肠易激综合征患者直肠感觉功能和肛肠动力学的研究

目的 探讨肠易激综合征(IBS)患者直肠的感觉功能和直肠肛门括约肌的动力学特征。方法 将34例IBS患者随机分为两组：腹泻组和便秘组各17例，采用PC Polygmf HR高分辨多道胃肠功能测定仪测定34例IBS患者和12例健康对照的肛门直肠压力、直肠容量感知、疼痛阈值、耐受阈值等指标。结果 腹泻组和便秘组IBS患者的直肠静息压、肛管括约肌静息压、最大缩窄压及肛管长度与健康对照组无显著性差异，初始感觉阉值、疼痛阈值、排便阈值，IBS腹泻组均低于正常对照组，而IBS便秘组均高于正常对照组。排便时IBS便秘组患者的肛管松弛压高于正常对照组。结论 IBS患者排便功能和直肠感觉功能存在异常。     

30例直肠癌超低位吻合保肛术患者围手术期肛肠测压观察及护理

目的 为了确保ISR手术效果,通过术前、术后对肛肠测压观察,评价超低位直肠癌行括约肌间切除手术(ISR)后的肛门排便功能,探求肛肠测压的方法 及护理.方法 对30例施行ISR手术的超低位直肠癌患者,通过术前、术后对肛肠测压观察、评估肠腔压力情况,术后肛门控便功能,按Williams标准评估肛门排便功能,提供相应的护理.结果 术后30例肛管静息压明显降低(P<0.01),肛门最大收缩压和直肠最大耐受容积较术前均明显降低(P<0.01),随着时间推移逐渐恢复,但不能恢复到术前水平,大部分患者术后肛门直肠抑制反射消失(3/30),且随着时间推移无明显恢复.按Williams的排便自制标准,30例患者术后3个月、6个月、12个月分别有86.7%、93.3%、96.7%的患者达到功能良好效果.结论 术前、术后准确测量直肠肛管静息压,做好测压的护理,并根据静息压情况、对肛门排便功能的评估调整护理措施,利于患者术后肛门排便功能的恢复.     

中低位直肠癌患者的肛门直肠功能及其影响因素

  目的  研究中低位直肠癌患者的肛门直肠功能及其影响因素  目的  2012年9月至2013年11月连续纳入在北京协和医院就诊的中低位直肠癌患者, 填写中低位直肠癌患者排便功能的研究报告表, 并进行三维高分辨肛门直肠压力测定检查。根据肿瘤远侧缘距肛缘的距离将患者分为中位组和低位组  结果  共纳入66例中低位直肠癌患者, 其中男45例, 女21例; 平均年龄(58.86±10.99)岁; 低位组22例, 中位组44例。95.5%患者有便血, 50.0%排便次数增多, 30.3%~40.9%有粪便性状异常、排便急迫感、排便不尽感、里急后重等症状; 便血、排便次数、排便不尽感与肿瘤浸润深度呈正相关(r=0.308, P=0.012;r=0.290, P=0.018;r=0.305, P=0.013)。所有患者的直肠肛门抑制反射均无受损, 持续便意感阈值和最大耐受量均较正常值明显降低; 持续便意感阈值、最大耐受量与肿瘤浸润深度呈负相关(r=-0.333, P=0.007;r=-0.323, P=0.009)。与中位组相比, 低位组患者排便费力发生率高(27.2%比6.8%, P=0.031), 肛门平均静息压低[87.20(49.80)mmHg比108.25(41.80)mmHg, P=0.017]  结论  在中低位直肠癌患者, 除便血外, 排便症状多样化, 且不具有特异性; 中低位直肠癌患者的直肠感觉功能受损明显, 肿瘤浸润深度和肿瘤远侧缘距肛缘的距离不同程度地影响患者肛门直肠感觉和动力功能。     

排便训练技术在功能性便秘患者中的应用

目的探讨排便训练技术对功能性便秘(functional constipation,FC)患者肛管直肠功能和临床症状的作用。方法按纳入标准选取门诊及住院的28例FC患者为试验组,根据试验组患者肛管直肠压力和直肠感觉功能的评估结果分别选择压力反馈训练法、直肠感受性训练法和腹式呼吸法进行排便训练。试验组于训练前及训练结束3个月后评估肛管直肠压力和直肠感觉功能;同期选择24名健康志愿者为对照组,入组时评估其肛管直肠压力和直肠感觉功能。结果试验组患者排便训练前用力排时肛管剩余压力高于对照组(P<0.05);排便训练后用力排时肛管剩余压力低于训练前(P<0.01),且与对照组的差异无统计学意义(P<0.05);试验组训练后用力排时直肠压力和排便指数高于训练前(P<0.01),且用力排时直肠压力高于对照组(P<0.05)。试验组患者排便训练前直肠初始感觉容量、直肠初始便意感容量、排便窘迫容量和直肠最大耐容量均高于对照组(P<0.05):而排便训练后以上4项指标较训练前降低(P<0.01),且以上4项指标与对照组比较差异均无统计学意义(P>0.05)。试验组训练后,自发排便次数、大便性状和粪便量少等症状较训练前改善(P<0.01);且排便困难、排便不尽感、肛门阻塞感和腹部胀气等伴随症状也较训练前改善(P<0.01)。结论排便训练技术能有效改善FC患者的盆底肌、肛门括约肌的功能,改善肛门外括约肌的协调性,降低直肠感觉阈值,并促进其临床症状的改善。     

成人盆底痉挛综合征患者直肠肛管压力的改变及综合医院焦虑/抑郁情绪测定评分的分析

[目的]探讨盆底痉挛综合征（SPFS）患者肛管直肠压力的变化及其焦虑抑郁评分的高低的临床意义.[方法]选择本院确诊SPFS患者68例（试验组）,无排便功能紊乱症状健康志愿者20例（对照组）,采用肛管直肠测定仪进行动力学检查,并采用综合医院焦虑/抑郁情绪测定表进行心理状况评估,比较两组直肠肛管压力和焦虑抑郁评分.[结果]试验组患者直肠肛门抑制反射（RAIR）阈值、肛管最大自主收缩压、肛管自主收缩持续时间、排便窘迫阈值和直肠最大容量感觉阈值显著低于对照组（P〈0.05）;肛管静息压和直肠初始感觉阈值显著高于对照组（P〈0.05）,直肠静息压和初次排便感觉阈值高于对照组,但两者比较无统计学意义（P〉0.05）;焦虑评分及抑郁评分均显著高于对照组（P〈0.05）.[结论]SPFS患者存在明显的直肠感觉功能下降和盆底肌肉协调运动障碍,且存在焦虑抑郁症状,为临床诊治提供依据.     

完全性脊髓损伤患者肛门直肠动力学研究

目的 探索颈、胸段完全性脊髓损伤后肛门直肠功能降碍对排便的影响。方法 利用肛门直肠动力检测仪，对照比较30例颈、胸段完全性脊髓损伤患者和30例正常人排便时肛门直肠动力学参数的变化。结果 颈、胸段完全性脊髓损伤患者排便时肛管压力下降幅度、直肠—肛管压力梯度和排便指数小于正常人(P＜0．01)。结论 脊髓损伤破坏了用力排便时肛门直肠活动的协调性，使自主排便机制受损，非自主排便成为主要排便机制。     

Modified Gant procedure for treatment of internal rectal prolapse in elderly women

BACKGROUNDAlthough rectal prolapse is not a life-threatening condition, it can cause defecation disorders, anal incontinence, sensory abnormalities, and other problems that can seriously affect quality of life.AIMTo study the efficacy of the modified Gant procedure for elderly women with internal rectal prolapse.METHODSSixty-three elderly female patients with internal rectal prolapse underwent the modified Gant procedure. The preoperative and postoperative anal symptoms, Patient Assessment of Constipation Quality of Life (PAC-QOL), Wexner incontinence score, incontinence quality of life score, and complications (massive hemorrhage, infection, anorectal stenosis, and anorectal fistula) were compared.RESULTSThe improvement rates of postoperative symptoms were defecation disorders (84.5%), anal distention (69.6%), defecation sensation (81.4%), frequent defecation (88.7%), and anal incontinence (42.9%) (P < 0.05). All dimensions and total scores of the PAC-QOL after the procedure were lower than those before the operation (P < 0.05). The postoperative anal incontinence score and Wexner score were significantly lower than those before the procedure (P < 0.05). The quality of life and total scores of postoperative anal incontinence were significantly higher than those before the procedure (P < 0.05). There were no serious complications and no deaths.CONCLUSIONThe modified Gant procedure has significant advantages in the treatment of elderly women with internal rectal prolapse.     

Does defecography help in diagnosis and clinical decision-making in defecation disorders?

Defecography is used to investigate patients with defecation disorders, especially obstructed defecation and anal incontinence. We studied 73 consecutive patients who complained of difficult defecation, anal incontinence, or idiopathic anorectal pain. The following defecographic parameters were recorded and compared in different patient groups: anorectal angulation, pelvic floor descent, formation of rectocele, and rectal invagination. Increasing number of childbirths correlated with pelvic floor descent in defecograms (r= 0.319, p< 0.05). There were no significant differences in defecographic parameters in patients with obstructed defecation, anal incontinence, or idiopathic anorectal pain. Thus, we conclude that defecography may be useful as an investigative tool in clinical research of defecation disorders, but it is of minor value in clinical diagnosis and decision-making.     

慢性功能性便秘患者睡眠影响因素与肛门直肠动力学指标分析

目的分析慢性功能性便秘(chronic functional constipation,CFC)患者睡眠影响因素及肛门直肠动力学指标特征。方法67例CFC患者和同龄、同性别健康体检者(对照组)31例接受匹兹堡睡眠质量指数问卷(PSQI)评估。CFC睡眠紊乱患者和对照组同时接受抑郁自评量表(SDS)、焦虑自评量表(SAS)和肛门直肠动力学检测。结果PSQI问卷评估中,CFC组的睡眠质量、入睡时间、睡眠效率、睡眠障碍、催眠药物、日间功能障碍和PSQI总分均明显高于对照组(P<0.05~0.01)。42例(62.7%)CFC患者存在睡眠紊乱,与对照组的一般情况和心理情绪评分比较中,前者的平均年龄、女性、平均文化程度和SAS、SDS标准分均明显高于对照组(P<0.05)。两组的肛门直肠动力学指标比较中,睡眠紊乱CFC患者的肛门括约肌的静息压、最大缩窄压、括约肌松弛压、肛管高压区的长度检测值以及直肠感知阈值、排便阈值、疼痛阈值和引发直肠肛门抑制反射最小容积均明显高于对照组(P<0.05~0.01)。结论CFC患者有明显的睡眠质量下降,后者与增龄、抑郁、焦虑评分、肛门外括约肌松弛不良或反常收缩以及各类肛门直肠敏感性指标增强有一定相关性。     

CT排便造影评价肛门外括约肌的功能

目的 采用CT排便造影显示肛门外括约肌(EAS)的形态及变化,评价其功能。方法 分静息、缩肛、排便3期采集60名健康志愿者的坐位CT排便造影图像,重建标准的肛管冠状位及正中矢状位图像,对耻骨直肠肌(Pr)和EAS进行形态学测量。结果 Pr、EAS的深部和浅部分别在肛门直肠结合部、肛管上部和中下部水平压缩肛管,EAS皮下部位于肛管下方,内翻呈圆锥状,与肛周皮肤共同自下而上封堵肛管。静息期,EAS深部间距(31.50±4.10)mm,浅部间距(28.36±4.14)mm,肛管-EAS皮下部夹角(60.95±19.20)°;缩肛期,EAS作向心运动,更紧地闭合肛管,深部间距(30.85±4.10)mm,浅部间距(26.04±3.48)mm,皮下部内翻程度加大,肛管-EAS皮下部夹角(56.87±16.18)°;排便期,EAS作离心运动,肛管开放,深部间距(37.51±5.17)mm;浅部间距(31.68±5.10)mm,皮下部自内上向外下翻转,肛管-EAS皮下部夹角(112.23±22.48)°。结论 EAS主要通过压缩、悬吊、绞索和套塞方式维持肛门自制。EAS的深部、浅部和皮下部在排便时依次开放,其皮下部作翻转运动参与排便。     

肛门失禁大动物模型的建立

目的探讨肛门失禁动物模型的造模方式及其临床意义。 方法本文采用两种方法进行肛门失禁巴马小型猪模型的创建,分别为通过外科手术操作对小型猪的肛门括约肌离断致猪肛门失禁动物模型的创建和骶神经麻醉药物注射的方法对小型猪的骶神经损伤所致猪肛门失禁动物模型的创建,对猪肛门失禁动物模型进行肛门静息压测定,并取肛门括约肌组织进行组织形态学检测及可变剪接基因检测。 结果括约肌离断法与骶神经损伤法均诱导巴马小型猪发生肛门失禁,具体表现为大便不能自行控制（括约肌离断组：第1天出现肛门失禁,第2~14天保持肛门失禁。骶神经损伤组：第1天出现不完全大便失禁,第2~6天开始大便失禁情况逐渐加重,至第7天出现完全肛门失禁,第8~14天均保持肛门失禁状态）、肛门静息压显著降低（骶神经损伤组10.29±0.23 mmHg,括约肌离断组7.32±0.53 mmHg均＜对照组26.31±2.58 mmHg）和括约肌组织形态破坏（肛门括约肌组织形态结构异常,括约肌全层变薄,固有层结缔组织变厚,肌纤维数量明显减少、变细、断裂,横纹肌致密程度明显下降）。括约肌离断法较骶神经损伤法诱导肛门失禁速度更快,并且肛门静息压更低。模型组与对照组肛门组织可变剪接基因检测结果显示存在可变剪接差异基因,京都基因和基因组百科全书（KEGG）富集分析表明,差异可变剪接基因富集于Regulation of lipolysis in adipocytes、PPAR signaling pathway、TGF-beta signaling pathway、Spliceosome等信号通路。 结论括约肌离断法和骶神经损伤均可有效的进行猪肛门失禁动物模型的建立,Regulation of lipolysis in adipocytes、PPAR signaling pathway、TGF-beta signaling pathway、Spliceosome等信号通路异常的可变剪接可能参与肛门失禁的发生,具体机制有待深入研究。     

Effects of secretin on peritubular capillary physical factors and proximal fluid reabsorption in the rat.

The effects of secretin vasodilation on peritubular capillary Starling forces and absolute proximal reabsorption were examined in the rat. Secretin was infused at 75 mU/kg per min into the aorta above the left renal artery. Efferent plasma flow increased from 125 +/- 28 to 230 +/- 40 nl/min with secretin infusion. Single nephron filtration rate (44 +/- 6 vs. 44 +/- 7 nl/min) and absolute proximal reabsorption (21 +/- 5 vs. 21 +/- 4 nl/min) were not significantly changed. Peritubular capillary and interstitial hydrostatic pressures increased with secretin infusions (from 9 +/- 0.4 to 15 +/- 0.7 mmHg and from 3 +/- 0.2 to 4 +/- 0.2 mmHg, respectively). Both peritubular capillary and interstitial oncotic pressures decreased (from 25 +/- 2 to 20 +/- 2 mmHg and from 10 +/- 1 to 4 +/- 1 mmHg, respectively) during secretin infusion. The net reabsorption pressure for peritubular capillary uptake significantly decreased from 9 +/- 2 to 5 +/- 2 mmHg and the coefficient of reabsorption increased from 3 +/- 1 to 6 +/- 2 nl/min per mmHg. We conclude that although secretin causes a vasodilation and decreases net reabsorption pressure, absolute proximal reabsorption is unchanged. Peritubular capillary uptake is maintained, and since net reabsorption pressure is decreased, the coefficient of reabsorption is increased.     

Nitrendipine once daily compared with nicardipine in the treatment of mild to moderate hypertension

Twenty-four patients with mild to moderate hypertension were randomly assigned to 42 days of treatment with 20 mg of nitrendipine once daily or 20 mg of nicardipine thrice daily. In the nitrendipine-treated and nicardipine-treated patients, respectively, mean resting blood pressure decreased from 163 +/- 12 and 161 +/- 11 mmHg at baseline to 152 +/- 12 and 146 +/- 9 mmHg at six weeks (P less than 0.001). Blood pressures were reduced after one day of treatment, followed by an attenuation of the drug effect. In both treatment groups, blood pressures after cycloergometric, isometric, and cold-pressure tests were significantly lower at six weeks than at baseline; at six weeks, blood pressures were also significantly reduced two hours after drug administration, compared with those at or just before drug administration. It is concluded that nitrendipine taken once daily is safe and effective in the treatment of mild to moderate hypertension.     

Rectal administration of nifedipine: haemodynamic effects and pharmacokinetics in hypertensives

The haemodynamic effects and pharmacokinetics of nifedipine suppositories, used mainly for hypertensive emergencies, were studied in 10 severely hypertensive patients. Following rectal administration, significant hypotensive effects occurred after 0.5 h and lasted until 7 h after administration. The mean (+/- SE) maximum decreases in systolic and diastolic blood pressures 1.5 h after administration were: systolic, 61.8 +/- 7.9 mmHg (P less than 0.001); and diastolic, 30.8 +/- 4.0 mmHg (P less than 0.001). No serious side-effects were reported and heart rate did not change significantly. Mean nifedipine concentration in the blood peaked at 52.4 ng/ml, 1 h after administration and, after 7 h, was still 14.3 ng/ml which is higher than the minimum plasma concentration required for hypotensive effects to occur. There was a close correlation between nifedipine concentration in the blood and hypotensive effects. These results indicate that rectal administration of nifedipine should be regarded as a useful alternative treatment in hypertensive emergencies.     

The effect of hyperglycaemia on cerebral potentials evoked by rapid rectal distension in healthy humans

BACKGROUND: Acute hyperglycaemia affects the perception of sensations arising from the gastrointestinal tract. The mechanisms responsible for this effect are unknown. Recordings of cerebral evoked potentials (EPs) can be used to assess the integrity of visceral afferent pathways. Our aim was to determine whether hyperglycaemia affects EPs elicited by rectal distension in healthy humans. MATERIALS AND METHODS: Twelve healthy men, aged 19-31 years, were studied. A manometric catheter, incorporating a rectal balloon, was positioned 7-10 cm from the anal verge. Balloon distensions at both 'low' ( approximately 20 mL) and 'high' ( approximately 28 mL) volumes were performed, in a single-blind, randomized order, during both euglycaemia (4 mmol L-1) and hyperglycaemia (12 mmol L-1). EPs were recorded from a midline scalp electrode (Cz, International 10-20 system) and averaged for each series of 50 distensions. EP latencies and interpeak amplitudes were calculated. RESULTS: Polyphasic EPs were recorded in all but one subject. Although the blood glucose concentration had no significant effect on the latencies of the EP peaks elicited by either 'low'- or 'high'-volume balloon distension, the interpeak amplitude (P1-N1) was greater during hyperglycaemia than during euglycaemia at the 'low' balloon volume (6.3 +/- 1.2 microV vs. 4.8 +/- 1.0 microV, P < 0.05). The blood glucose concentration had no significant effect on the perception of rectal balloon distension. CONCLUSIONS: We conclude that in normal subjects acute hyperglycaemia increases the amplitude of the cerebral EP elicited by rectal balloon distension at low balloon volumes, suggesting that the effects of hyperglycaemia on gastrointestinal sensation may be mediated by central mechanisms.     

Regression of left ventricular hypertrophy and control of hypertension in the spontaneously hypertensive rat (SHR): oxprenolol versus hydrochlorothiazide

The control of hypertension with antihypertensive agents, in the spontaneously hypertensive rats (SHR) can result in regression of established cardiac hypertrophy. This study compared the effects of therapy with oxprenolol (Ox) and with hydrochlorothiazide (Htz) for (1) regression of established left ventricular hypertrophy (LVH) and (2) blood pressure control. Three groups of SHR and 3 comparable groups of Wistar-Kyoto (WKY) rats, matched for age, sex and body wt, were treated with tap water (Gp I), 60-200 mg hydrochlorothiazide kg-1 day-1 (Gp II) and 15-500 mg oxprenolol kg-1 day-1 (Gp III) for 13 weeks. Systolic and diastolic blood pressures (SBP, DBP mmHg), left ventricular wt/body wt ratio (LVwt/Bwt mg g-1) and left ventricular wall thickness (LVWT mm) were recorded. Oxprenolol lowered both systolic (mean +/- S.E. mmHg, 130 +/- 7 vs 189 +/- 8; P less than 0.01) and diastolic blood pressures (mean +/- S.E. mmHg, 104 +/- 6 vs 159 +/- 6; P less than 0.001) and caused regression of left ventricular hypertrophy (mean +/- S.E. mg g-1, 2.91 +/- 0.06 vs 3.10 +/- 0.09; P less than 0.05). In contrast, hydrochlorothiazide did not control blood pressure (mean +/- S.E. mmHg, 183 +/- 5 vs 189 +/- 6 and 152 +/- 5 vs 156 +/- 6), but it did cause regression of left ventricular hypertrophy (mean +/- S.E. mg g-1, 2.67 +/- 0.03 vs 3.10 +/- 0.09; P less than 0.01). Left ventricular wall thickness, measured in the mid-ventricular region, was significantly reduced only by hydrochlorothiazide (mean +/- S.E. mm, 2.76 +/- 0.06 vs 3.21 +/- 0.01; P less than 0.05). These results suggest that regression of left ventricular hypertrophy can occur with or without control of hypertension in the SHR.     

Prediction of conversion from paroxysmal to permanent atrial fibrillation

BACKGROUND: Paroxysmal atrial fibrillation (PAF) transits to permanent atrial fibrillation (PEAF). The current study was to determine whether a P wave-triggered P wave signal averaged electrocardiogram (P-SAECG) and chemoreflexsensitivity (CHRS) are useful to predict a conversion to PEAF in patients with PAF. METHODS: The filtered P wave duration (FPD) and the root mean square voltage of the last 20 ms of the P wave (RMS 20) were measured by P-SAECG. The ratio between the difference of RR intervals in the ECG and venous pO2 before and after 5-minutes oxygen inhalation is measured (ms/mmHg) for the determination of CHRS. Results: A total of 180 patients with PAF were enrolled and followed for a mean of 22.5 months. PEAF occurred in 38 patients (21%) and these patients had a significantly larger left atrial size (43.2 +/- 4.9 vs. 41.0 +/- 5.4 mm, P = 0.021), a significantly longer FPD (158.8 +/- 18.2 vs. 136.7 +/- 16.6 ms, P < 0.0001), and a significantly lower CHRS (1.96 +/- 0.99 vs. 2.44 +/- 1.19 ms/mmHg, P = 0.024) than patients with PAF. Patients with PEAF tended to have a lower RMS 20 (2.38 +/- 0.65 vs. 2.75 +/- 1.18 microV, P = 0.067) than patients with PAF. The chi(2) test showed that the combination of FPD > or = 145 ms, RMS 20 < or = 3.0 microV, left atrial size > or = 41 mm, and CHRS < or = 2.0 ms/mmHg had the best predictive power for PEAF. Patients who fulfilled these criteria had a 12-fold increased risk for a conversion from PAF to PEAF. CONCLUSIONS: Our results show that a P-SAECG, an analysis of CHRS, and left atrial enlargement are clinical predictors of a progression from PAF to PEAF.     

Effects of proximal ventricular septal pacing on hemodynamics and ventricular activation

Recently the use of alternate site pacing to improve cardiac function in patients with bradyarrhythmias has increased. In the present study, hemodynamics of right ventricular septal pacing were studied in seven dogs. A bipolar screw-in lead and endocardial lead were placed in the proximal right ventricular septum and right ventricular apex, respectively. The right ventricle was paced from each site. A conductance catheter and Millar catheter were inserted into the left ventricle to determine the left ventricular pressure and the pressure-volume loop. Cardiac output was measured using the thermodilution method. In five of the seven dogs, ventricular activation was documented by isochronal epicardial activation mapping during each pacing mode. Mean arterial pressure and cardiac output during septal pacing were significantly higher than during apical pacing (110 +/- 17 mmHg vs 100 +/- 18 mmHg; 1.00 +/- 0.39 L/min vs 0.89 +/- 0.33 L/min). The positive dp/dt during septal pacing was significantly higher than during apical pacing (2137 +/- 535 mmHg/s vs 1911 +/- 404 mmHg/s). End-systolic elastance during septal pacing was significantly higher compared to apical pacing (13.1 +/- 0.3 mmHg/mL vs 8.9 +/- 4.0 mmHg/mL). The ventricular activation time during septal pacing was significantly shorter than during apical pacing. The epicardial maps generated during septal pacing were similar to those from atrial pacing. We conclude that hemodynamics and interventricular conduction are less disturbed by proximal right ventricular septal pacing than apical pacing in dogs with normal hearts.     

应用生物反馈训练无肛术后患儿的排便功能

背景先天性无肛术后患儿大便失禁常常会引起心理、生理和社会交往能力的障碍.目的采用生物反馈训练方法对先天性无肛术后大便失禁的患儿进行排便训练,以期改善患儿术后的排便功能.设计自身对照实验.单位中国医科大学第二临床学院小儿外科.对象纳入中国医科大学第二临床学院小儿外科1998-01/2004-10收治的无肛术后有大便失禁的患儿20例,其中完全大便失禁4例,稀便失禁7例,污便9例,均为随访病例.中低位无肛畸形9例;高位无肛畸形11例.方法利用直肠肛管向量测压与肛门外括约肌肌电等客观检测手段,对无肛术后大便失禁的患儿经自行收缩肛门和排便习惯训练1个月后,再选择适宜的矫治大便失禁的方法,进行针对性的生物反馈训练.①加强肛周肌肉力量的生物反馈训练2次/d,待3周后患儿能正确进行肛周肌肉收缩训练,可使用便携式生物反馈训练仪回家继续训练.②改善直肠感觉性与肛门外括约肌协调性生物反馈训练,要反复进行扩张气囊的训练,建立一种正常的排便反射,只要直肠扩张,肛门外括约肌就会出现反射性收缩,防止大便失禁.③每日三餐后30min内进行排便习惯的训练.④电刺激结合生物反馈训练每次持续10min,2次/d,连续三四周.主要观察指标①患儿的最大肛管压、肛管的向量容积和肛门外括约肌肌电的振幅变化.②训练前后患儿直肠肛管反射的阳性率.结果按实际处理分析,20例患儿均进入结果分析.①肛管的最大压力值中低位畸形和高位畸形组训练后比训练前增加[(24.88±16.58)和(18.18±13.71)kPa,(11.87±5.61)和(5.76±3.84)kPa,P＜0.05].②肛管内的向量容积中低位畸形和高位畸形组训练后比训练前增加[(608.10±131.06)和(452.17±69.43)cm(cmHg)2,(139.17±130.02)和(117.01±74.35)cm(cmHg)2,P＜0.05].③肛门外括约肌肌电振幅中低位畸形和高位畸形组训练后比训练前增加[(324.12±67.78)和(266.18±49.38)μV,(152.20±37.42)和(114.08±51.41)μV,P＜0.05].④直肠肛管收缩反射的阳性率训练后高于训练前[90%(18/20),55%(11/20)].结论经生物反馈训练后无肛术后各组肛周肌肉力量、直肠感觉性与肛门外括约肌协调性、排便习惯、肛门外括约肌能力均有明显提高,尤以中低位畸形最明显,最大限度的改善了肛门外括约肌功能,起到了治疗大便失禁的作用.     

Orthostatic hypertension in patients with type 2 diabetes

OBJECTIVE: The prevalence and clinical importance of orthostatic hypertension (OHT) in diabetic patients has not been elucidated, in contrast to orthostatic hypotension, which is occasionally found in diabetic patients with autonomic neuropathy. RESEARCH DESIGN AND METHODS: The prevalence and severity of orthostatic hypertension was investigated in 277 Japanese male patients with type 2 diabetes, including 90 hypertensive patients and 128 nondiabetic age-matched male subjects. Patients treated with antihypertensive drugs were excluded from the study. OHT was defined as an increase in diastolic blood pressure (DBP) from <90 to >or=90 mmHg and/or an increase in systolic blood pressure (SBP) from <140 to >or=140 mmHg after standing from supine position. Clinical profiles and several serum biochemical parameters were determined in addition to chest X-rays and electrocardiograms. RESULTS: The prevalence of OHT in normotensive and hypertensive diabetic patients was significantly higher than in control subjects (12.8 vs. 1.8%, P < 0.01, for normotensive patients; 12.6 vs. 11.1%, not significant, for hypertensive patients). Orthostasis induced a mean increase of 6.8 +/- 11.4 mmHg in SBP and 9.1 +/- 5.2 mmHg in DBP in diabetic patients with OHT compared with those without OHT (-1.0 +/- 9.0 and 3.8 +/- 6.6 mmHg, respectively). Vibration sensation in the lower limb was reduced in diabetic patients with OHT, but the percent coefficient of variation of RR interval, cardio-to-thoracic ratio on chest X-ray, and serum triglyceride levels were higher in these patients compared with normotensive diabetic patients without OHT. CONCLUSIONS: Orthostatic hypertension is a novel complication in normotensive diabetic patients and may associate with early stage neuropathy and development of sustained hypertension.