四磨汤和西沙必利治疗功能性消化不良的临床观察

目的：观察四磨汤和西沙必利功能性治疗功能性消化不良（ＦＤ）的疗效。方法：将１１２例ＦＤ患者随机分成四磨汤治疗组，西沙必利治疗组和两药联合治疗组３组，观察治疗前后症状的变化。结果：四磨汤２周与４周的总有效率分别为５６．７６％和７２．９７％，西沙必利治疗２周与４周的总有效率分别为６１．１１％和７７．７８％，疗效无显著性差异；     

慢性肺源性心脏病患者血清甲状腺激素及尿碘水平的临床观察

目的　探讨慢性肺心病患者甲状腺功能及尿碘水平变化。方法　应用放射免疫分析法及恒温消解尿碘分析法检测 ４１ 例不同缺氧程度的慢性肺心病患者及 ２５ 例健康对照组血清 Ｔ Ｔ３、 Ｔ Ｔ４、ｒ Ｔ３、 Ｔ Ｓ Ｈ 及尿碘水平。结果　慢性肺心病患者血清 Ｔ Ｔ３、 Ｔ Ｔ４、 Ｔ Ｓ Ｈ 及尿碘水平降低，以重度缺氧组降低幅度大，ｒ Ｔ３ 水平增高。结论　慢性肺源性心脏病患者血清 Ｔ Ｔ３、 Ｔ Ｔ４、 Ｔ Ｓ Ｈ 水平降低与缺氧程度及碘摄入量不足有关。     

功能性便秘和便秘型肠易激综合征的结肠运输试验及直肠感觉阈值比较

目的 对功能性便秘和便秘型肠易激综合征（IBS）患者进行肠道转运时间及其肛门直肠运动和直肠容量感觉研究，探讨两类疾病的结肠运动方式有何不同。方法 用不透X线标志物测定全结肠通过时间和结肠分段通过时间并计算转动指数。用电子气压泵研究肛门直肠压力、直肠对容量刺激的感觉和直肠顺应性。结果 便秘型IBS的结肠转动时间延长主要在右半结肠。功能性便秘的各个节段结肠均有延长，结合转动指数研究，发现直肠乙状结肠部位的延长更显著。两种疾病的肛门直肠括约肌静息压、收缩压和松弛压均无明显异常，但两者的顺应性和排便阈值均明显增高，其中功能性便秘的感觉阈值有增加。结论 IBS便秘型结肠运动紊乱主要在右半结肠，功能性便秘的结肠动力改变主要在直肠乙状结肠部为多。说明两者的结肠运动方式改变是不同的，对两者的鉴别诊断有帮助。     

功能性便秘患者肛管、直肠动力学变化及西沙必利影响的研究

便秘一直被视为棘手的临床问题,它严重地影响了人们的生活质量。结肠、肛、直肠功能性疾病导致排便异常是常见病。促动力学药物西沙必利治疗便秘已应用于临床,日益引起人们的重视。我们对50例功能性便秘患者进行了肛管、直肠动力学的测定并观察服用西沙必利前后肛管、直肠动力学的变化,旨在探讨便秘与肛直肠动力学的关系,观察药物的疗效,为临床治疗提供理论根据。现报道如下。     

老年2型糖尿病患者胃肠动力紊乱及其相关因素的研究

了解老年２型糖尿病患者全胃肠道及各段肠管的通过时间变化及其影响因素。方法应用乳果糖氢呼气方法测定ＯＣＴＴ，应用双ＭＡＲＫＥＲ法测定全胃肠道及各段结肠的通过时间，并进行肌电图检查及心理测试。结果糖尿病患者存在明显的胃肠动力紊乱，ＴＧＩＴＴ异常见于７０．０％的ＮＩＤＤＭ患者，快排空２６．％，慢性排空４３．３％，正常排空３０．０％。     

乳果糖氢呼吸试验测定口-盲肠传递时间

目的测定功能性消化不良（ＦＤ）和肠易激综合征（ＩＢＳ）患者口－盲肠传递时间（ＯＣＴＴ）．方法应用乳果糖氢呼吸试验（ＬＨＢＴ）测定了正常人１３例，ＦＤ２０例和ＩＢＳ（其中１５例主诉腹泻，１６例主诉便秘）３１例患者的ＯＣＴＴ．结果正常人ＯＣＴＴ为９５４±１９６ｍｉｎ，ＦＤ患者（９９２±２４５ｍｉｎ）与正常人比较无显著性差异（Ｐ＞００５），但其中５例动力障碍型ＦＤ的ＯＣＴＴ则显著延长（１２９０±１２０ｍｉｎ，Ｐ＜００１），以便秘为主的ＩＢＳ患者ＯＣＴＴ显著延长（１５４４±５５７ｍｉｎ，Ｐ＜００１），以腹泻为主的ＩＢＳ患者ＯＣＴＴ显著缩短（７３１±２２２ｍｉｎ，Ｐ＜００５）．结论ＦＤ和ＩＢＳ患者存在小肠动力学异常，ＬＨＢＴ可作为辅助检查小肠动力学异常的手段之一．     

结肠通过时间和盆底肌电图检查对功能性便秘分型的临床意义

功能性便秘是一种常见的胃肠道功能性疾病，随着社会生活方式和饮食结构等的改变，其发病率正逐年增高，并向年轻化发展。正确的分型对该病治疗方法的选择具有指导意义。目的：探讨结肠通过时间和盆底肌电图检查对功能性便秘分型的临床意义。方法：选择符合功能性便秘罗马Ⅱ诊断标准的患者32例，病史6个月-30年不等。应用不透X线的标志物进行结肠通过时间检查，计算传输指数(TI)和结肠排出率；同时结合盆底肌电图检查观察是否存在盆底肌与腹部肌群的矛盾运动。结果：结肠通过时间检查显示20例患者为出口梗阻型便秘，12例为慢传输型便秘。盆底肌电图检查显示出口梗阻型便秘患者均存在不同程度的盆底肌与腹部肌群的矛盾运动，慢传输型便秘患者中有4例存在盆底肌与腹部肌群的矛盾运动。结论：采用结肠通过时间和盆底肌电图检查可对功能性便秘作出分型，方法简便易行且无痛苦。     

高血压病患者血清甲状腺激素的水平及药物干预的变化

目的：探讨高血压病（ＥＨ）患者血清甲状腺激素的水平及药物干预后的影响。方法：用放射免疫法测定了６６例ＥＨ患者和３６例正常血压对照者及４１例ＥＨ患者服药（２５例服吲达帕胺２．５ｍｇ／ｄ或１６例服卡托普利１８．７５～７５ｍｇ／ｄ）８周后血清Ｔ３、Ｔ４的变化。结果：ＥＨ患者血清Ｔ３、Ｔ４水平显著高于对照组,均Ｐ〈０．０１;服吲达帕胺组或卡托普利组８周后血压,Ｔ３、Ｔ４水平较服药前均显著降低（Ｐ〈０．０５）。结论：ＥＨ患者血清Ｔ３、Ｔ４水平增高;吲达帕胺,卡托普利有效降血的同时均能显著降低血清Ｔ３、Ｔ４水平,甲状腺激素的失控可能参与高血压的形成或维持。     

福松对慢性功能性便秘肛门直肠运动的作用及疗效观察

目的：了解福松对慢性功能性便秘患者的治疗效果及对肛门直肠运动的作用。方法：将40例慢性功能性便秘患者随机分为福松组和乳果糖组。治疗两周，观察疗效及副作用。采用水灌注式测压系统检测10例慢性功能性便秘患者福松治疗前后肛门直肠运动功能。结果：福松和乳果糖治疗后排便次数明显增加，大便性状得到改善，80％左右患者排便困难缓解，70％患者排例质量改善，无明显副作用。福松治疗前后慢性功能性便秘患者肛门直肠动力和感觉无明显变化。结论：福松是治疗慢性功能性便秘的有效药物，对慢性功能性便秘患者肛门直肠运动功能无作用。     

老年慢性特发性便秘患者结肠动力学变化

目的：探讨老年慢性特发性便秘（ＣＩＣ）患者结肠运行功能变化及其与心理因素的关系,方法：应用不透Ｘ线标记物法及Ｚung抑郁自评量表（ＳＤＳ）及焦虎自评量表（ＳＡＳ）对５９例老年ＣＩＣ患者及３６例老年对照者进行结肠通过时间检查及心理状况分析,结果：（１）老年ＣＩＣ组全结肠及分段结肠通过时间较老年对照组明显延长（Ｐ＜０．０５）,（２）长期服用泻药组的老年ＣＩＣ患者其全结肠及分段结肠通过时间较间断服药和不服药者明显延长（Ｐ＜０．０５）,（３）老年ＣＩＣ患者ＳＤＳ,ＳＡＳ标准总分均明显高于对照组（Ｐ＜０．０５,（４）老年ＣＩＣ患者中结肠通过时间延长组ＳＤＳ标准通过时间延长组（Ｐ＜０．０５）,结论：老年ＣＩＣ患者存在结肠动力学异常,抑郁情绪和焦虑情绪与老年ＣＩＣ患者结肠运行功能异常有关。     

The effect of acarbose on the colonic transit time of elderly long-term care patients with type 2 diabetes mellitus

BACKGROUND: Constipation is common in elderly patients with diabetes mellitus (DM); its prevalence is estimated as up to 60% among patients with diabetic neuropathy. Acarbose, an alpha-glucosidase inhibitor, has a beneficial role in controlling DM, although one of its side effects is diarrhea. This study evaluates the efficacy of acarbose in improving constipation using transit time (TT) studies in elderly long-term care (LTC) patients. METHODS: Twenty-eight patients with type 2 DM and constipation were recruited for the study. TT was measured by radiopaque markers and was calculated separately for the four segments of the colon (ascending, transverse, descending, and rectosigmoid) and for the total colonic transit time (CTT). Segmental TT and CTT were evaluated in each patient before and after 1 week, and again after 4 weeks of treatment with acarbose. RESULTS: The mean baseline CTT measured in patients was 202 plus minus 136 hours. After 1 and 4 weeks of acarbose treatment, the baseline CTT significantly decreased to 149 plus minus 107 hours and 161 plus minus 97 hours, respectively (p <.002). For each segment studied, the TT was shortened, but it reached significance for the ascending and transverse colon only (p <.02 and p <.03, respectively). The effect of diet composition was examined. The amount of fiber consumed correlated with shortened CTT, while fat tended to be in negative correlation with TT. CONCLUSIONS: Acarbose therapy reduced the extremely prolonged CTT in LTC diabetic persons with constipation. The drug could be useful in relieving constipation in these patients, in addition to its beneficial effect in the control of diabetes.     

Colonic transit time in diabetic and nondiabetic long-term care patients

BACKGROUND: Constipation is a frequent health concern for elderly people. The increased incidence of constipation with age is mainly based on self-reported data. Only a few studies have examined this problem objectively and even fewer have carried this out in the special subpopulation of frail elderly patients. OBJECTIVE: The aim of this study was to examine colonic transit time (CTT) in frail elderly patients. We also attempted to compare CTT in diabetics and nondiabetics within this population. METHODS: 45 frail elderly patients, all immobile with and without diabetes mellitus, residing permanently in long-term geriatric departments were recruited for the study. All patients underwent segmental and total CTT studies using radiopaque markers. The segmental CTT was calculated separately for the four segments of the colon (ascending, transverse, descending, and rectosigmoid) and for the total transit time which was the sum of all four segments. RESULTS: The average CTT was extremely prolonged in all patients included in this study. In the diabetics the CTT was even longer with a mean total transit time of 200 +/- 144 h as compared with 143 +/- 95 h in the controls. The difference was not statistically significant. For each segment tested, the CTT was shorter in the control group, but these differences did not reach statistical significance. CONCLUSIONS: The CTT is prolonged in immobile frail elderly patients. No significant differences were noted between diabetic and nondiabetic patients.     

Normal colon transit time in healthy Chinese adults in Hong Kong

BACKGROUND AND AIM: Colon transit study with radio-opaque markers is helpful in the evaluation of chronic constipation. Normal reference values, based on radio-opaque markers, have not been reported from Chinese adults in Hong Kong. METHODS: Fifty-one healthy Chinese (27 men, age 42 +/- 12 years) were enrolled through a newspaper advertisement. They were requested to fill in detailed dietary records and a gastrointestinal symptom questionnaire. Each subject swallowed, under supervision, a total of three Sitzmarks capsules, one capsule at the same time on each of day 1, 2 and 3. Abdominal films were taken on days 4 and 7, also at the same time of the day. Total and segmental transit times were calculated using Metcalf's method. RESULTS: The upper limit of normal total colonic transit time (CTT) was 62 h, while right, left and rectosigmoid CTT were 16 h, 31 h and 32 h, respectively. Women of age 18-35 years had a longer rectosigmoid and total CTT compared with their male counterparts (mean total CTT: 39 h vs 18 h, P = 0.05). The CTT appeared to be unaffected by the usual dietary components. CONCLUSION: A single normal reference value for CTT appeared to be applicable to Chinese adults in Hong Kong, irrespective of age, sex and dietary content. However, young Chinese women (age 18-35 years) appeared to have longer total and rectosigmoid CTT.     

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.     

Colon transit time and anorectal manometry in children and young adults with spina bifida

Purpose

This study evaluates colon transit time (CTT) and anorectal manometry (ARM) in spina bifida (SB) patients in relation to the level of lesion, mobility, constipation, and continence status.

Methods

SB patients between 6 and 19 years, who are not using antegrade continence enemas and followed at the SB Reference Centre UZ Ghent, were asked to participate. Medical history was retrospectively retrieved from the medical file. Stool habits were prospectively collected using standardized questionnaires. CTT was measured using the 6-day pellet abdominal X-ray method. ARM was performed in non-sedated children with a water-perfused, latex-free catheter.

Results

Forty out of 52 eligible patients consented to perform CTT, of which 19 also performed the ARM. Fifteen (37 %) SB patients were constipated despite treatment. Twenty-six (65 %) were (pseudo) continent. The total CTT was significantly prolonged in SB patients (median CTT 86.4 vs. 36 h controls). The CTT was significantly prolonged in constipated SB patients compared to non-constipated SB patients (122.4 vs. 52.8 h). Spontaneously continent patients had a normal CTT (33.6 h) as well as a significantly higher resting pressure compared to the pseudo-continent and incontinent SB patients (resting pressure 56.5 vs. 32.5 mmHg). An abnormal CTT was associated with a treatment necessity to achieve pseudo-continence (p?=?0.006).

Conclusion

CTT in SB patients was significantly prolonged, indicating a neurogenic involvement of the bowel and slow transit constipation. SB patients with a normal CTT and a normal ARM spontaneously achieved fecal continence. CTT can help tailor the continence therapy in SB patients.     

老年慢性功能性便秘患者结肠和肛管直肠动力学的改变

目的 探讨功能性便秘患者结肠和肛管直肠动力学改变及其对便秘分型、临床治疗的指导意义.方法 对我院42例老年功能性便秘患者(CFC)及20例健康对照者,采用不透X线标记物法测定结肠通过时间(CTT),同时应用8通道水灌注式下消化道压力检测系统进行直肠、肛管动力学测定.结果 (1)老年CFC组全结肠通过时间及乙状结肠通过时间分别为(49.0±16.4)h和(20.1±13.5)h,较对照组(25.2±7.7)h和(7.8±4.1)h明显延长(t=6.16和t=3.97,均P<0.05);(2)老年CFC患者模拟排便时肛管压力为(39.6±15.7)mmHg,对照组为(17.6±9.3)mmHg,两组比较差异有统计学意义(t=5.79,P<0.05),老年CFC组13例患者模拟排便时出现肛管压力反常升高;老年CFC组直肠初始感觉阈和最大耐受容量分别为(49.2±10.5)ml和(175.2±52.6)ml,高于对照组的(33.6±8.5)ml和(123.4±39.1)ml,差异均有统计学意义(t=5.79和t=3.91,均P<0.05);直肠肛门抑制反射松弛率两组分别为59.5%和85.0%(x2=4.03,P相似文献   

Different segmental transit times in patients with irritable bowel syndrome and “normal” colonic transit time: is there a correlation with symptoms?

Background The Rome criteria serve as gold standard for establishing a diagnosis of irritable bowel syndrome (IBS), but only represent a cluster of symptoms. On the other hand, measurement of colonic transit time (CTT) with radiopaque markers is a solid and more objective method to quantify functional abnormalities. The goal of this study was to investigate whether the IBS symptoms, as defined in the Rome II criteria, correspond to objective physiological parameters, i.e. CCTs. Methods The study enrolled 148 healthy control subjects and 1385 consecutive IBS patients. Transit times were measured for the whole rectocolon (overall CTT) and for 3 segments (right colon, left colon, rectosigmoid area); segmental distribution of markers and diffusion coefficients were also assessed. In order to analyze homogeneous groups, we restricted analysis to subjects with “normal” CTT (≤70 hours). Results Six hundred forty four IBS patients (46%) and 14 control subjects (9%) had CTT >70 h and were eliminated. In subjects with CTT ≤70 h, CTT did not follow a normal (Gaussian) distribution. We identified 3 different CTT clusters in healthy controls and 4 clusters in IBS patients. Even if CTT was not significantly different between clusters, each cluster was characterized by a specific pattern of segmental colonic transit. There was a marked gender difference: women had longer overall CTT values than men, both in control and IBS patient groups (p<0.001). However, female IBS patients had significantly shorter colorectal transit times than female controls (p<0.001), as well as faster transit than in men through the left colon and rectosigmoid area. There were no significant differences in transit time between male IBS patients and male controls with the exception of a faster rectal transit in IBS patients (p<0.01). There was no association between segmental colonic transit values and sign or symptoms comprising the Rome II criteria. Conclusions In subjects with CTT ≤70 h, CTT does not follow a normal distribution but is clustered in subgroups that can be distinguished only by measuring segmental colonic transit. Within these subgroups, there is a marked difference in transit times between IBS patients and normal subjects, suggesting that IBS patients with “normal” CTT are not “normal”. The Rome II criteria do not reflect differences in segmental transit times in IBS patients with “normal” CTT. We therefore propose to evaluate segmental transit times in IBS patients with “normal” CTT, before and after treatment, in order to correctly interpretate variations in signs and symptoms. These findings have important implications in evaluating the effect of drugs on bowel function and should help define better inclusion criteria for studies evaluating new drugs for the treatment of IBS. An erratum to this article is available at .     

The Effect of Cisapride on Segmental Colonic Transit Time in Patients with Spinal Cord Injury

Objectives : The pathophysiological consequences of spinal cord injury (SCI) on function of the colon are complex and poorly understood. Regardless of the mechanism, many patients with SCI have deficient bowel control, which is frustrating and difficult to treat. We designed a study to assess whether a new prokinetic medication, cisapride, might be useful in this setting. Methods : Total and segmental colonic transit time were measured using the radiopaque marker technique in nine subjects with spinal cord injury and seven control subjects after the double-blind administration of cisapride (10 mg q.i.d .) or placebo. Results : In five quadriplegic subjects with prolonged colonic transit time, administration of cisapride was found to reduce left-sided colonic transit time from 24.2 to 13.8 h. In three of these five subjects, cisapride administration resulted in subjective improvement. No effect of cisapride on right-sided, rectosigmoid, or total colonic transit time was observed. Conclusion : The data suggest that cisapride might be a useful adjunctive measure in treating a subset of SCI patients with colonic inertia, but a larger study is needed before this can be routinely recommended.     

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。