排便训练技术在功能性便秘患者中的应用

目的探讨排便训练技术对功能性便秘(functional constipation,FC)患者肛管直肠功能和临床症状的作用。方法按纳入标准选取门诊及住院的28例FC患者为试验组,根据试验组患者肛管直肠压力和直肠感觉功能的评估结果分别选择压力反馈训练法、直肠感受性训练法和腹式呼吸法进行排便训练。试验组于训练前及训练结束3个月后评估肛管直肠压力和直肠感觉功能;同期选择24名健康志愿者为对照组,入组时评估其肛管直肠压力和直肠感觉功能。结果试验组患者排便训练前用力排时肛管剩余压力高于对照组(P<0.05);排便训练后用力排时肛管剩余压力低于训练前(P<0.01),且与对照组的差异无统计学意义(P<0.05);试验组训练后用力排时直肠压力和排便指数高于训练前(P<0.01),且用力排时直肠压力高于对照组(P<0.05)。试验组患者排便训练前直肠初始感觉容量、直肠初始便意感容量、排便窘迫容量和直肠最大耐容量均高于对照组(P<0.05):而排便训练后以上4项指标较训练前降低(P<0.01),且以上4项指标与对照组比较差异均无统计学意义(P>0.05)。试验组训练后,自发排便次数、大便性状和粪便量少等症状较训练前改善(P<0.01);且排便困难、排便不尽感、肛门阻塞感和腹部胀气等伴随症状也较训练前改善(P<0.01)。结论排便训练技术能有效改善FC患者的盆底肌、肛门括约肌的功能,改善肛门外括约肌的协调性,降低直肠感觉阈值,并促进其临床症状的改善。

Application of bowel training in patients with functional constipation

Objective To evaluate the clinical effects of bowel training in patients with functional constipation(FC).Methods Twenty-eight FC patients received bowel training for three months with an instrument which can carry on manometry feedback training and rectum sensory training.The clinical symptoms and anorectal motility of FC patients were evaluated before and 3 months after the treatment.The clinical symptoms and anorectal motility of 24 health volunteers were evaluated as a control group.Results The residual anal pressure of FC patients before treatment was significantly higher than that of the control group(P<0.05).After the bowel training the residual anal pressure of FC patients was significandy lower than before the training (P<0.01),and was similar to the control group(P>0.05 );the rectal squeeze pressure and defecation index of FC patients were significantly higher than before the training(P<0.01),and the rectal squeeze pressure of FC patients was significantly higher than that of the control group(P<0.05).The first sensation of distention,sensation of defecation,sensation of urgency and maximum tolerable volume of FC patients before the training were significantly higher than those of the control group(P<0.01). After the bowel training,the above indexes of FC patients were significantly reduced(P<0.01 )and were similar to the control group(P>0.05).The frequency of defecation,stool form and stool volume of FC patients after the training were significantly improved than before(P<0.01);the symptoms of straining,sensation of incomplete evacuation,ano-rectal obstruction and flatulence were significantly relieved(P<0.01).Conclusions The bowel training technique can effectively strengthen the functions of pelvic floor muscles and anal sphincter,improve the coordination of external anal sphincter,reduce the threshold of rectal sensation and relieve the clinical symptoms of FC patients.