老年便秘患者直肠肛门压力变化的研究

Changes of anorectal dynamics in elderly patients with chronic idiopathic constipation

  • 摘要: 目的: 探讨老年慢性特发性便秘(CIC)患者直肠肛门运动功能变化。方法: 采用瑞典Medtronic公司生产的消化道压力检测系统对59例老年慢性特发性便秘(CIC)患者和36例老年对照者及15例非老年对照者进行直肠肛门压力测定对照研究。结果: ①老年对照组肛管静息压、最大缩榨压和模拟排便时肛管压力变化均低于非老年对照组(P<0.05),括约肌长度短于非老年对照组(P<0.05),而直肠初始感觉阈值和引起直肠肛门抑制反射(RAIR)的最小容积高于非老年对照组(P<0.05)。②老年CIC患者最大缩榨压、模拟排便时肛管压力变化低于老年对照组(P<0.05),直肠初始感觉阈值、排便阈值和最大耐受容量均高于老年对照组(P<0.05),并有28例(4 7.5%)老年CIC患者模拟排便时出现肛管压力异常升高。结论: ①老年人存在肛门自制力减退、内脏感觉阈值升高和内脏运动神经反射迟钝等改变。②老年CIC患者与直肠低敏感、高耐受及排便时直肠肛管运动不协调有关

     

    Abstract: Objective: To investigate what anorectal dynamic abnormality exits in elderly patients with chronic idiopathic constipation(CIC). Methods: Study was performed in 59 elderly patients with CIC,36 elderly healthy subjects(EHS),and 15 non-elderly healthy subjects. Anorectal pressure was measured with Medtronic PcPolygraf,which was a water perfuse catheter system. Results: 1.The anal resting pressure(RP), maximal squeezing pressure(MSP) and the changes of anal pressure during defecation in elderly healthy subjects(EHS) were lower than those in non-elderly healthy subjects(NEHS,P <0.05). The length of anal sphincter in EHS was shorter than that in NEHS(P <0.05). The rectal lowest volume of sensory threshold(RLSTV) and the minimum relaxation volume of inducing anorectal inhibitory reflex were higher than those in NEHS(P <0.05). 2.MSP and the changes of anal pressure during defecation in elderly patients (EP) with CIC were lower than those in EHS(P <0.05). The RLSTV,the rectal threshold volume for desire to defecate and the rectal maximal volume of tolerance were higher than those in EHS (P <0.05). And there were 28 (47.5%) of EP who had increasing anal pressure when defecation was stimulated. Conclusions: 1.There were some anorectal functional disturbances in EHS,such as the decreasing of anal resistance,increasing the volume of sensory threshold and the slowness of reflux motion. 2. CIC in elderly parients may be associated with lower sensitivity,higher tolerance and discoordination of annorectum during defecation.

     

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