老年功能性便秘患者便秘症状和结直肠肛门功能检查的一致性分析  

Consistency between symptoms and colorectoanal function tests in elderly patients with functional constipation

作　　者：樊文娟[1] 王智凤[1] 谢小平 王瑾[2] 刘诗 张军[2] 方秀才[1] Fan Wenjuan;Wang Zhifeng;lie Xiaoping;Wang Jin;Liu Shi;Zhang Jun;Fang Xiucai(Department of Gastroenterology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Gastroenterology,Second Affiliated Hospital,Xi'an Jiaotong University,Xi'an 710004,China;Department of Gastroenterology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430022,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院消化内科,100730 [2]西安交通大学医学院附属第二医院消化内科,710004 [3]华中科技大学同济医学院附属协和医院消化内科,武汉430022

出　　处：《中华全科医师杂志》2018年第11期890-894,共5页Chinese Journal of General Practitioners

基　　金：“十一五”国家科技支撑计划(2007BA104B01)。

摘　　要：目的分析老年功能性便秘患者临床症状与胃肠传输时间(GITT)和肛门直肠压力测定(ARM)检查结果的一致性。方法纳入2010年6月至2012年10月在北京协和医院、西安交通大学医学院附属第二医院和华中科技大学同济医学院附属协和医院3家医院就诊的符合罗马Ⅲ诊断标准的功能性便秘老年患者共111例,年龄均>/60岁。记录2周便秘症状日记,包括每周自发排便次数、Bristol粪便性状、排便费力、排便时肛门直肠堵塞感、需要手法辅助排便、排便不尽感的频度和程度,并按症状进行分类。患者均完成48h GITT和ARM检查,分析临床症状与检查结果的一致性。结果111例患者中,男性和女性分别占48.6%(54/111)和51.4%(57/111),年龄(70.2±6.5)岁。在症状分类中,慢传输型、排便障碍型和混合型症状群患者分别占19.8%(22/111)、16.2%(18/111)和59.5%(66/111),4.5%(5/111)的患者症状分散。GITT结果中慢传输型、排便障碍型和混合型分别占54.1%(59/109)、1.8%(2/109)和29.4%(32/109),14.7%(16/109)的患者传输功能正常。ARM证实38.0%(41/108)的患者存在排便障碍。慢传输型症状群和混合型症状群患者中GITT存在慢传输的比例差异无统计学意义[50.O%(11/22)比57.9%(33/57),X^2=0.401,P=0.527],患者主要症状群分类与GITT分类的一致性较差(κ=-0.013);排便障碍症状群和混合型症状群患者ARM排便障碍比例差异无统计学意义[23.1%(6/24)比38.2%(21155),x^2=1.813,P=0.178]。主要症状群分类中是否有排便障碍与ARM检查结果的分类一致性较差(κ=-0.019)。结论老年功能性便秘患者症状以混合型症状为主,主要症状群与GITT、ARM结果的一致性较差。Objective To analyze the consistency between constipated symptoms and the parameters of gastrointestinal transit time (GITT),anorectal manometry (ARM)in elderly patients with functional constipation.Methods Total 111patients (54males and 57females)with an average age of (70.2±6.5)years,who met Rome 111 criteria of functional constipation were enrolled from June 2010to October 2012.After enrollment,patients took two-week diary,recording the spontaneous bowel movements per week,stool type of Bristol Stool Form,the frequency and severity of defecation straining,sensation of anorectal obstruction,manual maneuvers and sensation of incomplete evacuation.The GITT and ARM tests were performed,and the consistency between symptoms and test results were analyzed.Results Patients with symptoms of slow transit,defecation disorder and mixed symptoms were 19.8%(22/111),16.2%(18/ 111)and 59.5%(66/111)respectively;and 4.5%(5/111)patients had scattered symptoms.Based on results of GITT,slow transit subtype,defecation disorder subtype and mixed subtype were 54.1%(59/109),1.8%(2/ 109)and 29.4%(32/109)respectively;and 14.7%(16/109)patients were with normal transit time.ARM results showed that 38.0%(41/109)of patients had dyssynergic defecation.The percentage of slow transit in GITT test showed no significant difference between patients with slow transit symptoms and mixed symptoms [50.0%(11/22)vs.57.9%(33/57),X^2=0.401,P=0.527].The consistency of predominant symptom with GITT subtype was low (κ=-0.013).The percentage of dyssynergic defecation detected with ARM showed no significant difference between patients with defecation disorder-predominant symptom and with mixed symptom [23.1%(6/24)vs.38.2%(21/55),X^2=1.813,P=0.178].The consistency of defecation disorder-predominant symptom with dyssynergic defecation in ARM was low (κ=-0.019).Conclusion The mixed subtype symptoms are the most common presentations of elderly patients with functional constipation,and the consistency of predominant constipated symptoms with GITT,ARM test resul

关 键 词：老年人 便秘 胃肠传输 肛门直肠测压 

分 类 号：R574.62[医药卫生—消化系统]