腹部冷刺激对肠易激综合征患者内脏感觉阈值的影响

目的 探讨腹部冷刺激对肠易激综合征（IBS）患者内脏褡珠影响。方法 通过脐部放置冰袋加直肠球囊内充气（时相性）和直肠球囊内注入冰水，观察46例IBS患者症状变化及直肠初始感觉阈值和排便阈值，并与13例健康人对照。结果 （1）脐部放置冰袋加直肠球囊内充气可诱发部分患者症状的产生，如腹痛、腹部不适等，但对初始感觉阈值和排便阈值无明显影响。（2）直肠球囊内注入冰水后，除便秘型IBS的排便阈值稍有所增加但差异不显著外，其余患者初始感觉阈值及排便阈值均明显低于对照组，以腹泻型变化最明显。结论 腹部冷刺激对IBS患者内脏感觉阈值无明显影响，而直肠内冷刺激可明显降低初始感觉阈值，说明IBS患者感觉过敏并非整体痛阈降低所致，而仅指内脏感觉过敏。

Study on visceral perception thresholds after cold stimulation on abdomen in irritable bowel syndrome

Aim To study the changes of visceral perception thresholds after cold stimulation on abdomen and/or in rectum in IBS patients. Methods Rectal visceral perception thresholds in 46 patients with IBS and 13 normal controls were examined during rectal balloon (phasic) distention with air or cold water under cold stimulation on abdomen respectively. Results Compared with the healthy,IBS patients demonstrated significantly lower perception thresholds to rectal thermal and pressure stimuli, especially in patients with diarrhea predominant IBS. The cold stimulation on abdomen and rectal balloon distension with air had varied effects on symptoms in patients with IBS and did not affect visceral perception thresholds.But after injecting cold water into the rectal ballon except the constipation predominant IBS patients,others all showed significant decrease of initial perception thresholds and defecating thresholds,expecially in the diarrhea predominant patients.Conclusion Visceral hypersensitivity is one of the important pathogenetic mechanism of IBS. However,visceral perception thresholds don't change significantly after cold stimulation on abdomen.This indicates that the hypersensitivity of IBS patients only limitsin viscera not the whole.