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.

Study of in patients with chronic idiopathic constipation

Aim To investigate the possible pathogenesis of CIC by colonic,anorectal motility and psyche testing.Methods Anorectal manometry was carried out in 21 CIC patients by using Medtronic Synectics PC Polygraf,at the same time,the psychical factors were tested.20 healthy people were compared were also studied.Distal colonic manometry was carried out in 11 of 21 CIC patients,9 non-CIC patients were compared.Results CIC patients were older than controls ( P <0.05), showed lower anorectal sphincteric resting pressure( P <0.025) lower anorectal sphincteric squeezing pressure ( P <0.005) ,longer length of anal high pressure zone( P <0.005),larger minimum relaxation volume to elicit the anorectal inhibitory reflex( P <0.005),lower relaxation of internal anal sphincter( P <0.025),higher rectal defecation volume thresholds( P <0.005) and higher rectal maximum tolerable volume thresholds( P <0.005) with respect to controls.In the distal colonic manometry,11 CIC patients showed lower duration of peaks and motility index compared with 9 non CIC patients( P <0.005).In the aspect of psychical testing,the rate of psychical abnormalities was higher in CIC patients compared with controls (Anxiety: P <0.05;Depression: P <0.01).Conclusions The pathogenesis of CIC is complicated.Colonic and anorectal motility and psychical factors are all involved in the pathogenisis.