直肠静息压、外肛门括约肌静息压及EMG 2组比较差异无显著性;FOOC组与正常对照组比较,肛管主动收缩压和肛管最大缩榨压时间差异无显著性 ;肛管测压时进行模拟排便试验,观察有无括约肌反射.本组肛管测压及EMG嘱受检查者进行模拟排便动作,FOOC病人25%(10/40)肛管外括约肌无排便时的松弛反射,52.5%(21/40)E MG提示为矛盾性收缩,提示这部分患者存在盆底肌群失协调.用球囊扩张法检查肠管的感知是评价内脏感觉敏感性的常用方法,FOOC组最低感知量、排便感知量、直肠最大耐受量以及引起排便反射的最小感知量均比正常对照组高(P＜0.01),提示为低敏感性直肠.FOOC 组与正常对照组比较,肛管超慢波及不规律波增多,肛管慢波、自发性松弛减少,运动指数升高.结论 FOOC患者的肛管、直肠排便动力学的改变,揭示这类病人存在平滑肌、横纹肌、自主神经或体神经的功能障碍.动力学特点为慢性功能性便秘和分型、诊断和治疗策略选择提供依据.     

不同型别的功能性便秘患儿肛门直肠测压对照研究

目的探讨功能性便秘（FC）患儿与健康儿童肛门直肠动力学差异,为其临床分型诊断及治疗提供依据。方法采用功能性胃肠病罗马Ⅲ诊断标准,收集2008年1月至2009年1月在第四军医大学唐都医院儿科门诊及住院的FC患儿为FC组。选取同期无消化系统症状,平日排便正常的健康儿童为正常对照组。采用不透光X线硫酸钡条测定结肠传输指数（TI）,依据TI将FC组分为出口梗阻型（OOC）亚组、慢传输型（STC）亚组和混合型（MIX）亚组。通过肛门直肠测压法分析FC各亚组与正常对照组肛门直肠动力学差异。结果研究期间FC组纳入25例,其中STC亚组10例,OOC亚组15例,未发现MIX患儿;正常对照组纳入10名。FC组与正常对照组肛门括约肌静息压差异无统计学意义（P〉0.05）。STC亚组肛门括约肌最大收缩压与正常对照组差异无统计学意义（P〉0.05）,OOC亚组肛门括约肌最大收缩压显著高于正常对照组及STC亚组（P〈0.05）。FC组直肠最低敏感量及最大耐受量均显著高于正常对照组（P均〈0.05）。STC亚组与OOC亚组直肠最低敏感量及最大耐受量差异均无统计学意义（P均〉0.05）。结论FC患儿存在明显的肛门直肠动力和感觉异常;OOC和STC患儿的肛门直肠动力学存在差异。肛门直肠测压检查对协助诊断FC有一定价值。     

Therapiestrategien der chronischen Obstipation im Kindesalter

Chronic constipation in childhood results from (1) psychological/behavioural causes, (2) functional or organic gastrointestinal outlet obstruction, or (3) slowing of transit within the colon. Functional chronic constipation is treated by a complex conservative bowel management. Constipation refractory to routine medical treatment reveals, in a significant number of cases, organic causes. Histology of bowel biopsies is essential for the preoperative diagnosis of chronic constipation. Defective innervated bowel segments require surgical treatment. Intraoperative histological staining of bowel biopsies allows proper resection of aganglionic or dysganglionic bowel. This contribution describes the interdisciplinary, clinicopathological interactions involving children with chronic constipation.     

健脾温肾法治疗老年功能性便秘的临床观察

目的 观察健脾温肾法治疗老年功能性便秘的临床疗效。方法 选取2017年6月~2018年6月在我院治疗的70例老年功能性便秘患者为研究对象,随机分为治疗组和观察组,各35例,观察组给予中药健脾温肾治疗,对照组给予通便灵口服治疗,观察两组临床治疗总有效率、症状（粪便干结、排便时间、排便间隔）评分情况。结果 对照组总有效率为82.80%,低于观察组的91.40%,差异有统计学意义（P＜0.05）;治疗后,观察组粪便干结（0.46±0.31）分、排便时间（0.88±0.39）分、排便间隔（0.45±0.19）分和对照组粪便干结（0.71±0.31）分、排便时间（0.72±0.35）分、排便间隔（1.46±0.29）分评分较治疗前均降低,差异有统计学意义（P＜0.05）,且观察组改善优于对照组,差异具有统计学意义（P＜0.05）。结论 健脾温肾法治疗老年功能性便秘安全有效,能够有效的缓解老年脾肾阳虚型功能性便秘患者的排便困难症状。     

Colonic transit patterns and plasma cholecystokinin levels in children with recurrent abdominal pain.

Plasma cholecystokinin levels were measured in children with recurrent abdominal pain to investigate the relationship of plasma cholecystokinin levels with colonic transit patterns and clinical symptoms. Subjects consisted of 120 children (mean age 9.6 +/- 2.6 years) for whom colonic transit study had also been done. Plasma cholecystokinin levels were 79.2 +/- 58.7 pg/mL in children with colonic inertia, 70.7 +/- 47.0 pg/mL in hindgut dysfunction, 57.4 +/- 53.1 pg/mL in pelvic outlet obstruction, and 67.6 +/- 47.9 pg/mL in normal colonic transit. These data showed that there was a tendency of increasing plasma cholecystokinin levels in children with proximal colon transit delay, although there was no significant difference among four groups. Plasma cholecystokinin levels in children of 10 years of age and under (54.5 +/- 40.4 pg/mL) were significantly lower (p = 0.01) than in children over 10 years (79.1 +/- 59.8 pg/mL). Plasma cholecystokinin levels based on colonic transit patterns, however, were not significantly different between the two age groups. There was no significant difference in plasma cholecystokinin levels between groups based on defecation frequency per week, presence of defecation pain, symptoms of milk intolerance, or the presence of emotional stress. These results suggested that there was a tendency of increasing plasma cholecystokinin levels in the younger age group and in children with delay in proximal colonic transit, but further study is required in relation to plasma cholecystokinin levels based on colonic transit patterns in a large number of patients.     

肛裂患者术后采用系统化护理措施治疗便秘的临床疗效观察

目的：观察肛裂患者术后采用系统化护理措施治疗便秘的临床疗效。方法：选取2013年8月至2015年8月于我院诊治的肛裂术后患者220例,随机分为系统化护理组与常规护理组,每组110例。常规护理组患者采用常规护理措施,系统化护理组在常规护理组基础上采用系统化护理措施。比较两组患者术后便秘情况、排便分级情况、术后并发症及护理满意度。结果：与常规护理组相比,系统化护理组患者术后3天内有大便、用力排便、大便密结干硬、排便不尽感发生率较低(P<0.01)。与常规护理组相比,系统化护理组患者术后3天、5天排便分级0级率较高、2级率较低(P<0.05)。与常规护理组相比,系统化护理组患者术后切口裂开、切口感染发生率较低,住院天数较短,护理满意度较高(P<0.05)。结论：肛裂患者术后采用系统化护理措施可改善便秘情况,降低术后并发症及提高护理满意度。     

Management of chronic constipation in the elderly

Constipation is a common complaint among the elderly. Constipation can be defined as the passage of small hard stool infrequently and with difficulty. Definitions of constipation vary widely, and therefore Rome III criteria was recommended to be used in defining constipation. Constipation in the elderly is not simply related to the aging. It is a major feature of disorders of colorectal motility. The symptom of constipation could also arise secondary to other conditions. The management of chronic constipation in the elderly should include a detailed medical history and physical examination to exclude secondary causes for constipation. Laboratory evaluation should be performed in the initial assessment of the patient. If the initial investigations are normal, empiric therapy should be initiated. Patients not responding to the initial therapy are considered to have refractory constipation. Thus, diagnostic tests need to be performed in these patients. Further management such as newer medications, biofeedback and surgery might provide new hope to patients with refractory constipation. This review article focuses on the approach and treatment of chronic constipation in the elderly.     

综合护理干预在慢性阻塞性肺疾病稳定期便秘中的作用

目的探讨综合护理干预在慢性阻塞性肺疾病稳定期便秘中的防治作用。方法 62例慢性阻塞性肺疾病稳定期发生便秘的病例随机分成对照组和研究组,每组31例。对照组患者予以常规通便药物及饮食结构调整,研究组在此基础上予以建立良好排便习惯、心理护理、腹部按摩和适当运动等综合护理方法;分析比较两组患者的相关临床资料。结果与对照组相比,研究组的开始排便时间和大便形态恢复正常时间均明显缩短,第二周大便次数和第四周大便次数明显增多,且均具有统计学差异（P〈0.05）;SGRQ评分两组患者的活动受限、呼吸症状、疾病影响及其总分均具有统计学差异（P〈0.05）;对照组的总有效率为77.42%,研究组的总有效率为96.77%,两组患者干预后的总有效率具有统计学差异（P〈0.05）。结论综合护理干预措施可以显著改善慢性阻塞性肺疾病稳定期便秘患者的便秘症状,明显提高患者的生活质量,具有较好的临床效果。     

Primary constipation: an underlying mechanism

Primary (simple) constipation is a consequence of habitual bowel elimination on common toilet seats. A considerable proportion of the population with normal bowel movement frequency has difficulty emptying their bowels, the principal cause of which is the obstructive nature of the recto-anal angle and its association with the sitting posture normally used in defecation. The only natural defecation posture for a human being is squatting. The alignment of the recto-anal angle associated with squatting permits smooth bowel elimination. This prevents excessive straining with the potential for resultant damage to the recto-anal region and, possibly, to the colon and other organs. There is no evidence that habitual bowel elimination at a given time each day contributes considerably to the final act of rectal emptying. The natural behavior to empty the bowels in response to a strong defecation reflex alleviates bowel emptying by means of the recto anal inhibitory reflex.     

Physiopathological evaluation of defecatory problems in elderly people using saline enema test and fecoflowmetry

The population of the aged people is increasing rapidly in developed countries. Bowel care is recognized as an important factor to the wellbeing of the disabled elderly people. To evaluate the physiopathology of defecatory problems in the elderly, we applied saline enema test and fecoflowmetry; that is, pressure fluctuations of the rectum and anal canal were simultaneously recorded during saline infusion in the rectum, and then the saline evacuation curve was recorded in the elderly subjects. The patterns of the pressure fluctuations in the rectum and anal canal were analyzed in saline enema test. In fecoflowmetry, the shape of the evacuation curve and several parameters such as, flow rate and evacuation time were evaluated. The saline volume required to elicit rectal contractions and relaxations of the anal canal were significantly decreased in the patients with the lesions narrowing the spinal canal. The shape of evacuation curve represented the state of defecation in each subject. Subjects without defecatory problems had high flow rates and short evacuation time, while subjects with incontinence and/or constipation had low flow rates and long evacuation time. Furthermore, big and slow periodic pressure fluctuations of the anal canal, so called ultra slow waves, were seen in some patients with severe chronic constipation accompanying megacolon. These findings suggested that the physiopathology of defecatory problems in the elderly is variable and complicated, and that the appropriate treatment for these patients is achieved through appropriate evaluation.     

影响因素预测小儿肠套叠空气灌肠整复失败的价值

目的 探讨各影响因素对小儿肠套叠空气灌肠整复失败的预测价值。 方法 回顾性分析2012年1月~2019年12月武汉儿童医院收治的肠套叠患儿临床资料,包括性别、年龄、病程、阵发性哭吵/腹痛、血便、呕吐、发热、腹泻、腹部包块、住院时间、肠梗阻、套叠影位置、肠套叠类型、空气灌肠整复、手术治疗情况等。单因素分析采用Mann-Whitney U检验或卡方检验,二元logistic回归分析确定独立影响因素,ROC曲线分析各因素预测整复失败的价值。 结果 年龄、病程≥48 h、阵发性哭吵/腹痛、血便、呕吐、发热、腹泻、腹部包块、肠梗阻、套叠影位于左半结肠及住院时间在整复成功组和失败组间差异均有统计学意义（均P<0.05）。性别分布在两组间差异无统计学意义（P>0.05）。回归分析显示年龄是整复失败的保护因素,而病程时间≥48 h、血便、呕吐、发热、腹部包块、肠梗阻及套叠影位于左半结肠是危险因素。ROC曲线分析显示套叠影位于左半结肠、年龄、血便及肠梗阻均有一定预测准确性,其中年龄最佳截断点为10.5个月;肠梗阻、血便、年龄及套叠影位于左半结肠联合预测可提高准确性。 结论 年龄≤10.5个月、血便、肠梗阻及套叠影位于左半结肠预测整复失败均有一定准确性,联合预测准确性更高。