低容量聚乙二醇电解质散联合首荟通便胶囊在慢性功能性便秘患者结肠镜检查肠道准备中的应用研究

目的 探讨与标准大容量聚乙二醇电解质散（4L PEG-ELS）方案相比,低容量PEG-ELS联合首荟通便胶囊（SHLC）方案对慢性功能性便秘（CFC）患者结肠镜检查前肠道准备的有效性和安全性。方法 采用单中心、观察者盲法、随机对照试验方法,招募2021年1月-2021年12月在山东大学齐鲁医院（青岛）接受结肠镜检查的CFC患者282例,随机分配到SHLC+2 L PEG-ELS组、SHLC+3 L PEG-ELS组和4 L PEG-ELS组。观察患者波士顿肠道准备评分（BBPS）和肠道准备耐受性。结果 最终纳入240例患者。SHLC+2 L PEG-ELS、SHLC+3 L PEG-ELS和4 L PEG-ELS组的BBPS分别为（6.22±1.09）、（6.26±0.97）和（7.06±0.63）分,差异无统计学意义（P> 0.05）。节段性BBPS显示,3组患者在左半结肠[（2.32±0.72）、（2.41±0.64）和（2.58±0.59）分]、中段结肠[（2.18±0.83）、（2.26±0.76）和（2.44±0.81）分]和右半结肠[（1.67±0.71）、（1.72...     

Laxative Activities of Cassia Sieberiana and Senna Obtusifolia

Background

The root and stem bark of Cassia sieberiana DC. (Caesalpiniaceae) and the root of Senna obtusifolia (Linn) Irwin and Barneby (Caesalpiniaceae), used for constipation in Nigeria, were assayed for laxative properties in male albino rats using the official senna leaf (Senna alexandrina Mill. family Caesalpiniaceae) as the reference standard. This is with a view to finding alternative laxative drug to official senna which is presently being imported into Nigeria from the United Kingdom.

Materials and Methods

The mean percentage of wet faeces in rats, an indication of laxative activity, were obtained using established methods. The laxative activity was established at 500 mg/kg after the infusion of the drug was orally administered on male albino rats following established methods while a set of data was analyzed at 95 % confidence level.

Results

At 500 mg/kg, Senna obtusifolia root gave about 45 % wet faeces while Cassia sieberiana root gave about 40 % wet faeces while at the highest dose of 700 mg/kg, they produced 60 % and 38 % wet faeces, respectively. At these two doses, the official Senna gave 50.6 % and 66 % wet faeces, respectively. Thus, S. obtusifolia and C. sieberiana roots exhibited 89 % and 80 % of the potency of S. alexandrina (the official drug), respectively. The analysis of variance revealed a significant statistical difference in the levels of wet faeces produced by rats dosed with C. sieberiana root.

Conclusion

The results have shown that the roots of the two species could be developed as mild laxative drugs for children and pregnant women for whom the official senna will be contraindicated.     

芪蓉润肠口服液在老年腹股沟疝合并便秘患者围手术期的应用

目的 探讨芪蓉润肠口服液在老年腹股沟疝合并便秘患者围手术期的应用疗效. 方法回顾性分析我科2007年12月至2009年12月收治的930例老年腹股沟疝合并便秘患者临床资料,其中服用芪蓉润肠口服液(芪蓉组)710例,服用通便灵(对照组)220例,观察患者术后24 h、72 h及1周的排便情况及进行术后疼痛评分. 结果术后24 h,72 h及1周,芪蓉组能正常排便患者分别为587例(82.6%)、612例(86.2%)及647例(91.1%),不良反应4例(0.5%);对照组分别为158例(71.8%)、172(78.1%)及181例(82.3%),不良反应8例(3.6%). 结论芪蓉润肠口服液治疗老年便秘患者疗效肯定,起效快,不良反应少,可作为老年腹股沟疝合并便秘患者围手术期的辅助治疗用药.     

麻杏纤畅酥对便秘小鼠的通便作用及调控短链脂肪酸的保护作用研究

目的 研究麻杏纤畅酥对便秘小鼠润肠通便与肠道短链脂肪酸的作用。方法 采用复方地芬诺酯构建小鼠便秘模型,将小鼠随机分为5组：正常组、便秘模型组、阳性对照组、麻杏纤畅酥高剂量实验组和低剂量实验组,检测小鼠排便情况、肠道蠕动及粪便中短链脂肪酸含量等指标。结果 与对照组比较,便秘模型组小鼠的首粒黑便时间明显延长(P<0.05),4 h内粪便粒数、质量、含水量和小肠墨汁推进率均明显降低(P<0.05),说明成功构建小鼠便秘模型。与便秘模型组比较,麻杏纤畅酥可以有效减少小鼠首粒黑便时间(P<0.05),并且能增加粪便粒数(P<0.05)、质量(P<0.05)和粪便含水量(P<0.05),促进便秘小鼠小肠墨汁推进 (P<0.05),提高结肠肌层厚度(P<0.05),促进小鼠肠道代谢产生异丁酸、丁酸、异戊酸和戊酸。结论 麻杏纤畅酥有效促进便秘小鼠肠道蠕动并缓解了便秘,具有润肠通便的作用,本研究为麻杏纤畅酥的保健功效提供了依据。     

Animal models of cathartic colon

The incidence of cathartic colon has been increasing, but satisfactory treatments are still lacking. In order to study the pathological mechanisms of the disorder and identify effective treatment methods, researchers have established different animal models of cathartic colon. This minireview briefly summarizes several common cathartic colon animal models, induced with anthraquinone laxatives such as rhubarb, total anthraquinone, rhein, and emodin, or induced with diphenylmethane laxatives such as phenolphthalein. The advantages and limitations of these models are evaluated and analyzed. We hope that this review will facilitate the selection of suitable models and improve relevant modeling methods. We anticipate the development of more convenient and stable models that can reflect the characteristics of cathartic colon in humans, and serve as useful tools for further studies.     

Prospective randomized crossover trial comparing fibre with lactulose in the treatment of idiopathic chronic constipation

Background Fibre is often recommended as the first-choice treatment but its effects can be uneven. The aim of the study was to compare the clinical efficacy and tolerability of fibre versus lactulose in outpatients with chronic constipation. Methods In a prospective randomized crossover trial, patients were randomized to receive fibre or lactulose for four weeks. Between treatments, patients had at least one week free of laxatives. Results 50 patients, of median age 50 years (range, 18–85) were recruited and 39 patients completed the trial. Compared to fibre, lactulose resulted in significantly higher mean bowel frequency (7.3, 95% CI 5.7 to 8.9 vs. 5.5, 95% CI 4.4 to 6.5; p=0.001) and stool consistency score (3.4, 95% CI 3.1 to 3.7 vs. 2.9, 95% CI 2.5 to 3.3; p=0.018). Scores for ease of evacuation were similar. The frequencies of adverse effects were not significantly different, but greater in the lactulose group. Mean patients’ recorded improvement score was significantly higher after taking lactulose than fibre (6.2, 95% CI 5.5 to 7.0 vs. 4.8, 95% CI 4.0 to 5.9; p=0.017). Of the 39 patients who completed the trial, 24 (61.5%) preferred lactulose and 14 (35.9%) preferred fibre. Conclusions Lactulose had better efficacy than fibre for chronic constipation in ambulant patients, although both treatments were equally well tolerated in terms of adverse effects.     

Blood glucose response after oral lactulose intake in type 2 diabetic individuals

BACKGROUNDLactulose is approved for the symptomatic treatment of constipation, a gastrointestinal (GI) complication common in individuals with diabetes. Lactulose products contain carbohydrate impurities (e.g., lactose, fructose, galactose), which occur during the lactulose manufacturing process. These impurities may affect the blood glucose levels of individuals with type 2 diabetes mellitus (T2DM) using lactulose for the treatment of mild constipation. A previous study in healthy subjects revealed no increase in blood glucose levels after oral lactulose intake. However, it is still unclear whether the intake of lactulose increases blood glucose levels in individuals with diabetes.AIMTo evaluate the blood glucose profile after oral lactulose intake in mildly constipated, non-insulin-dependent subjects with T2DM in an outpatient setting.METHODSThis prospective, double-blind, randomized, controlled, single-center trial was conducted at the Clinical Research Center at the Medical University of Graz, Austria, in 24 adult Caucasian mildly constipated, non-insulin-dependent subjects with T2DM. Eligible subjects were randomized and assigned to one of six treatment sequences, each consisting of four treatments stratified by sex using an incomplete block design. Subjects received a single dose of 20 g or 30 g lactulose (crystal and liquid formulation), water as negative control or 30 g glucose as positive control. Capillary blood glucose concentrations were measured over a period of 180 min post dose. The primary endpoint was the baseline-corrected area under the curve of blood glucose concentrations over the complete assessment period [AUC_{baseline_c (0-180 min)}]. Quantitative comparisons were performed for both lactulose doses and formulations vs water for the equal lactulose dose vs glucose, as well as for liquid lactulose vs crystal lactulose. Safety parameters included GI tolerability, which was assessed at 180 min and 24 h post dose, and adverse events occurring up to 24 h post dose.RESULTSIn 24 randomized and analyzed subjects blood glucose concentration-time curves after intake of 20 g and 30 g lactulose were almost identical to those after water intake for both lactulose formulations despite the different amounts of carbohydrate impurities (≤ 3.0% for crystals and approx. 30% for liquid). The primary endpoint [AUC_{baseline_c (0-180 min)}] was not significantly different between lactulose and water regardless of lactulose dose and formulation. Also with regard to all secondary endpoints lactulose formulations showed comparable results to water with one exception concerning maximum glucose level. A minor increase in maximum blood glucose was observed after the 30 g dose, liquid lactulose, in comparison to water with a mean treatment difference of 0.63 mmol/L (95% confidence intervals: 0.19, 1.07). Intake of 30 g glucose significantly increased all blood glucose endpoints vs 30 g liquid and crystal lactulose, respectively (all P < 0.0001). No differences in blood glucose response were observed between the different lactulose formulations. As expected, lactulose increased the number of bowel movements and was generally well tolerated. Subjects experienced only mild to moderate GI symptoms due to the laxative action of lactulose.CONCLUSIONBlood glucose AUC_{baseline_c (0-180 min)} levels in mildly constipated, non-insulin dependent subjects with T2DM are not affected by the carbohydrate impurities contained in 20 g and 30 g crystal or liquid lactulose formulations.     

Randomized,Clinical Trial of Bowel Confinement <Emphasis Type="Italic">vs.</Emphasis> Laxative Use After Primary Repair of a Third-Degree Obstetric Anal Sphincter Tear

PURPOSE: Third-degree tears are generally managed by primary anal sphincter repair. Postoperatively, some physicians recommend laxative use, whereas others favor bowel confinement after anorectal reconstructive surgery. This randomized trial was designed to compare a laxative regimen with a constipating regimen in early postoperative management after primary obstetric anal sphincter repair. METHODS: A total of 105 females were randomized after primary repair of a third-degree tear to receive lactulose (laxative group) or codeine phosphate (constipated group) for three days postoperatively. Patients were reviewed at three days and at three months postpartum. Recorded outcome measures were symptomatic and functional outcome and early postoperative morbidity. RESULTS: Forty-nine patients were randomly assigned to the constipated group and 56 patients to the laxative group. The first postoperative bowel motion occurred at a median of four (mean, 4.5 (range, 1–9)) days in the constipated group and at two (mean, 2.5 (range, 1–7)) days in the laxative group (P < 0.001). Patients in the constipated group had a significantly more painful first evacuation compared with the laxative group (P < 0.001). The mean duration of hospital stay was 3.7 (range, 2–6) days in the constipated group and 3.05 days in the laxative group (range, 2–5; P = 0.001). Nine patients in the constipated group complained of troublesome postoperative constipation compared with three in the laxative group (P = 0.033). Continence scores, anal manometry, and endoanal ultrasound findings were similar in the two groups at three months postpartum. CONCLUSIONS: Patients in the laxative group had a significantly earlier and less painful bowel motion and earlier postnatal discharge. There was no difference in the symptomatic or functional outcome of repair between the two regimens. Presented at the meeting of the Society for Maternal-Fetal Medicine, San Francisco, California, February 2 to 7, 2003     

何首乌、制何首乌及何首乌发酵炮制品致泻作用与抗氧化活性的比较研究

目的：比较何首乌生品、传统炮制品及发酵炮制品的抗氧化活性及致泻副作用的差异,评价发酵法在何首乌炮制中的应用。方法：利用铁离子还原抗氧化法（FRAP法）评价何首乌生品与不同炮制品的抗氧化活性。利用小鼠粪便色点法及炭末推进法评价何首乌生品与不同炮制品的泻下副作用。结果：各种炮制方法均可显著降低何首乌的致泻副作用。其中用Rhizopussp．发酵的何首乌（FB）可显著降低何首乌致稀便的次数及时间,传统法炮制的何首乌及用Rhizopusoryzae发酵的何首乌（FA）可显著减弱小鼠肠道运动。同时,在50％和95％乙醇提取物组,发酵品FA和FB的抗氧化活性都强于传统方法炮制的何首乌。经传统方法炮制后何首乌中二苯乙烯苷含量降低,但发酵炮制品FA中二苯乙烯苷的含量无明显变化,传统方法炮制品及发酵炮制品FA中大黄素及大黄素甲醚含量均增加。结论：何首乌的传统炮制法及发酵炮制法在降低何首乌致泻副作用的同时也会不同程度地减弱其抗氧化活性。其中,利用米根霉Rhizopusoryzae发酵得到的何首乌可在降低致泻副作用的同时最大程度地保留何首乌的抗氧化活性,该发酵法可能成为何首乌炮制方法中新的研究方向。