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The influencing factors of constipation after stroke: a meta-analysis

ObjectiveTo systematically evaluate the related factors of constipation in patients with stroke. MethodsCochrane Library, PubMed, Web of Science, Embase, CNKI, VIP, Wanfang and China Biomedical Literature Database were searched by computer, and the retrieval time was set to May 2022. Case-control studies, cohort studies and cross-sectional studies on stroke and constipation were selected. Meta-analysis was performed using RevMan 5.3 software. ResultsA total of 13 studies involving 2 834 patients were included. Meta-analysis showed that age [odds ratio (OR) =2.54, 95% confidence interval (CI) (1.36, 3.73), P<0.001], lesion location [OR=1.98, 95%CI (1.27, 3.11), P=0.003], National Institutes of HealthStroke Scale score [OR=0.40, 95%CI (0.10, 0.70), P=0.010], hemiplegia [OR=4.31, 95%CI (2.59, 7.17), P<0.001], dysphagia [OR=2.32, 95%CI (1.27, 4.25), P=0.006], antidepressants [OR=2.33, 95%CI (1.62, 3.34), P<0.001], BI score [OR=?17.08, 95%CI (?33.07, ?1.08), P=0.04], eating pattern [OR=4.18, 95%CI (1.16, 15.09), P=0.030], drinking water volume ≥800 mL [OR=0.30, 95%CI (0.19, 0.46), P<0.001] might be the influencing factors of constipation in patients after stroke. The results of sensitivity analysis showed that age, education level, diabetes, smoking, stroke type, lesion location, diuretic and BI score might be the influencing factors of constipation after stroke (P<0.05). The results of bias analysis suggest that publication bias is less likely. Conclusions There are many risk factors for constipation in patients with stroke. Current evidence shows that age, diabetes, smoking and other 11 factors may be risk factors for stroke constipation, while high education level and drinking water ≥800 mL may be protective factors, and the other influencing factors have not been determined and need further study.

Analysis of Psychological Assessment Inventory in Patients with Functional Constipation

目的　探討功能性排便障礙人群心理評估中心理和情緒的變化。方法　采用SCL-90、SAS和SDS量表對72例功能性排便障礙患者進行心理評估并分析結果。結果　便秘組SCL-90測試的總分以及軀體化、抑郁、焦慮及精神病性這4項因子的評分結果均高于對照組（P＜0.001），2組其余各因子的評分結果差異沒有統計學意義（P＞0.05）。便秘組SAS和SDS測試的評分結果均高于對照組，表明便秘組焦慮和抑郁的評分均較對照組高（P＜0.001）。結論　功能性便秘患者不同程度伴隨有情緒和情感的異常，因此對該部分患者進行藥物干預的同時給予其心理輔導是非常有必要的。

Advances in Surgical Treatment for Colon Slow Transit Constipation

舒適護理在腰椎間盤突出臥床患者便秘中的應用

目的評價舒適護理應用于腰椎間盤突出患者臥床期間便秘中的效果，探討其臨床適用性。 方法將2013年5月-2014年5月就診的67例腰椎間盤突出患者隨機分為研究組（34例）和對照組（33例）。對照組患者實施常規護理，研究組患者在常規護理的基礎上增加了有針對性的膳食指導、心理疏導、腹部按摩、溫水洗肛及訓練反射性排便等舒適護理干預。觀察并記錄兩組患者治療后一般情況及干預療效。 結果接受護理干預的34例患者的術后首次排便時間、平均排便相隔時間和平均每次排便時間均低于對照組，差異有統計學意義（P＜0.05），研究組患者的護理干預療效高于對照組，差異有統計學意義（χ2=4.831， P=0.028）。 結論舒適護理對腰椎間盤突出患者臥床期間便秘中有很好的干預效果。

Some Questions about the Diagnosis and Treatment of Chronic NonSpecific Constipation

1概述便秘是很常見的癥狀，在美國便秘的發生率為2%，英國為10%，日本為4%，我國天津為4.4%［1］，女性發病概率是男性的3倍。多數便秘患者可經藥物治療治愈或改善癥狀，少數為難治性。少數便秘患者經手術治療效果較好。便秘不是一種病，而是多種疾病的一個癥狀，不同的患者有不同的含義，包括： ①大便量少、硬，排出困難； ②排便困難合并一些特殊的癥候群，如長期用力排便、直腸脹感、排便不完全或依靠手法幫助排便； ③7天內排便次數少于2～3次。臨床上常診斷為慢性頑固性便秘或特發性便秘，但其確切含義很難描述。“慢性”意指病史至少2年，或年幼時就發病； “特發性”說明我們對便秘的原因及流行病學了解不全面； “頑固性”意指經一般藥物及非手術治療很難奏效，常需手術治療［2］。

Clinical Value of Health Education Applied to Unhealthy Lifestyle-caused Functional Constipation

ObjectiveTo explore the clinical effect of healthy education on functional constipation caused by unhealthy lifestyle, and to analyze the disadvantages affecting the curative effect. MethodsA total of 167 cases of functional constipation from February 2009 to February 2012 were included. All of the patients were followed up for one year. We collected clinical data of curative effect and influencing factors, determined the clinical value of healthy education, and analyzed the influence of different factors on the curative effect of healthy education. ResultsThe total curative effect after one-year follow-up was 84.4%. The curative effect in elderly patients was significantly higher than that in middle-aged ones (P<0.05). The curative effect in urban patients was remarkably higher than that in rural ones (P<0.05). And the curative effect of patients with college degree wass much higher than that in patients with education background of primary school or below (P<0.05). ConclusionHealthy education has important value on releasing and eliminating functional constipation caused by unhealthy lifestyle. And it needs individual education aimed at patients with different age, education degree, and domicile.

Study on the Clinical Effect of Biofeedback Therapy for Functional Constipation

摘要:目的: 隨機對照研究、評估生物反饋訓練治療慢性功能性便秘的療效。 方法 : 60例慢性功能性便秘患者,隨機分為治療組30例和對照組30例。治療組接受1個療程(5周)生物反饋訓練治療(10次為一個療程、一次30～45分鐘、每周2次)。對照組患者接受聚乙二醇4000 10g BID 口服,療程5周。治療前后作便秘癥狀評分、結腸通過試驗檢測、直腸肛門壓力檢測。 結果 : 生物反饋訓練和聚乙二醇4000均可使多數慢性功能性便秘患者的大便次數、大便性狀及伴隨癥狀恢復正常或緩解,總有效率分別為667%和80%(P ＞005)。生物反饋訓練和聚乙二醇4000口服治療后,結腸通過試驗72小時標志物排出率分別為75%及73%,均較治療前明顯增加。生物反饋訓練治療后力排時肛門壓明顯下降。 結論 : 生物反饋訓練對出口梗阻型、慢傳輸型便秘均有效,是一種有效的、新興的治療慢性功能性便秘的方法,可作為功能性便秘的一線治療方法。Abstract: Objective: To assess the clinic effect of biofeedback therapy for functional constipation. Methods : Sixty cases of chronic functional constipation were randomly divided into treatment group (30 cases) and control group (30 cases). Cases in the treatment group were exposed to biofeedback for a fiveweeklong treatment course—individual treatment lasted for 3045 minutes and twice per week. Patients in the control group received PEG 4000 10g BID for five weeks. Data from constipation symptom score, colonic transit test, and anorectal manometry were done and compared before and after two kinds of treatments. Results : Biofeedback training and PEG 4000 could restore the stoolfrequency, stool characteristics and accompanying symptoms to normal or mitigation of the majority of patients with chronic functional constipation, with the total effective rates being 667% and 80% (P gt;005), respectively. After biofeedback training and PGE 4000 treatment, the discharge rate of 72hour markers of colonic transit test significantly increased to 75% and 73%, respectively. Additionally, anorectal pressure decreased dramatically after biofeedback training. Conclusion : Biofeedback training would play a positive role in outlet obstruction and slow transit constipation. Thus, it could be an effective firstline treatment of chronic functional constipation.

便秘藥物的合理選擇

便秘是一種常見病,發病率高,病因復雜。目前治療便秘的藥物種類繁多,各類藥物有其不同的作用機制、療效和不良反應。本文就各類便秘藥物的特點和應用,以及特殊人群便秘藥物的選擇進行討論,進而提高藥物的合理應用。

原發性便秘的外科治療

單吻合器行經肛門直腸膨出修補和直腸黏膜切除術治療排便障礙綜合征的臨床療效觀察

目的對由于直腸前突引起的排便障礙綜合征患者使用單吻合器行經肛門直腸膨出修補和直腸黏膜切除，并行術前、術后臨床癥狀和功能評估，評價該方法的手術效果。 方法2010年8月-2013年12月對39例患有直腸前突經過至少4個月的保守治療未見明顯好轉的女性患者采取單吻合器行經肛門直腸膨出修補和直腸黏膜切除術（TRREMS）治療，并觀察手術效果、并發癥及復發率。 結果平均手術時間為（40.00±3.78）min，術中平均出血量（15.00±5.01）mL，全部患者術后住院觀察24 h，均未見明顯早期并發癥，經隨訪12～24個月，3例出現手術相關并發癥（7.69%），1例吻合口狹窄（2.56%），經擴肛治療后，癥狀緩解，能自行排氣排便，2例出現肛門周圍疼痛不適（5.13%），疼痛評分3級，予以肛周局部外用藥物治療后疼痛緩解。術后排糞造影顯示共4例（10.26%）存在直腸前突殘留（均為Ⅰ級）。全部患者術后未出現出血、直腸陰道瘺、性交痛等并發癥。 結論TRREMS手術治療直腸前突引起的排便障礙綜合征無論在解剖學上還是在功能評價上都是安全有效的，且術后并發癥少，術后疼痛輕。