联用氟哌噻吨美利曲辛和匹维溴铵对伴有焦虑抑郁状态腹泻型肠易激综合征直肠动力感觉功能的影响

目的 研究联用氟哌噻吨美利曲辛和匹维溴铵对伴有焦虑抑郁状态腹泻型肠易激综合征(IBS-D)直肠动力与直肠感觉功能的影响.方法 44例伴有焦虑抑郁状态IBS-D患者按随机数字表法分为联用氟哌噻吨美利曲辛和匹维溴铵组(A组)和单用匹维溴铵组(B组),以25例健康体检者作为对照组.对两组患者服药前后直肠动力与直肠感觉功能进行检测对比.结果 服药前A组增加腹压肛门括约肌净增压为(3.0±1.2)kPa,B组为(2.9±1.2)kPa,均低于对照组的(3.6±1.6)kPa(P＜0.05);A组直肠最低敏感量、最大耐受量、最大顺应性分别为(55±20)ml、(145±78)ml、(21.9±12.9)ml/kPa,B组分别为(56±38)ml、(150±50)ml、(20.8±11.2)ml/kPa,均明显低于对照组的(80±38)ml、(190±50)ml、(30.8±15.2)ml/kPa(P＜0.01).服药后A组直肠最低敏感量、最大耐受量、最大顺应性均高于服药前(P＜0.01或＜0.05);B组仅直肠最低敏感量高于服药前(P＜0.05);A组直肠最低敏感量、最大耐受量、最大顺应性均高于B组(P＜0.05或＜0.01).结论 IBS-D患者直肠对容量刺激存在高敏感、低耐受、低顺应性和肛门自控能力减弱.联用氟哌噻吨美利曲辛和匹维溴铵治疗伴有焦虑抑郁状态IBS-D能更有效地改善直肠感觉功能.

Effect of flupentioxl melitracen and pinaverium bromide treatment on the changes of anorectal motility and rectal sensation in the patients of diarrhea-predominant irritable bowel syndrome accompanying with depression and/or anxiety status

Objective To study the effect of flupentioxl melitracen and pinaverium bromide treatment on the changes of anorectal motility and rectal sensation in the patients of diarrhea-predominant irritable bowel syndrome (IBS-D) accompanying with depression and/or anxiety status. Methods Forty-four patients with IBS-D accompanying with depression and/or anxiety status were divided into group A (flupentioxl melitracen and pinaverium bromide) and group B (pinaverium bromide) by random digits table,and treated for 4 weeks. Twenty-five healthy subjects were included as control group. The anorectal motility and rectal sensation before and after taking medicines were compared. Results When abdominal pressure was increased, the net increased pressure of anal sphincter was (3.0 ± 1.2 ) kPa in group A and (2.9 ± 1.2)kPa in group B. They were lower than that in control group [(3.6 ± 1.6) kPa](P＜ 0.05). The rectal lowest volume of sensory threshold, the maximal volume of tolerance and maximal compliance were (55 ± 20) ml,( 145 ± 78 ) ml, ( 21.9 ± 12.9 ) ml/kPa in group A, ( 56 ± 38 ) ml, ( 150 ± 50 ) ml, (20.8 ± 11.2) ml/kPa in group B. They were lower than those in control group [(80 ± 38 ) ml, ( 190 ± 50 ) ml, (30.8 ± 15.2 ) ml/kPa](P ＜ 0.01 ). The rectal lowest volume of sensory threshold, the maximal volume of tolerance and maximal compliance were higher than those before taking medicines. Only the rectal lowest volume of sensory threshold in group B was higher than that before taking medicines. The rectal lowest volume of sensory threshold, the maximal volume of tolerance and maximal compliance in group A after taking medicines were higher than those in group B (P ＜ 0.05 or ＜ 0.01 ). Conclusions Higher sensitivity, lower tolerance,lower compliance of rectum and weakened anal automatic control function in IBS-D may be associated with diarrhea and frequent defecation. Treatment combining flupentioxl melitracen with pinaverium bromide may preferably improve the aperception functions of rectum in the patients of IBS-D accompanying with depression and/or anxiety status.