精神因素对肠易激综合征患者内脏敏感性的影响

目的　探讨肠易激综合征 (IBS)患者选择性关注的特征及心理暗示对患者内脏敏感性的影响。方法　将改编后的抑郁症病人选择性关注调查卡用于IBS(符合罗马Ⅱ诊断标准 )患者选择性关注特征调查 ,随后观察IBS患者在不同暗示刺激下直肠气囊扩张的各种阈值与正常对照者的差异。结果　 36例IBS患者在看过调查卡片内容 30min后 ,回忆起的胃肠疾病相关的术语超过 50 % ,而对照组不超过 30 % (P <0 0 0 1 )。IBS患者直肠气囊扩张诱发的初始感觉 (2 1mmHg± 5mmHg)、排便感 (36mmHg± 9mmHg)、排便紧迫感 (51mmHg± 1 4mmHg)及最大耐受的阈值 (67mmHg± 1 7mmHg)均低于 2 6例健康对照组 (P <0 0 0 1 )。诱导IBS患者转移对胃肠刺激的注意力所需时间 (1 0min±4min)长于健康对照组 (2 8min± 1 2min) (P <0 0 0 1 ) ,转移注意力后两组受试者内脏敏感性阈值均比相应基线值增加 (P <0 0 5) ,但IBS患者初始感觉值增加更显著 (P <0 0 1 )。恶性视听暗示刺激能降低IBS患者组的各项内脏敏感性观察指标 (P <0 0 5) ,对健康对照组影响不显著。结论　对胃肠道症状及其刺激的选择性关注是IBS患者认知 行为的重要特征 ,转移注意力可明显减低患者对胃肠道刺激的反应。研究结果说明采用心理方法治疗IBS的合理性

Effect of psychological factors on visceral sensation of patients with irritable bowel syndrome

OBJECTIVE: To investigate the features of selective attention in patients with irritable bowel syndrome (IBS) and the effect of psychological hint on visceral sensation in IBS patients. METHODS: A set of 36 modified investigation cards originally developed for depression patients and including 12 cards describing gastrointestinal (GI) symptoms, 12 cards describing respiratory symptoms, and 12 cards with neutral terms, was used to investigate selective attention. 36 patients with diagnosis of IBS based on Rome II criteria, 23 patients with asthma, and 26 healthy volunteers, all without hemorrhoid, were asked to select one card from the set and put it in an envelop. A rectal balloon was inserted into the rectum of the examinees, then the balloon was inflated by pumping air so as to distend the rectum and the thresholds of initial filling sensation, evacuation sensation, urgent evacuation sensation, and utmost tolerance sensation were recorded. The examinees were asked to talk about something so as to divert their attention, and then examination of thresholds of rectal sensation and the time needed for diverting attention were recorded. After a rest for 5 approximately 10 minutes, the examinees were asked to fill the contents of selective attention they still remembered in a recording card. Then pictures of anatomy and pathology of colon were shown and conversation about gastrointestinal diseases was made to the examinees (as malignant stimuli) the changes of thresholds were recorded again. RESULTS: More terms about GI diseases were selectively recalled by the IBS patients than by asthma patients and healthy controls (all P < 0.001). During rectal distention, IBS patients had lower thresholds of initial sensation (21 +/- 5 mm Hg), evacuation sensation (36 +/- 9 mm Hg), urgent evacuation sensation (51.3 +/- 14.2 mm Hg), and utmost tolerance sensation (67 +/- 17 mm Hg) in comparison with the other two groups (both P < 0.001). After diverting the examinees' attention by talking and reading, the thresholds of the above mentioned different kinds of sensation in different groups increased significantly as compared with the basic values (all P < 0.05), in particular, the threshold of initial sensation in IBS patients increased markedly (P < 0.01). Focusing the examinees' attention on GI stimuli by reading pictures of malignant gastrointestinal diseases significantly decreased the sensation thresholds in IBS patients (P < 0.05). However, no remarkable change in the thresholds was recorded in the nonpatients. CONCLUSION: Selective attention of GI symptoms is the cognitive-behavioral characteristic of patients with IBS. Diverting the examinees' attention may decrease their response to stimuli. Psychological hint exerts significant influence on the rectal pain sensitivity of IBS patients. Psychotherapy may be helpful in treatment of IBS.