口服小麦纤维素治疗妊娠期便秘疗效观察

目的：观察小麦纤维素用于妊娠期便秘的疗效和安全性。方法：选择妊娠期便秘60例,随机分为观察组和对照组各30例。观察组口服小麦纤维素治疗2周;对照组采用传统方法治疗。比较两组治疗后便秘症状及大便性状情况。结果：观察组治疗第7天后,与对照组比较,排便困难、粪便性状和排便频率均显著好转（P＆lt;0.05）;治疗14天后,排便不尽感和肛门阻塞感显著改善（P＆lt;0.05）。总有效率86.7%。结论：小麦纤维素治疗功能性便秘疗效确切,且安全有效。     

润肠通便汤治疗原发性习惯性便秘

原发性习惯性便秘是以排便困难、排便不适感以及排便时间延长为主诉的症候群.表现为大便干结,大便量少,排出困难或合并某些特殊症状,如长时间用力排便后,有坠胀感、排便不尽感,甚至于需要用手帮助排便,在不使用泻剂的情况下,7d内自发排空粪便不超过2次或长期无便意.     

复方碳酸氢钠栓治疗功能性便秘的临床研究

目的 研究复方碳酸氢钠栓治疗功能性便秘的临床效果.方法 临床入选152例功能性便秘患者,随机分成2组,其中对照组（n=76）予以安慰剂塞肛,研究组（n=76）予以复方碳酸氢钠栓塞肛,1次/d.治疗1 w后,比较分析两组患者的相关临床资料.结果 研究组的周排便次数、周大便形状分型均值以及周排便不尽感天数均较对照组显著改善（P〈0.05）,总有效率也明显高于对照组（92.11% vs 48.68%,P〈0.05）;在主要不良反应发生率方面,两组（22.37% vs 18.42%）没有统计学差异（P＞0.05）.结论 复方碳酸氢钠栓治疗功能性便秘具有较好的安全性和有效性.     

结肠水疗联合益肠通秘汤及乳酸菌素片治疗脾肾阳虚型功能性便秘疗效观察

目的对比观察结肠水疗联合益肠通秘汤及乳酸菌素片治疗脾肾阳虚型功能性便秘的临床疗效。方法将2017年1月至2018年1月湖北省中医院肛肠科收治的91例脾肾阳虚型功能性便秘患者按照随机数表法分为治疗组(46例)与对照组(45例),其中治疗组患者采用结肠水疗联合益肠通秘汤及乳酸菌素片治疗,对照组患者采用结肠水疗联合枸橼酸莫沙必利片治疗,对比观察两组患者治疗30 d时的排便情况、临床疗效及治疗1年后的复发情况结果治疗30 d时,治疗组患者排便耗时、排便频率、排便顺畅度及便后不尽感评分明显低于对照组,差异具有统计学意义(t=4.487、4.734、4.647、4.262,P=0.003、0.004、0.004、0.008);治疗30 d时,治疗组患者治疗总有效率为95.65%,明显高于对照组患者的治疗总有效率77.78%,差异具有统计学意义(Mann-Whitney U=766.000,Z=-2.396,P=0.017)治疗1年后随访,治疗组32例痊愈患者中复发2例,复发率为6.25%;对照组21例痊愈患者中复发6例,复发率为28.57%。结论与结肠水疗联合枸橼酸莫沙必利片相比,结肠水疗联合益肠通秘汤及乳酸菌素片更能有效改善脾肾阳虚型功能性便秘患者的便秘症状,且复发率较低,疗效显著,值得临床推广应用。     

益肠通秘汤联合中药热奄包治疗老年脾肾阳虚型慢性便秘效果观察

目的探讨益肠通秘汤联合中药热奄包治疗老年脾肾阳虚型慢性便秘的临床疗效。方法选取2016年4月至2017年1月湖北省中医院肛肠科收治的60例老年脾肾阳虚型慢性便秘患者作为研究对象,并按照随机数表法随机分为试验组(30例)与对照组(30例),其中试验组患者在口服益肠通秘汤的同时采用中药热奄包热敷治疗,对照组患者单纯口服乳果糖口服溶液治疗,对比观察两组患者的腹胀、排便时间、排便顺畅度、便后不尽感等变化情况以及临床疗效与复发情况。结果治疗14 d后,两组患者腹胀、排便时间、排便顺畅度及便后不尽感较治疗前均明显改善,且尤以试验组改善最为显著,两组患者腹胀、排便时间、排便顺畅度及便后不尽感评分分别与治疗前对比,P均0.05,差异具有统计学意义;治疗14 d后,两组患者腹胀及便后不尽感评分对比,P均0.05,差异具有统计学意义;治疗14 d后,两组患者排便时间及排便顺畅度评分对比,P均0.05,差异无统计学意义;治疗14 d后,试验组患者中痊愈17例、显效6例、有效4例、无效3例、总有效率为90. 00%,对照组患者中痊愈9例、显效8例、有效3例、无效10例、总有效率为66.67%,两组对比,P0.05,差异具有统计学意义;治疗后6个月随访,试验组17例痊愈患者中复发4例,对照组9例痊愈患者中复发6例。结论益肠通秘汤联合中药热奄包治疗老年脾肾阳虚型慢性便秘,可有效缓解患者腹胀不适、排便时间延长、排便费力及便后不尽感等临床症状,疗效显著,且复发率较低,值得临床推广应用。     

老年人功能性便秘的药物治疗

老年人便秘为临床最常见的症状之一 ,患者常有粪便干结、排便困难或排便不尽 ,排便时间延长等 ,给患者造成痛苦和不便。随着便秘发病机制研究的逐步深入 ,便秘的治疗手段也更加丰富 ,口服给药因其方便、快捷仍是患者和临床医师的首要选择。然而 ,如何针对病情合理用药却是临床的一大难题。现就有关问题讨论如下。1　通便药物应用的重要性　　西方国家调查显示总人群中 10 %受便秘困扰 ,其发生率随年龄而增加。由于饮食结构和生活习惯的改变 ,我国 6 0岁以上便秘患者高达 11.5 % [1] 。便秘不但严重影响老年人的生活质量 ,且导致或诱发多种疾…     

结肠水疗治疗68例老年慢性功能性便秘临床观察

结肠水疗是通过结肠途径治疗系统(简称结疗机)对结肠进行清洗、灌药,治疗慢性功能性便秘(CFC)。便秘是指大便次数明显减少,每周排便次数少于3次,排便困难,粪便干结[1]。60岁以上且长期或慢性功能性便秘称为老年习惯性便秘,也可称为结肠性便秘和直肠性便秘。采用结肠水疗后,有针对性护理措施可有效缓解和预防便秘的发生,对提高老年人的生活质量有着重要意义,本文所选便秘患者,经过积极治疗和有针对性地护理,取得较好效果,现报道如下。     

便易通颗粒治疗功能性便秘100例疗效观察

功能性便秘是一种常见的功能性肠病（通过各种检查能排除肠道器质性病变）,其临床表现为长期排便费力、排便次数少、排便不尽感、大便干硬等。多因生活规律改变、情绪抑郁、饮食因素、排便习惯不良、药物作用等因素所致。好发于各个年龄阶段．尤其是中老年人。自2006年以来,我科通过门诊接诊的患者,采用协定方便易通颗粒治疗功能性便秘100例,取得了较为显著的效果,现总结报道如下。     

老年人便秘的诊断与治疗

便秘是一种常见症状 ,发病率高 ,可明显降低生活质量 ,还可导致大便失禁等严重并发症。1　分型一般认为 ,每周排便少于 3次为便秘 ,但大部分病人常主诉排便费力 ,排便不净 ,粪块质硬或成硬球状。根据大便次数、坚硬度及排便有无困难 ,人们将便秘分为功能型 (慢传输型 )和出口梗阻型[1] 。1 1　功能型便秘　当患者未服用泻药时 ,包含下述两个或以上症状并至少存在 12个月 :≥ 2 5%时间存在排便费力 ;≥ 2 5%时间粪质坚硬或呈球状 ;≥ 2 5%时间有排便不尽感 ;每周排便小于 3次。1 2　出口梗阻型便秘　≥ 2 5%时间存在排出阻滞感 ,及排便时间延…     

小儿推拿联合益生菌治疗儿童功能性便秘疗效观察

目的探讨小儿推拿联合益生菌对儿童功能性便秘的临床疗效。方法选择105例符合功能性便秘诊断标准的儿童,年龄2岁11个月～8岁2个月,随机分为两组,A组为对照组（n=54）使用双歧杆菌三联活菌胶囊口服治疗,B组为联合治疗组（n=51）使用小儿推拿联合双歧杆菌三联活菌胶囊口服治疗,观察治疗后两组的大便性状评分和每周排便次数。结果 B组14～28d大便性状评分优于对照组,每周排便次数多于对照组。结论小儿推拿联合益生菌治疗儿童功能性便秘可明显改善患者大便性状,增加每周排便次数,临床疗效优于单用益生菌口服治疗。     

妈咪爱联合乳果糖口服液治疗婴幼儿功能性便秘的临床观察

目的观察妈咪爱联合乳果糖口服溶液治疗婴幼儿功能性便秘(FC)的疗效。方法 80例功能性FC患儿按随机数字表法分为两组,对照组40例采用一般疗法(调节饮食;训练排便习惯;每天进行适量活动),治疗组40例在此基础上加服妈咪爱及乳果糖口服溶液,疗程均为21 d。观察便秘改善情况,并采用多功能消化道测压仪检测治疗前后直肠肛门动力学的改变。结果治疗组总有效率为91.3%,明显高于对照组的53.1%(P<0.01);两组治疗后直肠最低敏感量和最大耐受量均较治疗前降低(P<0.05),但治疗组治疗后的降低幅度明显高于对照组(P<0.01)。结论妈咪爱联合乳果糖口服液可有效恢复FC患儿肠道正常微生态,纠正直肠肛门动力学障碍,解除便秘。     

The value of the abdominal radiograph in children with functional gastrointestinal disorders

Functional gastrointestinal disorder is a common problem in childhood. The symptoms vary from a relative mild gastrointestinal problem such as abdominal pain or infrequent defecation to severe problems with fecal impaction and fecal incontinence. The aim of this review is to describe and evaluate the value of the different existing methods to assess fecal loading on an abdominal radiograph with or without the use of radio-opaque markers in the diagnosis of functional abdominal pain, functional constipation and functional non-retentive fecal incontinence. In our opinion, the abdominal radiograph has limited value in the diagnostic work-up of children with functional gastrointestinal disorders.     

Fecal bile acid concentration in distance runners.

Fecal bile acid concentration, fecal characteristics, bowel habits and habitual food intake were measured in male distance runners (n = 14) and sedentary men (n = 14). Fecal bile acid concentration was significantly (p less than 0.05) lower and stool weight, frequency of defecation and daily intake of fibre, carbohydrate, and protein were significantly (p less than 0.01) higher in the runners. After adjustment for differences in dietary fibre intake, fecal bile acid concentration was no longer significantly different between the distance runners and the sedentary men, but frequency of defecation remained significantly (p less than 0.05) higher in the runners. This study has identified lower fecal bile acid concentration in distance runners, which was probably due mainly to dilution of colon contents by higher consumption of dietary fibre. These findings may be relevant to the reduced incidence of colon cancer in physically active subjects.     

Iron status of active women and the effect of running a marathon on bowel function and gastrointestinal blood loss

This study compared the bowel function, fecal hemoglobin (Hb) loss, iron status and diets of 36 women of varying activity levels. In addition, we examined the effect of a marathon race on bowel function and fecal Hb loss in 15 of these women. The subjects were divided into 4 groups based on estimated daily exercise energy expenditure: Group A) less than 400 kcal/d (less than 1674 kJ/d); Group B) 400-599 kcal/d (1674-2507 kJ/d); Group C) 600-800 kcal/d (2511-3348 kJ/d); and Group D) greater than 800 kcal/d (greater than 3348 kJ/d). There were no differences in hematological and iron indexes among the 4 groups. Mean daily stool wet weights and individual stool weights were greater for groups B and D as compared to group A. However, transit time and frequency of defecation were not different. Daily fecal Hb losses (mg/day) were greater in groups B, C, and D as compared to A, but there was no difference in fecal Hb concentrations (mg/g feces) among the groups. Dietary intakes of energy, protein, fat and fiber were similar for all groups. Ascorbic acid and iron intakes from food significantly increased with increased estimated daily energy expenditure. Total intakes of ascorbic acid and iron, including oral supplements, were not different among the groups. Marathon racing resulted in a 21% increase in mean transit time, a 27% decrease in daily stool weight and 21% lower frequency of defecation. Fecal Hb concentrations and daily Hb losses before and after the race were not significantly different, despite an increased daily Hb loss in 10 of the 15 runners after the race.(ABSTRACT TRUNCATED AT 250 WORDS)     

聚乙二醇4000联合比沙可啶对帕金森病患者便秘症状及相关生活质量的影响

目的探讨聚乙二醇4000联合比沙可啶对帕金森病患者便秘症状及相关生活质量的影响。方法将98例明确诊断为帕金森病便秘的患者随机分为试验组49例和对照组49例,其中对照组予以聚乙二醇4000口服,治疗组在对照组方案基础上联合比沙可啶肠溶片口服,疗程均为2周,观察比较两组患者的大便频率、形状等便秘相关症状及其相关生活质量的变化。结果完成本研究试验者共87例,其中对照组44例,治疗后排便频率和粪便性状均有明显改善(P<0.05),治疗组43例患者在排便频率、粪便性状及费力程度等相关症状方面均较治疗前显著改善(P<0.05),组间比较:治疗组优于对照组(P<0.05);两组患者治疗后生活质量评分均有降低(P<0.05),且组间比较治疗组明显优于对照组,差异有统计学意义(P<0.05)。结论聚乙二醇4000联合比沙可啶对有效改善帕金森病患者便秘相关症状、提高其生活质量具有重要作用。     

排粪造影对功能性出口梗阻便秘的诊断

目的　探讨排粪造影对功能性出口便秘的诊断价值。方法　对 5 0 0例功能性出口便秘患者进行排粪造影检查。女性 3 49例 ,男性 15 1例 ,年龄 14～ 78岁 ,平均 3 6.7岁。病史在 2个月～ 3 8年。主要临床症状 :排便困难、不适、腹痛、腹胀 ,排便时间延长 ,肛门坠胀及解不净 ,多数病人需长期服泻药及灌肠帮助排便。排粪造影是给病人灌入 40 0～ 60 0ml硫酸钡混悬液 ,病人侧坐在排便装置上 ,在X线电视下作动态观察、摄片。结果　通过对 5 0 0例患者排粪造影检查 ,发现有直肠前突 14 4例、直肠黏膜脱垂 75例、直肠内套叠 5 6例、盆底痉挛综合征 10 2例、耻骨直肠肌肥厚 65例、会阴下降 12 1例、正常 2 9例 ,以上症状多数由两种或两种以上同时出现。结论　排粪造影对功能性出口便秘的诊断具有重要价值。     

骨牵引结合中药治疗老年股骨粗隆间骨折临床体会

目的：观察骨牵引结合中药口服治疗老年股骨粗隆间骨折的临床疗效。方法收集我院2008-2009年度老年股骨粗隆间骨折住院患者25例,其中内科情况较差不能耐受手术者10例,拒绝行手术者15例,均采用骨牵引加中药三期辨证治疗,即：早期活血化瘀、消肿止痛;中期和营通络、接骨续筋;后期补气养血,补益肝肾。针对治疗后患者的疼痛、活动度、步行能力、日常生活能力、X 片骨痂生长情况进行随访,随访时间10-24个月,平均14个月。结果住院期间无一例发生死亡、褥疮,骨折均愈合。25例中有23例获得较好疗效,能负重行走,步态较好,髋膝关节功能良好;2例（其中 A2型中1例, A3型1例）出现髋内翻畸形,患肢短缩,跛行,行走较困难。整体优良率达到92.0％。结论骨牵引结合中药三期辨证口服治疗老年股骨粗隆间骨折安全有效,可作为老年股骨粗隆间骨折保守治疗的有效方法之一。     

MR defecography in patients with dyssynergic defecation: spectrum of imaging findings and diagnostic value

Objectives

We describe the spectrum of findings and the diagnostic value of MR defecography in patients referred with suspicion of dyssynergic defecation.

Methods

48 patients (34 females, 14 males; mean age 48 years) with constipation and clinically suspected dyssynergic defecation underwent MR defecography. Patients were divided into patients with dyssynergic defecation (n = 18) and constipated patients without dyssynergic defecation (control group, n = 30). MRIs were analysed for evacuation ability, time to initiate evacuation, time of evacuation, changes in the anorectal angle (ARA-change), presence of paradoxical sphincter contraction and presence of additional pelvic floor abnormalities. Sensitivity, specificity, positive and negative predictive values and accuracy for the diagnosis of dyssynergic defecation were calculated.

Results

The most frequent finding was impaired evacuation, which was seen in 100% of patients with dyssynergic defecation and in 83% of the control group, yielding a sensitivity for MR defecography for the diagnosis of dyssynergic defecation of 100% (95% confidence interval (CI) 97–100%), but a specificity of only 23% (95% CI 7–40%). A lower sensitivity (50%; 95% CI 24–76%) and a high specificity (97%; 95% CI 89–100%) were seen with abnormal ARA-change. The sensitivity of paradoxical sphincter contraction was relatively high (83%; 95% CI 63–100%). A combined analysis of abnormal ARA-change and paradoxical sphincter contraction allowed for the detection of 94% (95% CI 81–100%) of the patients with dyssynergic defecation.

Conclusion

MR defecography detects functional and structural abnormal findings in patients with clinically suspected dyssynergic defecation. Impaired evacuation is seen in patients with functional constipation owing to other pelvic floor abnormalities than dyssynergic defecation.Dyssynergic defecation, which produces functional outlet obstruction during defecation, is one of the causes of chronic constipation. Dyssynergic defecation is a functional disorder characterised by either paradoxical contraction, an inability to relax the anal sphincter and/or puborectalis muscle, or impaired abdominal and rectal pushing forces. In the literature, many other terms such as anismus [1], dyskinetic puborectalis muscle [2], non-relaxing puborectalis syndrome [3], spastic pelvic floor syndrome [4, 5] and pelvic floor dyssynergia [6] have been used. An expert group (Rome III) [7] recently proposed the term “dyssynergic defecation” to appropriately describe the failure of co-ordination or dyssynergia of the abdominal and pelvic floor muscles involved in defecation. Different physiological tests can be used to investigate this functional disorder, including the balloon expulsion test, electromyography (EMG) of the puborectalis muscle and anorectal manometry. Defecography can be performed to rule out structural rectal abnormalities and provide an estimate of the degree of rectal emptying. As false-positive and false-negative results are common with these different tests, none can be used by itself as a gold standard for identifying patients with dyssynergic defecation.Most authorities recommend using a combination of diagnostic tests and clinical history. The Rome III expert group defined the criteria for the diagnosis of dyssynergic defecation based on clinical history, anorectal manometry, balloon expulsion test, EMG and conventional defecography (evacuation proctography) [7]. Functional imaging with conventional defecography is considered to be a useful adjunct in establishing the diagnosis of dyssynergic defecation. Delayed initiation of evacuation and impaired evacuation in particular, as seen on conventional defecography, are highly predicitive for the presence of dyssynergic defecation [8, 9]. Different structural imaging findings in conventional defecography have been described in patients with dyssynergic defecation; however, the usefulness of these findings is discussed controversially [8, 10, 11].The experience with MR defecography, which has shown to be a valuable alternative to evacuation proctography [12–15], is limited in dyssynergic defecation patients. There is only one study which has focused on the MR defecography findings in a study setting in patients with dyssynergic defecation [16]. Hence, the purpose of this study was to describe the spectrum of findings in MR defecography in patients referred with the suspicion of dyssynergic defecation and to assess the value of MR defecography in establishing this diagnosis. For the latter, the patients with dyssynergic defecation were compared with a group of constipated patients without dyssynergic defecation.     

多库酯钠治疗慢性功能性便秘的疗效分析

目的观察多库酯钠治疗慢性功能性便秘的疗效和安全性。方法按入组标准将60例功能性便秘患者随机分为2组。治疗组口服多库酯钠（100 mg,每天3次）治疗,对照组口服乳果糖（30 ml,每天1次）治疗,疗程2周。结果在用药1周后、用药2周后及治疗结束后1周,治疗组的大便次数及大便性状评分较对照组有统计学意义（P〈0.05）。两组临床疗效比较无统计学意义,但治疗组在用药1周后、用药2周后显效率显著高于对照组（P〈0.05）。两组不良反应的发生率均较低。结论多库酯钠治疗慢性功能性便秘临床效果明显,安全可靠。