帕金森病便秘与功能性便秘直肠肛管功能特点分析  

Analysis of anorectal functional characteristics in Parkinson's disease constipation and functional constipation

作　　者：李晓翠 刘子雨 翟惠虹 Li Xiaocui;Liu Ziyu;Zhai Huihong(Department of Gastroenterology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院消化内科,北京100053

出　　处：《首都医科大学学报》2025年第1期136-142,共7页Journal of Capital Medical University

摘　　要：目的比较帕金森病伴便秘(Parkinson's disease constipation,PDC)与功能性便秘(functional constipation,FC)患者肛门直肠功能变化,进一步了解PDC患者的便秘特点。方法将自2017年至2022年于首都医科大学宣武医院神经内科就诊的34例PDC患者作为PDC组,及消化内科就诊的39例FC患者作为对照组,用高分辨率肛门直肠测压的方法检测两组便秘患者的肛门直肠括约肌和盆底肌的动力、感觉、反射情况,比较两组患者肛门直肠功能变化,并根据测压结果分析比较两组患者的便秘特点。结果PDC组患者的肛管静息压、直肠排便压均显著低于FC组,差异均具有统计学意义[分别为(71.73±20.01)mmHg vs(85.02±19.74)mmHg,(22.30±21.12)mmHg vs(38.10±17.00)mmHg,1 mmHg=0.133 kPa,均P<0.05];PDC组患者高压带长度、肛门括约肌最大收缩压、持续收缩时间、肛门松弛率低于FC组,但差异均无统计学意义;FC组患者最大耐受阈值明显高于PDC组,但两组间差异无统计学意义;两组的直肠肛管抑制反射、初始感觉阈值、初始排便阈值及直肠顺应性差异均无统计学意义。测压结果显示,两组患者均以排便推进力不足为主。PDC组与FC组排便推进力不足比例分别为88.2%(30/34)和59.0%(23/39),排便协同失调比例分别为11.8%(4/34)和30.8%(12/39),排便推进力正常且无排便不协调比例分别为0%和10.3%(4/39)。两组的排便障碍类型构成比的差异存在统计学意义(χ^(2)=8.623,P<0.05)。结论PDC患者与FC患者均存在直肠肛门动力和感觉异常,测压分型主要表现为排便推进力不足。但相比FC患者,PDC患者的肛管静息压、直肠排便压明显降低,深入研究PDC患者肛门直肠功能变化及便秘特点,可有助于提高对疾病的认识,为PDC制定合理的治疗方案提供相关依据。Objective To compare the changes in anorectal function between patients with Parkinson's disease constipation(PDC)and with functional constipation(FC),and further understand the constipation characteristics of PDC patients.Methods From 2017 to 2022,34 patients with PDC and 39 patients with FC who visited the Department of Neurology and the Department of Gastroenterology in Xuanwu Hospital,Capital Medical University were selected as the observation group and the control group.High resolution anorectal manometry was used to detect the motility,sensation and reflex of anorectal sphincter and pelvic floor muscles in the two groups of patients with constipation,and to compare the anorectal function changes of the two groups of patients.according to the results of manometry,the characteristics of constipation in the two groups of patients were analyzed and compared.Results The resting anal sphincter pressure and intrarectal pressure in the PDC group were significantly lower than those in the FC group,with statistical significance[(71.73±20.01)mmHg vs(85.02±19.74)mmHg,(22.30±21.12)mmHg vs(38.10±17.00)mmHg,respectively,1 mmHg=0.133 kPa,all P<0.05].The length of high pressure zone,maximum squeeze pressure,continuous systolic time and anal relaxation rate in PDC group were lower than those in FC group,but no statistically significant differences;The maximum tolerance threshold of patients in the FC group was significantly higher than that in the PDC group,but there was no statistically significant difference between the two groups.There was no statistically significant difference in rectanal inhibitory reflex,initial sensory threshold,initial defecation threshold,and rectal compliance between the two groups.According to the pressure measurement results,it was found that both groups of patients mainly had insufficient defecation thrust.The proportions of insufficient defecation propulsion in PDC group and FC group were 88.2%(30/34)and 59.0%(23/39),the proportions of dyscoordination were 11.8%(4/34)and 30.8%(12/39),and t

关 键 词：帕金森病伴便秘 功能性便秘 肛门直肠测压 

分 类 号：R574[医药卫生—消化系统] R742[医药卫生—内科学]