功能性便秘临床症状与肛门直肠测压特征的相关性研究  

Correlation between clinical symptoms of functional constipation and characteristics of anorectal manometry

作　　者：徐岚[1] 谢忱 殷民月 陈文杰 许春芳[1] XU Lan;XIE Chen;YIN Minyue;CHEN Wenjie;XU Chunfang(Department of Gastroenterology,the First Hospital Affiliated to Soochow University,Suzhou,Jiangsu,215000)

机构地区：[1]苏州大学附属第一医院消化内科,江苏苏州215000

出　　处：《实用临床医药杂志》2023年第2期67-72,共6页Journal of Clinical Medicine in Practice

基　　金：江苏省苏州市科技计划(SKY2021038)。

摘　　要：目的分析功能性便秘(FC)症状与基于高分辨率肛门直肠测压(HR-ARM)诊断的肛门直肠动力、感觉异常的相关性。方法前瞻性收集2020年6月—2021年12月在苏州大学附属第一医院行HR-ARM的FC患者资料,检查前记录便秘症状的发生情况并填写症状评分系统(CSS)总分,分析症状与HR-ARM参数和HR-ARM结果的相关性。结果排便费力患者较无排便费力患者肛管残余压高(t=2.359,P=0.021),肛管松弛率低(t=-2.996,P=0.004),直肠推进压高(t=3.099,P=0.003)。粪便干硬患者的直肠推进压低于粪便柔软患者,差异有统计学意义(t=-2.440,P=0.017)。需要辅助排便的患者较无需辅助排便的患者肛管残余压高(t=2.249,P=0.027),急迫便意阈值低(U=451.000,P=0.013)。腹胀患者初始感觉阈值低于无腹胀患者,差异有统计学意义(U=532.500,P=0.016)。HR-ARM结果显示,与无排便费力的患者比较,排便费力患者不协调性排便的发生率较高,差异有统计学意义(χ^(2)=4.697,P=0.030)。CSS总分与肛管残余压呈正相关(r=0.263,P=0.019),与肛管松弛率呈负相关(r=-0.386,P<0.001)。结论FC患者的排便费力症状主要与不协调性排便有关,并非排便推进力不足导致。肛管残余压高、肛管松弛率低的FC患者表现出更严重的便秘症状,2个参数可以更好地评估FC病理生理学异常情况。Objective To analyze the correlations of symptoms of functional constipation(FC)with anorectal motor and paresthesia diagnosed by high-resolution anorectal manometry(HR-ARM).Methods Data of FC patients with HR-ARM in the First Hospital Affiliated to Soochow University from June 2020 to December 2021 were prospectively collected.Before examination,the occurrence of constipation symptoms was recorded and the total score of symptom scoring system(CSS)was filled in,and the correlations of symptoms with HR-ARM parameters and HR-ARM results were analyzed.Results Patients with exertion in defecation had higher anal residual pressure(t=2.359,P=0.021),lower anal relaxation rate(t=-2.996,P=0.004),and higher rectal propulsive pressure(t=3.099,P=0.003)than those without exertion in defecation.Patients with hard stools had lower rectal propulsive pressure(t=-2.440,P=0.017).Patients who needed manual maneuvers to facilitate defecation had higher anal residual pressure(t=2.249,P=0.027)and lower threshold value of willingness in urgent defecation(U=451.000,P=0.013).The first sensitive volume of patients with abdominal bloating was lower than that of patients without abdominal bloating(U=532.500,P=0.016).HR-ARM results showed that patients with exertion in defecation had higher incidence of dyssynergic defecation compared with those without exertion in defecation(χ^(2)=4.697,P=0.030).CSS score was positively correlated with anal residual pressure(r=0.263,P=0.019),and negatively correlated with anal relaxation rate(r=-0.386,P<0.001).Conclusion The symptoms of exertion in defecation in patients with FC are primarily associated with dyssynergic defecation rather than inadequate defecatory propulsion.High residual anal pressure and low anal relaxation rate in patients with FC have more severe symptoms.They could better assess the pathophysiological abnormalities of FC.

关 键 词：功能性便秘 临床症状 肛门直肠测压 不协调性排便 肛管松弛率 肛管残余压 

分 类 号：R442.2[医药卫生—诊断学] R574[医药卫生—临床医学]