生物反馈治疗老年人功能性便秘86例疗效

慢性功能性便秘(chronic f unctional constipation,CFC)在我国60岁以上老年人中发病率占10%～23%[1],严重影响现代人生活质量,且在结肠癌、肝性脑病、乳腺疾病、早老性痴呆等疾病的发生中有重要的作用,在急性心肌梗死、脑血管意外时可导致死亡.生物反馈训练治疗具有简便、无痛、无创、安全的特点,是一种治疗CFC的新兴生物行为治疗方法,本文应用生物反馈训练治疗老年人慢性功能性便秘,临床疗效较好.     

功能性便秘的生物反馈治疗及评价

生物反馈治疗最早创立于20世纪60年代,随着胃肠病学的发展和行为疗法在胃肠疾病治疗中的应用研究,生物反馈治疗的作用日趋显著,尤其广泛应用于FC、功能性大便失禁(functional fecal inconti-nence,FI)等功能性结直肠肛门病。1生物反馈治疗FC的机制和方法1.1机制生物反馈治疗是松弛疗法与生物反馈技术的结合;是在行为疗法基础上发展的一种新的心理治疗技术,即利用仪器描记人体正常情况下意识不到的、与心理生理活动有关的某些生物信息(如肌电活动、脑电波、皮肤温度、心率、血压等),并转换成可察觉到的声、光等反馈信号,使人体学会有意识…     

短疗程生物反馈训练治疗慢性功能性便秘的临床研究

我们应用短疗程生物反馈治疗慢性功能性便秘病人 ,取得较好的疗效 ,现报道如下。1　材料与方法1.1　一般资料　 5 3例慢性功能性便秘患者 ,女 4 5例 ,男 8例 ,年龄 2 1～ 72岁 ,平均 4 3.8岁。患者均做过结肠镜检查 ,排除了大肠、肛门器质性疾病。便秘的诊断均符合我国 1999年 5月制定的《便秘诊治暂行标准》。1.2　仪器　SPSOrionPC/ 12EMG肌电生物反馈训练治疗仪为MedtronicSynectics公司生产。其中主要包括 2个非损伤性电极、训练治疗软件、计算机。1.3　生物反馈训练治疗方法　首先反复向患者讲解正常的排便机制和治疗过程及目的 ,…     

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。     

生物反馈联合乳果糖治疗老年功能性便秘的疗效

目的 观察生物反馈联合乳果糖治疗慢性功能性便秘的临床疗效.方法 将144例慢性功能性便秘患者分为两组,治疗组予生物反馈联合乳果糖治疗;对照组予乳果糖治疗,评估临床疗效及盆底表面肌电,治疗前后行便秘症状总分与盆底表面肌电值的相关性分析.结果 两组治疗后临床症状评分较治疗前均有改善(P＜0.05).治疗组总有效率83.02％,对照组67.18％,差异有统计学意义(P＜0.05);治疗前后Glazer盆底肌评估中快速收缩阶段最大收缩波幅、持续收缩阶段收缩波幅与便秘症状总分均存在负相关(P＜0.05),持续收缩阶段变异性与便秘症状总分均存在正相关性(P＜0.05).结论 生物反馈和乳果糖治疗均能有效改善慢性便秘患者临床症状,二者联合有协同作用,Glazer盆底表面肌电评估方案可作为临床诊断和治疗慢性功能性便秘的参考依据.     

不同分型功能性便秘直肠感觉功能障碍及生物反馈治疗

[目的]观察不同罗马Ⅲ标准分型功能性便秘患者直肠感觉障碍及生物反馈治疗效果。[方法]对100例功能性便秘患者予以排粪造影、结肠传输试验及肛肠动力学检测临床分型,结肠慢传输型31例,出口梗阻型36例,混合型33例,予生物反馈训练,4周为一观察疗程。对生物反馈治疗效果以及三型患者治疗前、后直肠感觉功能指标(直肠对容量刺激的初始感觉阈值、排便感觉阈值、排便窘迫阈值、直肠最大耐受量)进行观察分析。[结果]经t检验显示,FC患者治疗前、后排便感觉阈值差异无统计学意义(P>0.05),初始感觉阈值、排便窘迫阈值、直肠最大耐受量均较治疗前有所降低(P<0.01)。治疗前、后结肠慢传输型初始感觉阈值、排便感觉阈值、排便窘迫阈值、直肠最大耐受量均高于混合型和出口梗阻型。[结论]生物反馈有助于脑调节大肠的传导动力和恢复肠道感觉功能,调节直肠感觉功能,有助于建立正常的排便规律和排便行为,增强肌力。     

生物反馈联合普芦卡必利治疗老年功能性便秘的疗效观察

［摘要］　目的　观察生物反馈（BF）联合普芦卡必利治疗老年功能性便秘（FC）的效果。方法　选择2020年7月至2021年12月苏州科技城医院收治的老年FC患者84例,采用随机数字表法分为观察组和对照组,每组42例。观察组采用BF疗法联合普芦卡必利进行治疗,对照组采用普芦卡必利进行治疗,连续治疗6周。比较两组的临床疗效、便秘评分、每周自发性完全排便（SCBM）次数、复发率和不良反应发生情况。结果　与治疗前比较,观察组和对照组治疗后的便秘评分降低,每周SCBM次数增加,差异有统计学意义（P<0.05）,且观察组较对照组改善更显著（P<0.05）。观察组总有效率高于对照组,差异有统计学意义（83.33% vs 61.90%, χ²=4.850,P=0.028）。随访3个月,观察组复发5例（11.90%）,对照组12例（28.57%）,两组复发率比较差异有统计学意义（χ²=30.612,P<0.001）。两组不良反应发生率比较差异无统计学意义（7.14% vs 9.52%, χ²=0.000,P=1.000）。结论　BF联合普芦卡必利能够有效治疗老年FC,复发率低,且安全性良好。     

两类功能性便秘患者行生物反馈治疗的疗效及随访比较

目的比较生物反馈治疗对两类功能性便秘（FC）的临床疗效及随访效果。方法选择2010年1月至2013年1月收治的72例FC患者,其中慢传输型便秘（STC）患者37例、出口梗阻型便秘（OOC）患者35例。所有患者均行生物反馈治疗,比较患者肛管静息压和肛管最大收缩压,并进行为期半年的随访。结果所有患者均完成2周生物反馈治疗,治疗后OOC组的肛管静息压与入院时同组和治疗后STC组相比,差异均无统计学意义;但治疗后OOC组肛管最大收缩压（146.73±24.51）mmHg明显高于入院时同组（112.51±22.5）mmHg及治疗后STC组（108.35±21.29）mmHg,P〈0.05。所有患者均随访半年。随访后OOC组的汉密尔顿焦虑量表（HAMA）评分（8.25±2.27）显著低于入院时同组（11.01±3.14）及随访后STC组（11.43±3.71）,P〈0.05。随访后OCC组的疾病不确定感量表（MUIS）评分（36.45±7.43）显著低于入院时同组（50.45±12.48）及随访后STC组（44.42±9.67）,P〈0.05。但随访后OCC组的Zung抑郁自评量表（SDS）评分与入院时同组及随访后STC组相比差异均无统计学意义。两组患者总体有效率相比,差异无统计学意义;但OOC组患者治愈率（48.57%）明显高于STC组（29.73%）,P〈0.05。结论生物反馈能有效治疗FC,对OOC的疗效更好。     

针灸联合生物反馈治疗出口梗阻型便秘的临床研究

[目的]探讨针灸联合生物反馈治疗出口梗阻型便秘的效果。[方法]将122例功能性便秘患者随机分为2组。观察组60例:给予针灸联合生物反馈治疗;对照组62例:仅给予生物反馈治疗。对比2组疗效、排便情况、小便情况、盆底表面肌电情况。[结果]2组治疗后排便情况、小便情况均较治疗前改善(P0.05),且观察组改善幅度优于对照组(P0.05)。2组治疗后盆底表面肌电主要指标均较治疗前改善(P0.05),且观察组改善幅度优于对照组(P0.05)。[结论]采取针灸联合生物反馈疗法对出口梗阻型便秘进行辨证施治,较单纯生物反馈疗法优势明显,可有效改善患者临床症状,提高治疗效果。     

生物反馈治疗老年慢性功能性便秘的肛门直肠动力学改变

随着社会生活方式和饮食结构的改变，功能性便秘随着年龄增长而增加，我国60岁以上的老年人慢性便秘的发病率可达10％以上。对急性心肌梗死、脑血管疾病等老年患者，便秘可导致生命意外。老年人慢性功能性便秘的治疗，尤其是顽固性功能性便秘的治疗，目前尚无满意的方法，生物反馈训练法是一种有效的方法，本研究根据用力排便时直肠压及肛门括约肌压，对老年慢性功能性便秘患者治疗前分型，按照分型，指导生物反馈训练，从而取得较好的治疗效果。     

生物反馈对功能性便秘患者症状和心理状态的影响

背景：功能性便秘（FC）是一种消化系统常见的功能性胃肠病，生物反馈是其有效治疗方法之一。目的：探讨生物反馈治疗对FC患者临床症状和心理状态的影响。方法：对78例符合FC罗马Ⅱ标准的患者行生物反馈训练，应用症状积分量表、结肠转运时间、Zung焦虑自评量表（SAS）、抑郁自评量表（SDS）等评定患者治疗前后临床症状和心理状态的综合改善情况。结果：生物反馈治疗FC的总有效率为79．5％。生物反馈治疗前，与中国常模相比，FC患者的焦虑（39±8对31±13）和抑郁（52±9对42±11）积分显著升高（P均〈0.01）。生物反馈治疗后，患者焦虑（33±7对39±8）和抑郁（46±8对52±9）显著改善（P均〈0．01）。结论：生物反馈不仅可改善FC患者的临床症状，还可改善其异常心理状态。     

Effect of Biofeedback Therapy in Constipation According to Rectal Sensation

Background/Aims

The pathophysiologic mechanism of rectal hyposensitivity (RH) is not well documented, and the significance of RH in biofeedback therapy (BFT) has not been evaluated. Thus, we aimed to assess the effect of BFT in constipated patients according to the presence of RH.

Methods

Five hundred and ninety constipated patients (238 males and 352 females) underwent anorectal physiologic assessments. Of these, anorectal manometry was performed before and after BFT in 244 patients (63 RH and 181 non-RH patients).

Results

The success rate of BFT was 56% in the RH and 61% in the non-RH group (p=0.604). The measurements of resting pressure, squeezing pressure, desire to defecate volume, urge to defecate volume, and maximum volume were decreased after BFT in the RH group (p<0.05), whereas only resting and squeezing pressures were decreased in the non-RH group (p<0.05). Among the RH group, individuals who responded to BFT showed decreased resting pressure, squeezing pressure, desire to defecate, urge to defecate, and maximum volume and increased balloon expulsion rate; among those who did not respond to BFT, only desire to defecate volume was improved.

Conclusions

In constipated patients with RH, changes of anorectal manometric findings differed in comparison to patients without RH. The responses to BFT showed both anorectal muscle relaxation and restoration of rectal sensation.     

Randomized,Controlled Trial Shows Biofeedback to be Superior to Alternative Treatments for Patients with Pelvic Floor Dyssynergia-Type Constipation

Purpose This study was designed to determine whether biofeedback is more effective than diazepam or placebo in a randomized, controlled trial for patients with pelvic floor dyssynergia-type constipation, and whether instrumented biofeedback is necessary for successful training. Methods A total of 117 patients participated in a four-week run-in (education and medical management). The 84 who remained constipated were randomized to biofeedback (n=30), diazepam (n=30), or placebo (n=24). All patients were trained to do pelvic floor muscle exercises to correct pelvic floor dyssynergia during six biweekly one-hour sessions, but only biofeedback patients received electromyography feedback. All other patients received pills one to two hours before attempting defecation. Diary data on cathartic use, straining, incomplete bowel movements, Bristol stool scores, and compliance with homework were reviewed biweekly. Results Before treatment, the groups did not differ on demographic (average age, 50 years; 85 percent females), physiologic or psychologic characteristics, severity of constipation, or expectation of benefit. Biofeedback was superior to diazepam by intention-to-treat analysis (70 vs. 23 percent reported adequate relief of constipation 3 months after treatment, chi-squared=13.1, P<0.001), and also superior to placebo (38 percent successful, chi-squared=5.7, P=0.017). Biofeedback patients had significantly more unassisted bowel movements at follow-up compared with placebo (P=0.005), with a trend favoring biofeedback over diazepam (P=0.067). Biofeedback patients reduced pelvic floor electromyography during straining significantly more than diazepam patients (P<0.001). Conclusions This investigation provides definitive support for the efficacy of biofeedback for pelvic floor dyssynergia and shows that instrumented biofeedback is essential to successful treatment. Support by NIDDK - Grant #R01DK57048, General Clinical Research Center, UNC at Chapel Hill, grant #RR00046, Sandhill? Scientific, Incorporated, Jansen Pharmaceuticals, Milan Pharmaceuticals. Presented at meeting of The American College of Gastroenterology, Honolulu, Hawaii, October 30 to November 2, 2005.     

Long-Term Study on the Effects of Visual Biofeedback and Muscle Training as a Therapeutic Modality in Pelvic Floor Dyssynergia and Slow-Transit Constipation

PURPOSE: Biofeedback training has been shown as an effective therapeutic measure in patients with pelvic floor dyssynergia, at least in the short term. Long-term effects have received less attention. Moreover, its effects in patients with slow-transit constipation have been scarcely investigated. This study was designed to assess in an objective way the medium- and long-term effects of biofeedback and muscle training in patients with pelvic floor dyssynergia and slow-transit constipation. METHODS: Twenty-four patients (14 with pelvic floor dyssynergia and 10 with slow transit) meeting the Rome II criteria for constipation, and unresponsive to conventional treatments, entered the study. Clinical evaluation and anorectal manometry were performed basally and three months after a cycle of electromyographic biofeedback and muscle training; moreover, a clinical interview was obtained one year after biofeedback. Patients with slow-transit constipation also had colonic transit time reassessed at one year. RESULTS: Clinical variables (abdominal pain, straining, number of evacuations/week, use of laxatives) all significantly improved in both groups at three-month assessment; anorectal manometric variables remained unchanged, apart from a significant decrease of sensation threshold in the pelvic floor dyssynergia group and of the maximum rectal tolerable volume in the slow-transit constipation group. At one-year control, 50 percent of patients with pelvic floor dyssynergia still maintained a beneficial effect from biofeedback, whereas only 20 percent of those complaining of slow-transit constipation did so. Moreover, the latter displayed no improvement in colonic transit time. CONCLUSIONS: In our experience, patients with pelvic floor dyssynergia are likely to have continued benefit from biofeedback training in the time course, whereas its effects on slow-transit constipation seems to be maximal in the short-term course.     

Effects of Prebiotics and Synbiotics on Functional Constipation

The objective was to determine the effects of prebiotics and synbiotics on adults with functional constipation (FC). Medline, Embase and the Cochrane Library were searched for literature published up to February 2015. We selected randomized controlled trials (RCTs) that reported administration of prebiotics or synbiotics to adults with FC. The end points included stool frequency, stool consistency and other symptoms related to constipation. Mean differences (MD) or standard mean differences (SMD) were used for continuous outcomes and risk ratios for discontinuous outcomes using a random-effects model. The Cochrane Risk of Bias Tool was used to determine the quality of the trials. Funnel plots and Egger’s test were used to analyze for publication bias. We included 5 RCTs involving 199 patients who were administered prebiotics and 8 RCTs involving 825 patients who were administered synbiotics. Prebiotics increased weekly stool frequency (MD: 1.01 bowel movements/week, 95% CI: 0.04-1.99) and improved stool consistency (SMD: ?0.59, 95% CI: ?1.16 to ?0.02). Subgroup analysis showed specific effects for galacto-oligosaccharides on stool frequency, consistency, ease of defecation and abdominal pain. Synbiotics significantly improved stool frequency (MD: 1.15 bowel movements/week, 95% CI: 0.58-1.71), consistency (SMD: 0.63, 95% CI: 0.33-0.92) and reduced whole-gut transit time (MD: 13.52, 95% CI: ?26.56 to ?0.49) in patients with FC. Subgroup analysis showed specific effects for fructo-oligosaccharides and probiotic combinations on stool frequency, consistency, straining defecation and bloating. Galacto-oligosaccharides and synbiotics made up of fructo-oligosaccharides with probiotic combinations may improve stool frequency, consistency and some other symptoms related to constipation.     

肠易激综合征便秘型和功能性便秘结、直肠肛门动力学研究

目的 研究肠易激综合征(IBS)便秘型和功能性便秘患者结肠、直肠动力,直肠感觉功能.方法 对IBS便秘型患者52例和功能性便秘患者48例进行肛门直肠测压检查,并做结肠传输试验.同时选择正常健康人作对照组.结果 IBS便秘型组和功能性便秘组与对照组间直肠静息压、肛管静息压和肛门括约肌最大缩榨压比较均未见明显差异.IBS便秘型组初感阈值及排便阈值(75.00±34.04 ml,117.31±37.60 ml)较正常对照(97.14±20.54 ml,138.57±19.94 ml)明显降低.功能性便秘组排便阈值及最大耐受阈值(187.92 ±68.62 ml,252.5±93.40ml)较正常对照组(138.57±19.94 ml,181.43±18.34 ml)明显升高.IBS便秘型组各项感觉阈值较功能性便秘组均明显降低.功能性便秘组较IBS便秘型组患者结肠传输试验符合出口梗阻的比例高,但无统计学差异.结论 IBS便秘型直肠感觉过敏,功能性便秘直肠感觉迟钝.     

Functional Benefits of Dysphagia Therapy Using Adjunctive sEMG Biofeedback

This article describes a retrospective analysis of functional outcome, time in therapy, and cost per unit of functional change in patients who received therapy for pharyngeal dysphagia. Twenty-five patients presenting dysphagia following stroke and 20 patients with dysphagia following treatment for head/neck cancer completed a systematic therapy program supplemented with surface electromyographic (sEMG) biofeedback. Eighty-seven percent (39/45) of all patients increased their functional oral intake of food/liquid including 92% of stroke patients and 80% of head/neck cancer patients. Patients with dysphagia following stroke demonstrated greater improvement than those in the head/neck cancer group. Patients in the stroke group completed more therapy sessions thus increasing the total cost of therapy, but they made more functional progress resulting in lower costs per unit of functional change than patients in the head/neck cancer group. Limitations of this study are described in reference to implications for future clinical research on the efficacy of this therapy approach.     

Biofeedback in the treatment of a selected dysphagic patient

Electromyography and biofeedback techniques are well established in the disciplines of physical medicine for the retraining of muscle groups to approximate functional performance. This report documents the application of biofeedback techniques to the treatment of swallowing dysfunction in a selected dysphagic patient.