功能性便秘患者直肠肛门压力变化

目的研究功能性便秘患者直肠肛门运动功能,探讨该疾病发生的可能机制。方法测定了35例慢性功能性便秘患者和11例正常对照者的直肠肛门压力及排便功能。结果①直肠静息压、肛门括约肌静息压及其最大缩窄压等在功能性便秘患者和正常人之间无显著差异(P>0.05);②肛管高压带长度在功能性便秘患者显著高于正常人(P<0.0005);③功能性便秘患者直肠壶腹部的感觉阈值和最大耐受量显著高于正常对照组(P<0.05),直肠最大顺应性显著低于正常对照组(P<0.0005),引起直肠肛门抑制反射的直肠扩张容量在便秘组显著高于正常对照组(P<0.05),肛门松弛率在便秘组显著低于正常对照组(P<0.05);④功能性便秘患者排便时肛门内外括约肌松弛反射均障碍,尤以外括约肌明显。结论功能性便秘患者存在直肠肛门运动功能障碍,这在其发病机制中起重要作用。     

慢性便秘的诊断及其临床亚型的鉴别诊断

便秘是临床常见的症状，包括便次太少，或排便不畅、费力、粪便干结且量少等。系统诊断很重要。病史采集和常规检查能初步鉴别器质性便秘和功能性便秘。肛门直肠测压和全胃肠通过时间等特殊的检查，能进一步指导便秘各临床亚型的诊断。     

Dermatoglyphic patterns in children with chronic constipation

Analysis of the fine ridge configurations on the digits of the palms and soles (dermatoglyphics) may sometimes help in the diagnoses of certain medical disorders. Dermatoglyphic patterns have been reported to be associated with congenital anomalies, such as congenital heart disease, duodenal ulcer, abdominal pain, and constipation. The palmar dermatoglyphic patterns of 77 children with constipation (39 functional and 38 organic constipation) were recorded. The control group consisted of 84 children with inguinal hernia. Those patients with at least one arch identified on any digit of either hand were termed arch positive. There was no significant correlation between arch positivity and constipation (functional or organic), or inguinal hernia (chi square,P=0.9211). Therefore, the presence of palmar arches cannot be used as a screening device for children with chronic constipation, especially of organic etiology.Supported in part, by NIH grant M01RR00042.     

Cisapride in neurologically impaired children with chronic constipation

The efficacy of cisapride as a treatment for chronic constipation in children with severe brain damage was studied in 20 children. Each subject was randomly assigned to double-blind treatment with either cisapride (N=10) or placebo (N=10) for 12 weeks. Stool habits, total gastrointestinal transit time, colonic segmental transit times, and anorectal motility were evaluated in all children before and at the end of the treatment period. Although cisapride significantly (P<0.05) increased stool frequency from baseline to week 12 and no significant change was documented in the placebo group, the mean change in stool frequency per week from baseline to 12 week was not significantly different between the two treatment groups. The use of laxatives or suppositories was significantly (P<0.05) decreased by cisapride, but remained unchanged in the placebo group. Furthermore, cisapride significantly (P<0.05) reduced rectal compliance but had no effect on total gastrointestinal transit time and colonic segmental transit times. In summary, in neurologically impaired children with chronic constipation, cisapride increased bowel frequency but did not alter the delay in total and segmental gastrointestinal transit times.     

应用伊托必利治疗慢性便秘的疗效观察

目的探讨应用伊托必利治疗慢性便秘的疗效。方法对84例慢性便秘患者根据其病理生理特点分型(STC、OOC、MTC),并应用伊托必利治疗2周,观察疗效。结果①应用伊托必利治疗慢性便秘患者2周后胃肠传输时间(Gastrointestinal Tran-sit Time,GITT)缩短;②应用伊托必利治疗2周后便秘患者肛门直肠压力及感觉功能无显著性差异。③应用伊托必利治疗慢性便秘患者2周后,STC组各症状评分较治疗前降低;OOC组各症状评分较治疗前无变化,MTC组排便频率症状评分较治疗前降低,其余较治疗前无变化。结论应用伊托必利治疗慢传输型便秘较出口梗阻型及混合型便秘效果更好。     

Reproducibility of colonic transit study in patients with chronic constipation

PURPOSE: Major therapeutic decisions are rendered based on a single colonic transit study. Therefore, the aim of this study was to assess the reproducibility of colonic transit time in patients with chronic constipation. MATERIALS AND METHODS: Fifty-one patients with chronic idiopathic constipation were randomly selected to undergo two separate colonic transit tests. All clinical conditions, methodology, and patients' instructions were identical on both occasions. The gamma rate (linear correlation analysis) was undertaken between the first and second colonic transit times. Groups were divided according to the diagnoses of colonic inertia (slow-transit constipation), paradoxical puborectalis contraction, and chronic idiopathic constipation (normal-transit constipation). RESULTS: In 35 of 51 patients (69 percent), the results were identical between the two studies; however, in 16 patients (31 percent), the results were disparate (gamma correlation coefficient =0.53;P<0.01). The specific correlation coefficients for patients with colonic inertia, paradoxical puborectalis contraction, and chronic idiopathic constipation were 0.12, 0.21, and 0.60 (P<0.01), respectively. Moreover, the success rate of colectomy for colonic inertia was significantly higher in patients who underwent a repeat transit study confirming inertia than in patients who underwent colectomy based on a single study. CONCLUSIONS: Overall, colonic transit time is reproducible in patients with chronic constipation. The correlation coefficient is best for patients with idiopathic constipation and worst for patients with colonic inertia. This new finding suggests that suboptimal surgical outcome may be attributable to inaccurate diagnosis. Because of this poor correlation coefficient, in patients with colonic inertia, consideration should be given to repeating the colonic transit study before colectomy to help secure the diagnosis and improve outcome.This study was sponsored in part by a generous educational grant from the Caporella family.Read at The American Society of Colon and Rectal Surgeons' 100th Anniversary and Tripartite Meeting, Washington, D.C., May 1 to 6, 1999.     

慢性特发性便秘发病机制探讨

目的通过结肠、肛门直肠动力学的变化及心理学基础初步探讨慢性特发性便秘(CIC)可能的发病机制.方法用肛门直肠测压法检测21例CIC患者肛门直肠动力学的变化,同时进行心理测试.20名健康者作对照.CIC组中11例行远端结肠测压,9例非CIC组作对照.结果CIC患者年龄偏大(P＜0.05);肛门括约肌静息压、最大缩榨压降低(P＜0.025,P＜0.005);肛管高压带长度增加(P＜0.005);引起直肠肛门抑制反射的最小松弛容量(MVR)增加(P＜0.005),肛门括约肌松弛率下降(P＜0.025);直肠内部容量刺激的排便阈值和最大耐受量均明显增加(P＜0.005,P＜0.005);11例CIC组患者远端结肠测压结果表明收缩时间百分比、动力指数较非CIC组均明显降低(P＜0.005);CIC患者焦虑、抑郁精神心理异常倾向的出现明显高于对照组(P＜0.05,P＜0.01).结论CIC发病机制是复杂的,结肠、肛门直肠动力学及精神心理因素均参与发病.     

Long-term follow-up of children with chronic idiopathic constipation

To determine the outcome of chronic idiopathic constipation, we followed 62 children with chronic idiopathic constipation (mean age: 5.2±2.8 years) for a period of five years. Each child received the same initial treatment over a 12-week period and was then followed every three months. After five years from diagnosis, chronic idiopathic constipation persisted in 52% of the children; 47% who remained symptomatic were >10 years old at the time of the five-year evaluation. Of the 27 who were constipated in the first year of life, 63% remained constipated after five years. Children who recovered within the five-year interval were significantly different from those that remained symptomatic in age of onset of constipation (P<0.05) and family history of constipation (P<0.05). After five years, both severity of abdominal pain and degree of soiling significantly decreased in both the recovered and unrecovered groups (P<0.05). This study suggests that chronic idiopathic constipation persists for 5 years in at least half of children. Early age of onset and family history of constipation are predictive of persistence. Abdominal pain and soiling improve in long-term follow-up irrespective of constipation outcome.     

慢性便秘的分型和肛门直肠测压表现

目的：对慢性便秘按结肠传输时间（CTT）和传输指数（TI）进行分型,观察便秘及便秘各型肛门直肠动力学和敏感功能的变化。方法：采用一次口服20枚不透X线标记物于72h拍摄腹平片的方法,根据CTT和TI对慢性便秘进行传输分型;用肛门直肠测压的方法测定不同类型便秘的肛门直肠动力及感觉功能的变化。结果：慢性便秘的传输分型为四型：传输时间正常型（NTC）、慢传输型（STC）、出口梗阻型（OOC）和混合型（MC）。便秘组的肛管静息压和收缩压降低,最大耐受容积增大（P＜0．05）。NTC患者肛管静息压降低（P＜0．05）;STC患者静息压、收缩压降低,最大耐受容积增大（P＜0．05）;OOC患者最大耐受容积增大（P＜0．05）。结论：此种传输试验方法更简单;根据CTT和TI对便秘进行传输分型可体现便秘的动力学原因;不同类型的便秘存在不同的结肠、肛门直肠动力学改变和直肠感觉异常。     

Irritable bowel syndrome and chronic constipation: Fact and fiction

Irritable bowel syndrome(IBS) and functional constipation(FC) are the most common functional gastrointestinal disorders. According to the Rome ⅢCriteria these two disorders should be theoretically separated mainly by the presence of abdominal pain or discomfort relieved by defecation(typical of IBS) and they should be mutually exclusive. However,many gastroenterologists have serious doubts as regards a clear separation. Both IBS-C and FC,often associated with many other functional digestive and non digestive disorders,are responsible for a low quality of life. The impact of the media on patients' perception of these topics is sometimes disruptive,often suggesting a distorted view of pathophysiology,diagnosis and therapy. These messages frequently overlap with previous subjective opinions and are further processed on the basis of the different culture and the previous experience of the constipated patients,often producing odd,useless or even dangerous behaviors. The aim of this review was to analyze the most common patients' beliefs about IBS-C and CC,helping physicians to understand where they should focus their attention when communicating with patients,detecting false opinions and misconceptions and correcting them on the basis of scientific evidence.     

生物反馈治疗慢性便秘的疗效评价

生物反馈治疗以其高疗效、无副作用的特点,成为慢性便秘、特别是功能性排便障碍的一线治疗方案之一。许多因素可能影响对生物反馈治疗效果的判断。本文将就此进行综述,总结客观评价生物反馈疗效时需要注意的方面,为将生物反馈治疗更好地应用于临床提供参考。     

Effect of cisapride on chronic idiopathic constipation in children

The efficacy of cisapride, a new prokinetic drug, as a treatment for chronic functional constipation of childhood was studied in 20 constipated children. Each subject had a stool frequency less than 4/week and/or total gastrointestinal transit time >33 hr and was randomly assigned to double-blind treatment with either cisapride (N=10) or placebo (N=10) for 12 weeks. Stool habits, total gastrointestinal transit time, and anorectal motility were evaluated in all children before and at the end of the treatment period. Cisapride significantly increased stool frequency from 1.2±0.6 to 5.1±1.9 stools/week (mean±SD;P<0.05), whereas the lesser effect of placebo was not significant (1.2±0.8 to 2.8±0.8 stools/weeks;P=0.4). Both treatments significantly (P<0.05) decreased laxative or suppository use. Total gastrointestinal transit time was decreased by cisapride (90.8±9.2 hr to 57.2±20.2 hr;P<0.05) but was not affected by placebo. Anorectal manometry showed that cisapride, but not placebo, significantly decreaed the rectoanal inhibitory reflex threshold and the conscious rectal sensitivity threshold. It is concluded that cisapride improves gastrointestinal motility and bowel habits in children with cronic idiopathic constipation and may be useful in the management of some children with this disorder.     

慢性便秘患者临床特征的研究

目的探讨慢性便秘(CC)患者的临床特点。方法收集医院门诊的CC患者200例,入组患者需填写一份调查问卷,内容包括人口统计学特征、排便习惯及泻剂使用史。将所收集的资料使用EPI3.02录入,并对结果进行统计学分析。结果 200例接受问卷调查的CC患者中,女∶男=2.23∶1(138∶62)。便秘症状谱中,女性无便意/便意少者占所有女性的65.2%,占男性的50.0%,女性排便不尽感者占57.2%,男性占38.7%,二者差异均具有统计学意义(P<0.05)。200例CC患者年龄为10～91岁,女性与男性平均年龄分别为(45.8±17.1)岁及(53.5±22.3)岁,差异有统计学意义(P=0.000)。女性与男性患者发病年龄高峰分别在20～29岁及60～69岁。文化程度:文盲占6.0%,小学占13.5%,初中占24.0%,高中占23.5%,大专占20.5%,大学占11.0%,大学以上占1.5%。饮食习惯:以精粮为主者占95.0%,以素食为主者占76.0%,吃蔬菜水果很少者占39.5%。少年组、青年组、中年组及老年组使用通便药者分别占3.0%、34.5%、22.5%和35.0%。泻剂依赖现象:老年组、中年组及青年组依次为10.0%、8.0%和3.5%,差异有统计学意义(P=0.004)。结论女性CC是男性的2.23倍;慢传输型便秘(STC)与出口梗阻型便秘(OOC)患者中女性较男性比例高;女性平均发病年龄明显小于男性;女性发病年龄高峰为20～29岁,男性为60～69岁;文化程度影响CC的发生率;饮食中多摄入粗粮杂粮及肉类可预防便秘的发生;老年CC泻剂的使用率最高,并且随着年龄的增长,CC患者对泻剂的依赖性增大。     

五羟色胺与慢性便秘

五羟色胺(5-hydroxytryptamine,5-HT)是肠神经系统中一重要的单胺类神经递质.95％来源于消化系统,其中90％位于肠黏膜的嗜铬细胞(enterochromaffin cells,EC),10％位于肠道神经元.5-HT在引发胃肠蠕动和分泌反射,以及调节内脏感觉中起关键作用.有关5-HT在功能性胃肠疾病...     

体重指数、胃动素与慢性便秘的临床研究

目的 讨论体重指数、胃动素与慢性便秘之间的关系。方法 79例慢性便秘患者按体重指数分为A〈20、B20～25、C〉25三组，计算各组患者所占比例，同时检测各组患者空腹及餐后1h的血浆胃动素水平，分析它们之间的差异，并与40例健康人作对照。结果 A、B、C三组慢性便秘患者所占比例分别为53．2％、25．3％、21．5％，A组患者比例明显高于B、C组，差异有显著性（P〈0．01）。A、B、C三组患者及对照组空腹及餐后1h的胃动素水平分别为：（226±38）pg／nL、（280±47）pg／nL、（293±42）pg／nL、（346±58）pg／nL；（265±47）pg／nL、（331±43）pg／nL、（328±52）pg／nL、（427±56）pg／nL。A组低于B、C组，差异有显著性（P〈0．05），B、C组低于对照组，差异亦有显著性（P均〈0．05），B、C组之间差异无显著性（P〉0．05）。结论 低体重指数患者在慢性便秘的人群中所占比例更大，其原因可能与胃动素释放水平低下有关。     

西沙必利对慢性功能性便秘患者结肠转运时间的作用

目的 了解另人结肠转运时间的正常值,并探讨西沙必利对慢性功能性便秘患者的结肠转运时间（ＣＴＴ）的作用。方法 通过连续３ｄ各服一粒含不透Ｘ线标志物的胶囊后于第４、第７天拍摄腹部平片的简化方法,测定２５例正常人及２５例慢性功能性便秘患者的全结肠节段结肠转运时间。对全结肠转运时间延长的便秘患者,给予西沙必利１０ｍｇ每日３次口服治疗,疗程４周。在最后１周复查ＣＴＴ,比较服药前后ＣＴＴ的变化。结果 全结肠转     

慢性阻塞性肺疾病患者骨骼肌功能障碍与氧化应激

近年来慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)的全身表现引起关注,尤其是营养不良、体质量减轻、骨骼肌功能障碍等与COPD患者预后密切相关.氧化应激不但是COPD的发病机制之一,也是导致其骨骼肌功能障碍的重要原因,而运动本身可以诱发和加重COPD患者局部和全身的氧化应激,使病情复杂化.抗氧化治疗是COPD治疗的新靶点,为COPD的运动康复治疗带来了新课题.     

Pilot study of subtotal colectomy with antiperistaltic cecoproctostomy for the treatment of chronic slow-transit constipation

PURPOSE: Functional results of total colectomy with ileorectal anastomosis for the treatment of chronic constipation caused by colonic inertia are often considered unsatisfactory because of the frequency of postoperative diarrhea and the high rate of postoperative small-bowel obstruction. Patients affected by severe colonic inertia underwent a subtotal colectomy with a novel antiperistaltic cecorectal anastomosis. The aim of the study was to assess the functional results after preservation of the cecorectal junction. METHODS: Eight females affected by isolated colonic inertia and two females with both paradoxical puborectalis contraction and colonic inertia, of a median age of 40 years, underwent subtotal colectomy with antiperistaltic cecorectal anastomosis. Before antiperistaltic cecorectal anastomosis all ten patients were laxative-dependant, with a mean bowel frequency of ten days; eight of them (80 percent) had distention, seven (70 percent) bloating, and three (30 percent) abdominal pain. RESULTS: There was no mortality or major postoperative morbidity. One month after antiperistaltic cecorectal anastomosis, bowel frequency was a mean of 2.2 (range, 1–4) per day, with a semiliquid stool consistency. After one year, bowel frequency was a mean of 1.3 (range, 0.5–3) per day, with a solid stool consistency; the same results were recorded at last follow-up. Although no patients used antidiarrheal medicine, laxatives continued to be used by both patients with paradoxical puborectalis contraction. All ten (100 percent) of the patients reported a good or improved quality of life. CONCLUSION: This preliminary experience seems to show that antiperistaltic cecorectal anastomosis is safe and effective for patients with colonic inertia. It results in prompt and prolonged relief from constipation for patients with isolated colonic inertia.     

慢性阻塞性肺疾病患者氧化应激与肺功能的相关性

目的探讨COPD患者氧化应激状态以及对肺功能的影响。方法选择COPD患者88例,行肺功能测定,根据FEV1%及FEV1/FVC分为轻、中、重三组,并对所有入选者抽取静脉血,化学比色法检测血清还原型谷胱甘肽(GSH)、丙二醛(MDA)、超氧化物歧化酶(SOD)的水平。结果与轻度组比较,中、重度COPD患者SOD、GSH水平明显下降,MDA明显升高(P<0.05、P<0.01)。相关分析显示:MDA与肺功能(FEV1%、FEV1/FVC)呈负相关(P<0.01、P<0.05),SOD、GSH与肺功能呈正相关(P<0.01、P<0.05)。结论 COPD患者体内存在氧化应激失衡,随着氧化/抗氧化功能失衡加重,肺功能下降加剧。