运动神经元病伴随尿便功能障碍的原因分析  

Analysis of the causes of micturition and defecation dysfunction in motor neuron disease patients

作　　者：赵蕾[1] 崔丽英[1] 杜华[1] 李本红[1] 吴双[1] 

机构地区：[1]中国医学科学院北京协和医院神经科,100730

出　　处：《中华神经科杂志》2014年第11期767-771,共5页Chinese Journal of Neurology

摘　　要：目的 探讨运动神经元病（MND）患者尿便障碍的伴随情况及其原因.方法 对MND患者临床特点、尿便功能评价以及肛门括约肌肌电图结果进行分析,探讨MND患者尿便障碍的伴随情况,并结合临床资料分析其可能原因.结果 50例MND患者中有9例（18.0％）有尿便障碍症状,其中便秘4例（4/9）,尿频、尿急伴或者不伴尿失禁、大便急迫感4例（4/9）,排尿、排便无力感2例（2/9）,尿等待1例（1/9）.9例患者肛门括约肌肌电图均在正常范围.结论 MND患者可以合并不同类型及不同程度的尿便功能障碍,其中便秘、尿便急迫感以及尿便无力感是3个主要类型,且尿便功能障碍一般不来源于外括约肌功能障碍.自主神经受累引起的胃肠道功能活动异常、肢体活动能力降低及活动减少、上运动神经元明显受累及呼吸肌受累可能是MND患者出现尿便障碍症状的主要原因.Objective To investigate the clinical features and causes of micturition and defecation dysfunction in motor neuron disease （MND） patients.Methods The micturition and defecation function was evaluated by a questionnaire covering storage and voiding of urine and feces respectively in 50 MND patients.The clinical features and external anal sphincter electromyography （EAS-EMG） were analyzed to explore the causes of micturition and defecation dysfunction in MND patients.Results Micturition and defecation dysfunction was detected in 9 of 50 （18.0％） MND patients.The main types of micturition and defecation dysfunction were constipation （4/9）,urinary frequency,urgency with or without incontinence,fecal urgency （4/9）,powerlessness for micturition and defecation （2/9）,hesitancy for micturition （1/9）.EAS-EMG was normal in 9 MND patients accompanied with micturition and defecation dysfunction.Conclusions MND patients accompanied with micturition and defecation dysfunction were not very rare.Constipation,urgency and powerlessness were the main types of micturition and defecation dysfunction and they were not related to the function of external anal sphincter.Gastrointestinal dysfunction from abnormal autonomic nerve involvement,muscle weakness and the resulted reduced activity,severe upper motor neuron damage and respiratory muscle weakness may be the main causes of micturition and defecation dysfunction in MND patients.

关 键 词：运动神经元病 肌萎缩侧索硬化 便秘 排尿障碍 肛管 肌电描记术 

分 类 号：R744.8[医药卫生—神经病学与精神病学]