帕罗西汀对慢传输性便秘伴焦虑抑郁障碍患者肛门直肠动力和感觉的影响  

Effect of paroxetine on anorectal motility and sensory of patients with STC accompanied with depression and anxiety

作　　者：王永兵[1] 赵晓晖[2] 张文忠[1] 杨娟[2] 张根福[1] 朱振亚[1] 

机构地区：[1]上海市浦东新区人民医院肛肠外科,上海201299 [2]上海市浦东新区人民医院神经内科,上海201299

出　　处：《中国现代医学杂志》2015年第6期77-81,共5页China Journal of Modern Medicine

基　　金：上海市浦东新区卫生和计划生育委员会重点学科群建设基金(No:PWZxq2014-13)

摘　　要：目的探讨抗焦虑抑郁药物对慢传输性便秘(STC)伴焦虑抑郁障碍患者肛门直肠动力和感觉的影响及其可能机制,为STC的规范化综合治疗提供临床帮助。方法选择STC病例128例,予HAMD评分,87例评分≥8分界定为STC伴焦虑抑郁障碍。随机分为对照组(42例)、抗焦虑抑郁药物研究组(45例),对照组予乳果糖口服液10 ml,每天3次,8周,研究组相同剂量乳果糖口服液的同时予帕罗西汀20 mg/d,8周。两组分别于治疗前、治疗后8周实施肛门直肠动力和感觉的检测。结果两组均未发生严重不良反应,研究组有2例于6~7周间失访;两组治疗前肛门直肠动力和感觉功能各指标间差异无统计学意义;治疗组治疗前后相比,肛门括约肌压力有所提高(P<0.05),直肠最低敏感量、直肠最大耐受量、直肠最大顺应性均有显著下降(P<0.01),但直肠静息压、缩窄压、模拟大便括约肌净减压差异无统计学意义(P>0.05);两组治疗后8周相比,治疗组肛门括约肌压力、直肠最大耐受量较对照组改变有显著性差异(P<0.05),直肠最低敏感量、直肠最大顺应性较对照组下降更显著(P<0.01),直肠静息压、缩窄压、模拟大便括约肌净减压差异无统计学意义(P>0.05)。结论有必要将焦虑抑郁的评价列入到STC患者常规诊疗过程中;对于伴有情绪障碍者应及时予抗焦虑抑郁药物的干预,从而打断情绪障碍与肛门直肠动力和感觉障碍之间的恶性循环。【Objective】To explore the effect and the mechanism of antidepressant drugs on anorectal motility and sensory of the patients with slow transit constipation（STC） accompanied with depression and anxiety so as to provide clinical help for standardization of the comprehensive treatment for STC.【Methods】A total of 128 cases with STC were given a mark with HAMD, the 24 th Edition. Among them 87 cases scored ≥8 score were defined as STC with anxiety and depression. They were randomly divided into the control group（42 cases） and antidepressant and anxiolytic drug research group（45 cases）. The control group was given 10 ml lactulose oral liquid, 3 times a day for 8weeks. The research group was given the same dose lactulose oral solution and additional paroxetine 20 mg/d for the same period of treatment. The anorectal dynamics and sensory were detected before treatment, after 8 week implementation in the two groups. 【Results】There were no serious adverse reactions in either group. 2 cases of the study group lost in the follow-up at 6th^7thweek. There was no significant difference of the indexes of anorectal motility and sensory function between the two groups before treatment（P〈0.05）. Compared with those before treatment, the anal sphincter pressure increased in the treatment group after treatment of 8 W（P〈0.05）, and the lowest amount of rectal sensitivity, the rectal maximum tolerable volume and the rectal maximum compliance decreased significantly（P〈0.01）;but there was no significant difference in the rectal resting pressure, the shrinkage narrow pressure and the simulated stool sphincter net pressure（P〈0.05）. After treatment for 8 weeks, there were significant differences between the two groups in the changes of the anal sphincter pressure and the rectal maximum tolerable dose（P〈0.05）; the lowest volume rectal sensitivity and the rectal maximum compliance in the treatment group decreased more significantly than those of the control group（P〈0.01）. But there wa

关 键 词：慢传输性便秘 焦虑抑郁状态 帕罗西汀 肛门直肠动力感觉 干预 

分 类 号：R574[医药卫生—消化系统] R656[医药卫生—内科学]