慢性功能性便秘肛直肠压力检测EMG生物反馈训练的疗效  

Effects of biofeedback training by EMG on patients with chronic functional constipation

作　　者：杨柳明[1] 林济宝 赵延龙[1] 梁绛菱[1] 林红[1] 钟智[1] 陈荣伟[1] 谢俊芳[1] 刘付妍 吴志荣[1] 

机构地区：[1]广东省廉江市人民医院消化内科,广东省廉江市524400

出　　处：《世界华人消化杂志》2004年第3期730-733,共4页World Chinese Journal of Digestology

基　　金：广东省卫生厅科学技术研究基金资助课题;No.990112~~

摘　　要：目的:探讨慢性功能性便秘(CFC)患者肛直肠压力及肌电(EMG)活动特点;同时观察生物反馈训练系统对CFC患者的疗效及对上述指标的影响. 方法:用BioLab动力学参数监测系统(液态式),多道胃肠功能检查仪对144例CFC患者检测,并用OrionPC/12mEMG 生物反馈治疗仪进行肌电评估和训练,20名健康者作对照. 结果:与健康对照组相比,CFC患者肛管静息压(AQP)稍下降(P>0.05)、最大缩榨压(MSP)从15.7±1.4下降到12.7±1.4(P<0.01),直肠感知阈值(RVST)和最大耐受量(MTV) 均从12±6.2和29.3±6.8增高到14.9±6.6和36.0±7.3 (P<0.01;P<0.01);EMG评估CFC患者盆底肌与腹前斜肌有矛盾运动100%,盆底肌静息状态下运动幅值从5.3±2.8升高到10.2±2.8(P<0.01)和腹前斜肌运动幅值从34.4±5.2降低到30.8±4.9(P<0.01);OrionPC/4EMG生物反馈洲练治疗后最大缩榨压(MSP)从12.7±1.4上升到19.9±1.8 (P<0.01),直肠感知阈值(RVST)和最大耐受量(MTV)均从14.9±6.6和36.0±7.3降低到11.5±4.9和30.9±6.4 (P<0.01;P<0.01);EMG评估CFC患者盆底肌与腹前斜肌矛盾运动100%被纠正,盆底肌静息状态下运动幅值从10.2±2.8下降到5.4±1.6(P<0.01)和腹前斜肌运动幅值从30.8±4.9增高到38.2±5.4(P<0.01),生物反馈治疗CFC患者临床症状改善总有效率为84.03%,增加疗程的频次可使疗效从78.8%增加到91.7%(P<0.05)、缩短治疗间隔可使疗效从69.2%增高到92.8%(P<0.05),辅助家庭训练可以提高疗效和降低复发率. 结论:CFC患者存在肛门直肠动力、感知觉及肌电活动异常,OrionPC/12 mEMG生物反馈系统可以改善上述异常表现,对84.0%的CFC患者具有良好的疗效,较长时间的强化训练可望提高近期疗效,辅助家庭训练可降低复发率.AIM: To study characteristics of anorectal pressure, EMG activity and effect of biofeedback training system on patient with chronic functional constipation (CFC). METHODS: Anorectal manometry was carried out in 144 cases of CFC by a monitor system (liquid-phase type) and Biolab dynamics parameter before and after the biofeedback training. 20 healthy individuals were taken as control. RESULTS: Compared with controls, CFC patients showed slightly lower anal quiesent pressure (P>0.05), lower anorectal sphincteric squeezing pressure (15.7±1.4 vs 12.7± 1.4) (P<0.01), higher rectal defection volume thresholds and higher rectal maximum talerable volume thresholds (12±6.2 vs 14.9±6.6; 29.3±6.8 vs 36.0±7.3) (P<0.01; P<0.01); EMG assessments showed that 100% patients with CFC had the contradictory movement between the pelvic floor muscle (PFM) and abdominal anterior oblique muscle (AAOM). The movement extent of the PFM rose from 5.3±2.8 to 10.2±2.8 under quiet state (P<0.01), and AAOM reduced from 34.4±5.2 to 30.8±4.9 (P<0.01); All the abnormalities significantly improved with Orion PC/ 12 m EMG biofeedback training therapy. After biofeedback training therapy, symptoms of CFC patients were improved with efficient rate of 84.03%; With increase of the treatment time and shortening of the interval and assistant training, the curative efficacy rose and the recurrence rate reduced (78.8% vs 91.7%; 69.2% vs 92.8%) (P<0.05; P<0.05). CONCLUSION: CFC patients have abnormal anorectal pressure, sensation threshold and unusual anus electric activities. Biofeedback training therapy can improve the above-mentioned indexes and is effective in 84.03% of the patients. The relatively intensive long-time training can improve the curative rate in a short period, and family assistant training can reduce the recurrance rate of the disease.

关 键 词：慢性功能性便秘 肛直肠压力检测 生物反馈训练 肌电 发病机制 

分 类 号：R574.62[医药卫生—消化系统]