老年人慢性便秘的非药物治疗

老年人便秘的发病率越来越高,严重影响老年人生活.老年人便秘的治疗目的:缓解症状、改善或恢复正常的排便.治疗原则:个体化的综合治疗,避免滥用泻剂.治疗方法:包括药物治疗、非药物治疗和外科手术治疗.器质性便秘的治疗应去除原发病因.     

慢性便秘的药物治疗

慢性便秘(chronic constipation,CC)是一种常见的消化系统病症,用于CC治疗的药物很多,正确合理选择药物对CC的治疗非常重要。现笔者结合国内外相关文献报道,就治疗CC现有的药物及新药研究进展综述如下。1泻剂1.1容积性泻剂(膨松剂)此类药物在肠道不被吸收,在肠腔内吸收水分后,增加粪便量,使干硬的粪便变得松软易于排出。另外,不消化的植物纤维在结肠被细菌分解,产生乙酸、丁酸等短链脂肪酸,也能营养结肠黏膜,促进肠道益生菌的生长,增加结肠蠕动。药物主要有含纤维素和欧车前的各种制     

老年人慢性便秘的药物治疗

由于多种原因,老年人中便秘的发病率很高.尽管慢性便秘本身并不是恶性疾病,但不少患者长期受症状困扰,严重影响了他们的生活质量,必须给予这部分患者规范的治疗.然而我们发现这些患者的就诊率并不高,往往缺乏必要的检查评估,常常自行购买一些药物,尤其是廉价的刺激性泻药,服用方法上也不够规范,导致病情长期不能缓解,出现药物依赖,甚至严重的不良反应.     

重视老年人慢性便秘的治疗

慢性功能性便秘（CFC）是老年人的常见病,其危害不容忽视。CFC的治疗包括生活方式调整、药物、生物反馈、手术等多种方法,但老年人CFC的疗效仍差强人意,难治性便秘并不少见。为了进一步提高老年人CFC治疗水平,应给患者制订个体化的治疗方案,积极应用国内外推荐的慢性便秘处理流程,规范治疗行为,同时深入开展老年人CFC的治疗研究,利用多中心、双盲、随机、安慰剂对照临床研究,重新评价一些传统疗法、传统药物（尤其是中药）及新近上市药物治疗老年人CFC的疗效和安全性,为安全有效治疗老年人CFC提供更多的循证医学依据。     

慢性便秘的治疗进展

慢性便秘(chronic constipation CC)是一种很常见的症状,涉及多学科方面。如内、外、儿、妇、老年病等科。往往给患者带来许多苦恼,严重时会影响生活质量。而今,随着现代人生活节奏的加快,精神压力的增加及饮食结构的改变,其发病率有逐渐升高的趋势。国外资料显示。慢性便秘的发病率在年轻人3％,中年人8％,老年人20％。在中国有报道估计1／     

成人慢性便秘的非药物治疗简述

便秘(constipation)即为排便次数减少、粪便量减少、粪便干结、排便费力;慢性便秘(chronic constipation,CC)的病程至少是6个月。随着社会老龄化、饮食结构改变、精神心理压力、社会因素等影响,CC的患病率逐年增加。CC可继发痔疮、肛裂等肛肠疾病,增加结肠癌、心血管疾病、阿尔茨海默病等发生风险,增加患者的经济和心理负担。目前的治疗主流是以药物为主的经验治疗,长期药物通便导致的不良反应、疗效减退、医疗资源耗费等,使便秘的非药物治疗得以重视。本文就CC的非药物治疗进行初步探讨。     

老年人慢性便秘及行为学

便秘不分年龄和性别均可发生，但高危人群是儿童、妊娠妇女，手术（心肺、妇科、腹部及肛门）后患者及老年人，老年便秘占２５％～３３％，老年人慢性便秘只是一个主诉，可以由于全身或肛周疾病而引起排便困难，排便是一组肌群的动作，协调与完成这个动作，却与排便行为十分相关，分析如下：老年人便秘特点一、老年人膈肌、腹肌、提肛肌与结肠壁平滑肌收缩能力普遍下降，因此排便动力较成年人明显下降。健康老人肠内粪便运转至直肠的时间是５天，虚弱老人长达８天，生理上的特点，无形促使老年人容易便秘。二、老年人随着增龄，胃肠粘膜萎缩…     

老年人慢性便秘的中成药治疗

慢性便秘可由多种疾病引起,临床治疗以有效通便、合理用药并维持疗效为主要目的,目前西医治疗以泻剂使用为主。中成药作为中医药大家族中的一员,不仅具有对症治疗、寓泄于补、标本兼顾的特点,而且因其使用方便,副作用较少,在临床上被广泛应用。结合文献及临床体会,我们将老年人便秘患者分为大肠热结证、肠道气滞证、大肠湿热证、肺脾气虚证、脾肾阳虚证及经亏血少证等证型,辨证施治,实行个体化治疗,达到疗效较好、副作用较少的目的。     

老年慢性心力衰竭的药物治疗进展

慢性心力衰竭(CHF)是老年人最常见的临床综合征之一,是各种心脏病的严重阶段,发病率高,5年存活率与恶性肿瘤相仿[1].我国60岁以上老年CHF患者将会不断增加[2].据我国50家医院住院病例调查,心力衰竭的住院率只占同期心血管病的20%,但死亡率却占40%[3].老年人由于机体的老化,器官功能的衰退,药代动力学及药效学改变,加之并发病的存在,使病情与治疗更为复杂化,常担心药物不良反应而导致患者停药,药物治疗顺从性差[4].本文就老年CHF的临床药物治疗进展作一综述.     

慢性功能性便秘临床治疗研究现状

慢性功能性便秘是一种全球范围的常见症状.流行病学资料[1、2]显示其发病率在亚洲约为8.75％,在西方国家则为27％,在我国为4％～6％.2006年颁布的“罗马Ⅲ-功能性胃肠病”已明确将出口梗阻型便秘归类至功能性肛门直肠病,称为功能性排便障碍,功能性便秘则特指以结肠传输减慢为主的患者[3].其典型的症状包括[4]：肠道蠕动减慢、大便干硬以及排便时困难.随着生活习惯和饮食结构的改变,慢性功能性便秘发病率仍呈上升趋势.目前仍无规范的治疗指南,笔者根据文献回顾性总结了治疗便秘的常用及新兴药物,并根据中医药在慢性功能性便秘的治疗提出现代中医药的研究方向.关键词：便秘,慢性功能性;药物治疗分类号：R574.62 文献标识码：A文章编号：1671-038X（2013）11-0611-03     

Use of complementary and alternative medicine to treat constipation in the elderly

Many modalities of complementary and alternative medicine, such as probiotic bacteria, traditional herbal medicines, biofeedback and massage, have been used to treat constipation in older adults. Virtually all studies in the published literature have been plagued with methodological problems, such as lack of blinding. Chinese herbal medications have been the most frequent subject of studies in controlled trials, but have suffered from methodological insufficiencies, and few have been published in publications other than Chinese language journals. Several therapies, such as yogurt containing probiotic bacteria and massage, are relatively easy to use by the patient, and are likely to cause few adverse reactions. Therefore, complementary and alternative therapies might show the greatest promise for being adopted as adjunctive therapies to conventional treatment. Geriatr Gerontol Int 2013; 13: 533–538.     

伴有慢性便秘的老年缺血性结肠炎的临床特点

目的对伴有便秘的老年缺血性结肠炎（IC）患者的临床特点进行总结,旨在更好地指导临床工作,减少误诊、漏诊。方法回顾性地分析复旦大学附属华东医院消化内科2008年至2013年收治的160例老年IC患者,其中男35例,女125例,根据有无便秘分为便秘组和非便秘组,比较两组IC患者的基础疾病、临床表现、误诊情况、实验室检查、内镜和病理组织学检查结果,以及诊治经过及疾病转归等。结果160例IC患者中,便秘患者占57．5％;便秘组发病年龄低于非便秘组;临床表现不典型;误诊率高（48．8％）;病变程度较重;治疗2周后黏膜完全愈合率63.0％低于非便秘组79．9％。便秘组中78．3％的患者病变位于左半结肠与非便秘组75．0％相仿。结论慢性便秘在老年IC中常见,是老年IC发病的重要危险因素。伴有慢性便秘的老年IC患者临床表现不典型,当慢性便秘患者存在其他危险因素如高血压、冠心病、糖尿病等,一旦出现腹痛或便血时应高度警惕IC发生,应尽早行肠镜检查,明确诊断。     

慢性便秘的流行病学研究现状

慢性便秘是临床常见病症,老年人是其高危高发人群。慢性便秘不仅危害患者的身心健康、降低患者的生活质量,而且产生的直接医疗费用不菲,加重了患者和社会的经济负担。深入开展便秘的流行病学的研究,掌握慢性便秘的流行病学特点,尤其是危险因素及高危人群,对于制订慢性便秘的干预策略和干预措施以及开展慢性便秘的社区综合干预,都具有极其重要的意义。本文主要就慢性功能性便秘的流行病学研究现状做一简要综述,供同道参考。     

Prucalopride succinate for the treatment of constipation: an update

Constipation is a disorder frequently complained about by patients in daily clinical practice. However, to date, its treatment is still commonly unsatisfactory, especially concerning patients’ quality of life, when using conventional measures. Prucalopride, a selective 5-hydroxytryptamine receptor 4 agonist, was introduced to the market in 2009 and has been commercially available in Europe since 2010. The main effect of prucalopride is to stimulate colonic motility, which explains its efficacy to treat constipated patients unresponsive to other regimens. Literature search was carrieod out to look for effects of prucalopride on constipated patients. Several papers were found demonstrating that prucalopride is effective in treatment of constipated patients. Due to its few side effects, the lack of cardiovascular effects and interactions with other drugs, prucalopride may be safely used in elderly people as well.     

慢性功能性便秘的微生态治疗进展

慢性功能性便秘是一种常见的肠道疾病,目前的治疗方法主要为药物治疗。肠道微生态的深入研究揭示了肠道微生态紊乱与肠道疾病的相互关联作用,而恢复肠道微生态平衡也逐渐成为疾病治疗的一种手段。近几年肠道微生态的治疗在慢性功能性便秘领域取得了一定的进展,口服益生菌以及粪菌移植等治疗手段均获得了良好的效果。本文对慢性功能性便秘的微生态治疗的研究进行初步总结,为后续的益生菌种类的完善和治疗手段的改进提供思路。     

Association between falls and high-risk medication use in hospitalized Asian elderly patients

Aim:   Most studies looking at the relation between medication use and fall among the hospitalized elderly patients, were done in Western countries. So, a study was planned to investigate the role of medications in causing falls in hospitalized Asian elderly patients.
Methods:   Case note review was done for all patients age 65 years and above, who fell at least once during their hospital stay over a 12-month period. Information obtained from the case notes included: (i) demographic information; (ii) Modified Morse Fall scale; (iii) circumstances and time of fall; and (iv) medication use. From the hospital admission database, an age- and sex-matched control group was selected for comparison.
Results:   Over the 12-month study period, 298 patients met the study criteria. Average age of the patients was 75.8 years, 60.4% were male and 84.9% were Chinese. Multivariate analysis showed that fallers had longer lengths of stay and were more likely to have a history of falls. Fallers were also more likely to be taking hypnotics, cough preparations and anti-platelets, but less likely to be taking paracetamol. Fallers were on fewer medications.
Conclusion:   Elderly hospitalized patients on hypnotic drugs, cough preparations and anti-platelets were more likely to fall. Appropriate usage of analgesics, especially paracetamol, to relieve pain may reduce falls.     

Prucalopride for the treatment of constipation: a view from 2015 and beyond

Introduction: Prucalopride is a prokinetic drug, that has been commercially available in recent years for the treatment of chronically constipated patients. In this update of a previous 2016 article, we reviewed the more recent data supporting its role in the treatment of constipation and constipation-associated conditions.

Areas covered: We carried out an extensive literature review on the effects of prucalopride for the years 2012–2018 by means of scientific databases and manual research. More evidence was found on its possible therapeutic role in conditions in which constipation plays a role as an associated symptom, such as opioid-induced constipation, constipation-predominant irritable bowel syndrome, post-operative ileus, colonic diverticular disease, drug-related constipation, and chronic intestinal pseudo-obstruction.

Expert opinion: Based on the added literature evidence, we feel that prucalopride is an effective, although expensive, drug for the treatment of primary and secondary forms of constipation, and of other clinical conditions associated with constipation.