替加色罗治疗老年慢性功能性便秘的临床观察

目的评价替加色罗治疗老年慢性功能性便秘的疗效和安全性。方法本试验通过38例老年慢性功能性便秘患者接受替加色罗治疗,疗程4周,观察排便次数和大便性状的变化。结果治疗2周和4周的总有效率分别为55.3%和60.5%;排便次数(次.周-1)分别由治疗前(1.48±0.61)增至(3.52±0.93)(2周)和(3.57±0.89)(4周),P<0.05;治疗2周和4周后患者大便性状正常例数由治疗前的0例增至17例和18例;治疗4周后患者的腹胀、腹痛、排便困难、食欲不振等四症状的缓解率均>60%。不良反应的发生率为5.3%,未见严重不良反应。结论替加色罗是一种治疗老年慢性功能性便秘有效、安全的药物。     

排便技术训练对功能性便秘患者临床症状及肛管直肠功能的影响

目的：探讨排便技术训练对功能性便秘患者临床症状及肛管直肠功能的影响。方法选取本院2010年3月~2012年2月收治的36例功能性便秘患者作为对照组,给予常规综合干预措施。选取本院2012年3月~2014年2月收治的40例功能性便秘患者作为研究组,在对照组的基础上给排便技术训练方案。比较两组干预前后的肛管直肠压力、直肠感觉功能及排便基本情况。结果研究组干预后的肛管静息压、肛门最大收缩压、用力排便时直肠压力显著高于对照组,差异有统计学意义(P<0.05)。研究组干预后的直肠初始感觉容量、直肠初始便意感觉容量、排便窘迫容量及直肠最大耐受容量显著低于对照组,差异有统计学意义(P<0.05)。研究组干预后的便秘症状评分显著低于对照组,差异有统计学意义(P<0.05)。结论排便技术训练方案在功能性便秘患者中的应用效果显著,能有效改善患者的直肠肛管受损程度,并促进正常排便,减轻不良症状。     

太宁调节功能性出口梗阻型便秘患者肛管直肠功能的研究

目的观察太宁对功能性出口梗阻型便秘患者的疗效及对便秘患者肛管直肠功能的影响,探讨太宁治疗便秘的机制。方法根据结肠运输时间和运输指数选择功能性出口梗阻型便秘患者,给予太宁治疗,并设康妇消炎栓为对照。用药前后观察便秘患者临床症状积分和肛管直肠功能变化。结果太宁治疗后,出口梗阻型便秘患者症状评分显著下降,其有效率明显优于康妇消炎栓组,且太宁治疗后患者肛管静息压、模拟排便时的肛管压力及直肠感觉阈值均显著降低。结论太宁可恢复功能性出口梗阻型便秘患者直肠感觉功能,纠正直肠肛管动力异常,是对其治疗的有效药物。     

替加色罗对便秘型肠易激综合征肠转运时间的研究

肠易激综合征(irritable bowel syndrome，IBS)是以反复发作的腹痛或腹部不适，排便习惯改变为特征的慢性功能性肠道病变。其病理生理机制尚未完全清楚，目前认为主要是胃肠动力异常和内脏感觉异常。恢复正常的肠动力和肠神经系统的信号传递是肠易激综合征合理药物治疗的靶点例。     

盐酸伊托必利对功能性便秘重叠消化不良患者的症状及胃肠运动功能的影响

目的观察盐酸伊托必利对功能性便秘重叠消化不良患者的症状及胃肠运动功能的影响。方法将慢性功能性便秘重叠功能性消化不良患者分为伊托必利治疗组(40例)和多潘立酮对照组(40例),观察并记录便秘和消化不良症状,应用不透X线标志物法对每组各20例治疗前后胃肠运动功能进行检测。结果 2组消化不良症状均有改善,治疗组更为明显;治疗组便秘症状有显著改善;治疗组与对照组有效率为80%和58%(P<0.05);2组胃排空率较治疗前有所增加,治疗组全胃肠排出率明显增加。结论伊托必利治疗慢性功能性便秘重叠功能性消化不良安全有效,能改善症状,促进胃肠运动功能恢复。     

莫沙必利联合穴位注射对功能性消化不良患者近端胃舒张和胃排空功能的影响

目的 探讨莫沙必利片联合穴位注射对功能性消化不良(FD)患者近端胃舒张和胃排空功能的影响.方法 收集FD患者142例,随机分为对照组和联合组,每组71例.对照组给予枸橼酸莫沙必利片治疗,联合组在口服枸橼酸莫沙必利片治疗同时,给予穴位注射复方丹参注射液治疗.观察两组治疗前、后血清胃动素(MTL)、胃促生长素(Ghrelin)水平、胃底气体评分、胃排空率及饮水和显影剂后0、30、60 min时的近端胃容积变化,同时对比两组的临床疗效.结果 治疗后联合组的血清MTL、Ghrelin水平分别为(218.6±27.4) pg/ml、(3.8±1.6) ng/ml,明显高于对照组的(175.1±26.5) pg/ml、(3.2±1.5)ng/ml (P＜0.05);胃底气体评分为(0.4±0.2),明显低于对照组的(0.6±0.3);胃排空率为(75.8±19.4)％,明显高于对照组的(57.2±l6.6)％(P＜0.05);治疗后饮水和显影剂后60 min时,联合组近端胃容积为(12.4±4.6)ml,明显小于对照组的(22.6±5.2)ml(P＜0.05),联合组的显效率及总有效率分别为63.4％、87.3％,明显高于对照组的35.2％、63.4％ (P＜0.05).结论 枸橼酸莫沙必利片联合穴位注射能有效提高FD患者的MTL、Ghrelin水平,降低胃底气体评分,促进胃排空,改善近端胃舒张功能,提高临床疗效.     

盐酸伊托必利片对功能性消化不良患者生化指标及胃电图和胃动力的影响

目的探讨盐酸伊托必利片对功能性消化不良患者血清5-羟色胺(5-hydroxytryptamine,5-HT)、生长抑素(somatostation,SS)及胃电图和胃动力的影响。方法选择2012年1月~2014年1月期间在广东省广州南方医科大学南方医院纳入的115例患者,按照随机数字表法随机分为观察组(n=59)和对照组(n=56)。对照组采用常规治疗方法,观察组在对照组基础上结合盐酸伊托必利片50 mg,每天3次,餐前30 min口服,疗程均为4周。结果治疗前,2组血清5-HT和SS含量、胃体、胃小弯、胃大弯、胃窦电节律和电功率比较,差异不具有统计学意义。与治疗前相比,治疗后2组血清5-HT和SS含量、胃体、胃小弯、胃大弯、胃窦电节律和电功率均显著降低,且具有统计学意义(P<0.05),与对照组相比,观察组血清中5-HT和SS含量、胃体、胃小弯、胃大弯、胃窦电节律和电功率显著降低,且具有统计学差异(P<0.05);与对照组相比,观察组初始压力和初始容积、最大耐受容积和最大耐受压力值均显著升高,且均具有显著性意义(P<0.05)。结论盐酸依托必利片对功能性消化不良患者效果显著,具有重要临床研究价值,值得临床进一步推广研究。     

柴枳平肝汤联合多潘立酮片治疗功能性消化不良肝胃不和证54例及对胃肠激素、血清神经肽S受体-1水平的影响

目的 观察柴枳平肝汤治疗功能性消化不良(FD)肝胃不和证对病人胃肠激素、血清神经肽S受体-1(NPSR1)水平的影响.方法 选取三亚市中医院2016年10月至2019年2月收治的FD肝胃不和证病人108例,采用随机数字表法分为对照组和观察组,各54例,分别给予单纯多潘立酮片治疗和柴枳平肝汤联合多潘立酮片治疗,比较两组治...     

数字化音乐电胃肠起搏对食管癌术后肠道屏障功能、炎症和氧化应激的影响

目的探讨数字化音乐电胃肠起搏对食管癌术后肠道屏障功能、炎症和氧化应激的影响。方法选取 2016年 3月至 2018年 6月于河北省胸科医院住院的 120例食管癌病人作为研究对象,分为四组,即 A、B、C和 D组, A组病人给予胃肠减压等一般治疗措施, B组病人在 A组的基础上给予足三里穴按摩, C组病人在 A组的基础上给予胃肠起搏, D组在 A组的基础上给予数字化音乐电胃肠起搏治疗,共治疗 7d。观察胃肠功能的恢复情况,包括肠鸣音恢复时间、排气时间、排便时间、胃管留置时间、胃液引流量;酶联免疫吸附试验检测血清中内毒素、二胺氧化酶( DAO)、紧密连接蛋白( Occludin)、闭锁小带蛋白( ZO?1)、肿瘤坏死因子 ?α(TNF?α)、白细胞介素 ?6(IL?6)、白细胞介素 ?8(IL?8)和白细胞介素 ?10(IL?10)的含量;蛋白质免疫印迹检测外周血单个核细胞中 Toll样受体 ?4(TLR4)/核因子 ?κB(NF?κB)信号通路的表达;黄嘌呤氧化酶法检测超氧化物歧化酶( SOD)的活性,硫代巴比妥酸法检测丙二醛( MDA)的含量。结果 D组的肠鸣音恢复时间( 36.20±5.15)h、排气时间( 52.87±4.51)h、排便时间( 73.42±6.92)h、胃管留置时间( 80.95±7.65)h、胃液引流量( 895.44±101.35)mL、内毒素( 5.37±2.40)ng/L、DAO(2.71±0.70)U/ L、Occludin(13.61±3.20)μg/L、ZO?1(23.55±3.60)μg/L、TNF?α(12.35±3.61)ng/L、IL?6(16.48±4.01)ng/L、IL?8(37.87±9.71)ng/L均低于 A组［(48.72±5.93)h,(68.17±6.45)h,(87.20±6.67)h,(97.34±8.19)h,(1334.50±211.80)mL,(11.83±3.62)ng/L,(3.69±0.53) U/L,(21.56±3.94)μg/L,(31.01±4.33)μg/L,(26.31±4.29)ng/L,(33.72±5.44)ng/L,(82.67±12.55)ng/L］、 B组［( 45.62±5.50)h,(63.48±6.70)h,(79.95±7.69)h,(91.17±6.89)h,(1180.46±196.15)mL,(8.55±2.19)ng/L,(3.31±0.64)U/L,(19.49±2.88)μg/L,(27.36±4.02)μg/L,(20.70±3.88)ng/L,(25.09±4.85)ng/L,(72.63±11.44)ng/L］、 C组［(41.04±6.11)h,(61.25±5.81)h,(77.29±7.13) h,(88.72±9.03)h,(1047.28±160.33)mL,(7.80±3.25)ng/L,(3.12±0.59)U/L,(15.51±3.49)μg/L,(28.11±4.52)μg/L,(17.65±3.24) ng/L,(26.67±5.03)ng/L,(65.51±13.10)ng/L］,且 B、C组低于 A组( P＜0.05),但是四组间 IL?10的含量差异无统计学意义( P＞0.05)。 D组外周血单个核细胞中的 TLR4(0.44±0.11)和 NF?κB(0.28±0.13)蛋白表达量均低于 A组［(1.00±0.24)(1.00±0.21)］、 B组［( 0.86±0.15)(0.84±0.22)］、 C组［( 0.75±0.20)(0.45±0.16)］且 B、C组低于 A组( P＜0.05)。 D组血的 SOD含量清中,(418.50±36.22)U/L高于 A组( 363.62±24.01)U/L、 (385.09±30)U/L、C组( 391.33±27.44)U/L,且 B、C组高于 A组( P＜均,B组,.58,0.05); D组血清中的 MDA含量( 5.11±0.66)μmol/L均低于 A组( 6.42±0.85)μmol/L、B组( 5.89±0.74)μmol/L、C组( 5.65±0.80) μmol/L,且 B、C组低于 A组( P＜0.05)。结论数字化音乐电胃肠起搏能够改善食管癌术后病人的肠道屏障功能,下调血清炎性因子含量和外周血单个核细胞中 TLR4/NF?κB信号通路的表达,降低氧化应激水平。     

Tegaserod for dyspepsia and reflux symptoms in patients with chronic constipation: an exploratory open-label study

Objective To evaluate the potential role of tegaserod in the management of functional dyspepsia (FD) and gastroesophageal reflux disease (GERD) in patients with chronic constipation and to determine the possible efficacy of tegaserod on solid-phase gastric emptying and gastric hypersensitivity. Method This was an exploratory open-label trial of tegaserod therapy for dyspepsia and reflux symptoms in patients with chronic constipation. The study cohort consisted of 90 patients randomized to three treatment groups for a study period of 4 weeks (tegaserod 6 mg, twice daily; esomeprazole 40 mg, once daily; tegaserod 6 mg, twice daily plus esomeprazole 40 mg, once daily). Twenty healthy volunteers provided control values. Clinical symptoms were evaluated by one of the investigators using a Gastrointestinal Symptom Rating Scale (GSRS). Solid-phase gastric emptying and colonic transit were measured by the radiopaque barium marker method, and the water load test (WLT) was used to evaluate gastric sensation and the function of proximal stomach. The proportions of patients with complete relief of epigastric pain /discomfort, epigastric fullness, early satiety and heartburn in the tegaserod group and the tegaserod plus esomeprazole group were compared with the esomeprazole group, respectively. Results The mean global gastrointestinal (GI) scores of all three treatment groups reported using the GSRS showed the same trend, with decreasing scores over the 4-week study period indicating a reported decreasing severity of symptoms that was significantly different from baseline values. Patients in the tegaserod plus esomeprazole group reported the lowest global GI scores after 4 weeks, as expected. Solid-phase gastric emptying (GER) and colonic transit (CTT) increased significantly in the tegaserod 6 mg twice daily group compared with baseline. These parameters did not change in the esomeprazole group at week 4 compared with baseline. In terms of gastric sensation, in the tegaserod group, the proportions of patients with hypersensitivity of the first perception threshold did not change at week 2 or week 4 compared with baseline; however, in this group and in the tegaserod plus esomeprazole group, the proportions of patients with hypersensitivity of discomfort threshold decreased significantly at week 4 compared with baseline. In the esomeprazole group, there were no changes in the proportions of patients with hypersensitivity of the first perception threshold and discomfort threshold at week 2 or 4 compared with baseline. No severe adverse events were recorded, and the medications were in general well-tolerated. Conclusion Tegaserod is effective and safe at improving dyspepsia and reflux symptoms in patients with chronic constipation, and tegaserod plus esomeprazole is superior to esomeprazole alone in the resolution of epigastric pain/discomfort and heartburn.     

慢性功能性便秘非药物性治疗的研究

目的对慢性便秘进行分型,观察胃肠起搏、生物反馈等非药物性治疗对不同类型便秘的效果。方法采用肌电图、胃肠传输试验和肛门直肠测压检查等方法,将便秘分为慢传输型(STC)、出口梗阻型(OOC)和混合型(MIX),针对不同类型便秘分别采用胃肠起搏、生物反馈等非药物治疗方法并评估疗效。结果治疗后慢传输型、出口梗阻型、混合型患者的症状积分均有明显下降,与治疗前相比差异有显著意义(P<0.05)。结论针对不同类型便秘分别采用胃肠起搏、生物反馈等非药物治疗方法可获得较好的临床症状改善及远期效果,对减少泻剂的滥用和依赖有一定的帮助。     

Effects of prucalopride on colonic transit, anorectal function and bowel habits in patients with chronic constipation

BACKGROUND: There is a need for better tolerated drugs to normalize bowel function in chronic constipation. Prucalopride is a highly selective, specific, serotonin4 receptor agonist with enterokinetic properties. AIM: To evaluate the effects of prucalopride on bowel function, colonic transit and anorectal function in patients with chronic constipation. METHODS: Twenty-eight patients were enrolled in this double-blind, placebo-controlled, crossover study (prucalopride: 1 mg, n=12; 2 mg, n=16). Patients kept a bowel function diary. Colonic transit times and anorectal function (anal manometry, rectal sensitivity and rectal compliance) were assessed. RESULTS: Prucalopride (1 mg) compared to placebo significantly increased the mean number of spontaneous complete, spontaneous and all bowel movements per week. Prucalopride (1 mg) significantly decreased the percentage of bowel movements with hard/lumpy stools and straining and increased the urge to defecate. Prucalopride (1 and 2 mg) decreased the mean total colonic transit time by 12.0 h (prucalopride 42.8 h vs. placebo 54.8 h; P=0.074). No statistically significant effects were found in any of the anorectal function parameters. Prucalopride was well tolerated. There were no clinically relevant changes in standard safety parameters. CONCLUSIONS: Prucalopride significantly improves stool frequency and consistency, and the urge to defecate, and may decrease colonic transit times in patients with chronic constipation.     

Effects of psyllium therapy on stool characteristics, colon transit and anorectal function in chronic idiopathic constipation

Background: Psyllium is widely used in the symptomatic therapy of constipation. Its effects on colonic function and their correlation with symptomatic response have not been defined. Methods: After a 4-week baseline, placebo, run-in phase, 22 subjects with idiopathic constipation confirmed by prospectively administered stool diaries were randomly assigned to receive either psyllium (5 g b.d., 11 patients) or placebo (11 patients) for 8 weeks, followed by another 4-week wash-out, placebo phase. A colon transit study and anorectal manometry were performed at the beginning and at the end of each study phase. Subjects recorded, in diaries, their daily stool frequency, difficulty with defecation and weekly stool weight. Results: Stool frequency increased significantly after 8 weeks of psyllium treatment (3.8 ± 0.4 vs. 2.9 ± 0.1 stools/week, P < 0.05) as did stool weight (665.3 ± 95.8 g vs. 405.2 ± 75.9 g, P < 0.05). Subjects also reported an improvement in stool consistency (stool consistency score: 3.2 ± 0.2 vs. 3.8 ± 0.2, P < 0.05) and pain on defecation (pain score: 2.0 ± 0.4 vs. 2.6. ± 0.5, P < 0.05) on psyllium. Colon transit and anorectal manometry parameters were unchanged on psyllium. Subjects treated with placebo did not show any change in either subjective or objective measures of constipation. Conclusions: Psyllium increases stool frequency and weight and improves stool consistency in idiopathic constipation. These effects are not associated with significant changes in either colonic or rectal motor function. We suggest that the beneficial effects of psyllium in constipation are primarily related to a facilitation of the defecatory process.     

护理干预在补气行气活血润肠法治疗慢传输型便秘中的研究

目的 观察评价优质综合护理干预措施在补气行气活血润肠法治疗慢传输型便秘(STC)中的应用效果.方法 将66例经补气行气活血润肠法治疗慢传输型便秘患者按照数字表法随机分为对照组与观察组,各33例.对照组给予常规护理;观察组则在对照组基础上给予优质护理干预,并比较两组护理效果.结果 观察组护理干预前QOL各项评分与对照组比较,差异无统计学意义(均P＞0.05);观察组护理干预后QOL各项评分明显高于对照组(均P＜0.05).观察组护理满意度为96.97％,明显高于对照组的81.82％(x2=3.995 2,P＜0.05).结论 优质护理干预对经补气行气活血润肠法治疗慢传输型便秘患者,能够有效提高患者的生活质量及患者对护理满意度,值得临床大力推广应用.     

The rationale,efficacy and safety evidence for tegaserod in the treatment of irritable bowel syndrome

A growing body of evidence implicates abnormal serotonergic regulation of gastrointestinal function in the pathogenesis of the irritable bowel syndrome (IBS). Drugs targeting this system are therefore attractive concepts. The partial 5-HT₄ receptor agonist tegaserod might be predicted to have positive therapeutic effects on a constipated and uncomfortable gut. However, IBS runs a chronic, benign course and carries no associated mortality, so it is imperative that the safety profile of new pharmacological agents made available to physicians is exemplary. The authors review the evidence for 5-HT in the aetiology of IBS and its symptoms, and the data available concerning the partial 5-HT₄ receptor agonist tegaserod, in terms of rationale, efficacy and safety.     

慢性便秘治疗药物的研究进展

慢性便秘是一种常见疾病,能够明显影响患者的生活质量,并且需要投入大量治疗费用。用于治疗慢性便秘的药物种类较多,包括促动力药、促分泌药、胆汁酸调节剂和缓泻剂等药物,但是目前没有一种药物能够治疗所有类型的慢性便秘。按照相关作用机制,介绍了一些临床使用或在研的慢性便秘的治疗药物。     

慢传输型便秘大鼠结肠肌间神经丛变化的研究

目的观察大黄所致慢传输型便秘大鼠结肠肌间神经丛的变化,揭示大黄与该病发展的相关性。方法利用中药大黄制作大鼠慢传输型便秘动物模型,观察结肠传输功能及生长抑素（SOM）、P物质（SP）的表达,结肠肌间神经丛病理及超微结构变化。结果大黄模型组结肠传输功能缓慢;黏膜慢性炎症,全层大量嗜酸性粒细胞浸涡;肌阃神经丛神经细胞空泡变性、减少;结肠肌间神经丛内未找到Cajal间质细胞,大鼠结肠肌间神经丛SOM、SP含量较对照组明显下降（P〈0．01）。结论大黄等蒽醌类泻剂损伤结肠壁神经丛,使结肠传输功能下降。因此,对慢传输型便秘患者治疗时,应避免长期应用此类药物。     

己酮可可碱对慢传输型便秘模型大鼠的结肠黏液分泌和结肠肌电活动的影响

目的研究己酮可可碱对大鼠慢传输型便秘模型结肠肌电活动特点及其黏膜上皮杯状细胞黏液分泌情况的影响,探讨己酮可可碱对慢传输型便秘的疗效及相关机制。方法灌胃给予复方苯乙哌啶并限水导致大鼠慢传输型便秘模型,结扎分离取出的盲结肠段随即固定,制作石蜡切片,AB-PAS染色,供组织学观察;埋植电极,观察大鼠结肠肌电活动。结果己酮可可碱中、高剂量组粪便表面出现较多黏液,与模型组相比差异具有统计学意义(P<0.05)。已酮可可碱组的肠电慢波、慢波频率变异系数及频率、振幅变异系数,与模型组比较差异具有统计学意义(P<0.05)。结论己酮可可碱可以通过改善便秘模型大鼠的肠道微循环,提高肠道动力,增加结肠黏液的分泌,恢复结肠肌电的慢波频率及振幅,从而起到治疗慢传输型便秘的作用。