功能性便秘患者社会、心理、行为状况调查及生物反馈治疗效果随访

Social, psychosocial and behavior characteristics of patients with functional constipation and the follow-up of the effects of biofeedback therapy

目的:评估功能性便秘患者心理状况、遭遇生活事件情况、观察生物反馈疗效的随访结果,了解与便秘发生有关的因素、便秘对患者生活的影响及患者对便秘的信心。方法:①选择1998-01/2001-12在南京医科大学第一附属医院消化科胃肠动力中心接受生物反馈治疗的功能性便秘患者44例为治疗组。男16例,女28例。均自愿参加。排除不能接受电话和信件随访者。2000-12/2001-04选择古平岗社区健康自愿者31人为对照组,男12人,女19人。②采用美OrionPC/4EMG肌电生物反馈训练治疗系统,患者每周到本院胃肠动力中心训练3次,50～60min/次,1个疗程10～15次,同时每天在家中进行同步练习,练习时间和次数因人而异。③纳入对象心理社会状况和遭遇生活事件的评估采用症状自评量表(包括90多项内容,并分为躯体化、强迫、人际关系、抑郁、焦虑、敌对、恐怖、偏执和精神病性等9大症状因子。分别记1～4分,1为无,4为严重。其主要评分指标为总分、总均分、阳性项目数、阴性项目数、阳性症状均分)、医院焦虑抑郁量表(主要用于医院内科门诊或住院评定患者的焦虑和抑郁状态,由14个条目组成,其中7个条目评定焦虑,7个条目评定抑郁,每一条目以0～3四级记分)和生活事件量表(共65个项目,包括职业、学习、婚姻和恋爱、家庭和子女、经济、司法、人际关系等方面常见的生活事件)。以上量表均在治疗开始前完成。④社会、心理、行为因素及生物反馈疗效随访采用自拟患者情况调查表问卷调查法。生物反馈治疗前的内容为患者的一般情况、既往和目前排便情况、病程、既往检查治疗情况,平素饮食活动情况,便秘对其生活质量的影响;远期随访的内容包括进行生物反馈治疗前后症状改善情况、自己对疗效的评价,以及对便秘的认识、对治疗的信心和希望等。采用电话调查、信函调查及家访调查3种形式进行3年随访调查。⑤组间计量资料差异性测定采用单因素方差分析和t检验,计数资料性测定采用χ2检验。结果:①功能性便秘患者44例,健康者31人均进入结果分析并完成量表调查。②症状自评量表评定结果:症状自评量表总分、总均分、阳性项目数、阳性症状均分、躯体化、强迫症、人际关系、抑郁、焦虑、恐怖、偏执、精神病性评分:治疗组均明显高于对照组(t=2.456～4.729,P<0.05～0.01)。阴性项目数治疗组:明显低于对照组(t=2.687,P<0.01)。敌对评分:两组差异不明显(P>0.05)。③医院焦虑抑郁量表评定结果:焦虑、抑郁总分:治疗组明显高于对照组(t=3.875,3.274,P<0.01)。④生活事件量表评定结果:治疗组患者中与退休和父母死亡有关的各有7例,与工作变动有关的有6例,与夫妻严重争执、搬家、子女就业有关的各有5例。⑤生物反馈疗效的随访结果:生物反馈治疗当时(近期)自主排便每周5次以上无排便困难者36例(36/44);1年后随访资料显示自主排便每周5次以上无排便困难者21例(48%);自主排便时好时坏,间断借助泻药者8例(18%);治疗后症状改善不明显者15例(34%)。⑥对便秘发生相关因素的认识:认为便秘发生与饮食(缺少粗纤维、饮水少、辛辣食品等)有关的患者最多,为14例(32%);认为便秘发生与其他合并症(糖尿病、哮喘、心脏病)的存在有关的患者最少,为3例(7%)。⑦便秘对患者生活的影响:认为便秘对生活有部分影响的最多,为27例(61%);认为便秘无大影响的最少,为3例(7%)。⑧患者对便秘治疗的信心:认为便秘可治愈的最多,为19例(43%);认为便秘无法治愈的最少,为5例(11%)。结论:①功能性便秘患者较正常人存在更多的心理问题,以焦虑和抑郁更为突出。②功能性便秘患者中便秘症状的发生或加重往往与工作生活中的某些事件有关。③93%的患者认为便秘对个人生活产生了不同程度的负面影响。④48%的功能性便秘患者远期疗效(1年以上)显著。⑤患者认为便秘发生与饮食因素关系最大,且大多数患者认为便秘可以治愈。

AIM： To evaluate the psychosocial characteristics, life events, and the outcome of biofeedback in patients with functional constipation, and investigate the correlative factors of functional constipation, and the effects of constipation on quality of life and the confidence of the patients.METHODS： ①Forty-four（male 16 and female 28） patients with functional constipation were selected as the functional constipation group, who were treated in the Center for Gastrointestinal Motility of the First Affiliated Hospital of Nanjing Medical University during January 1998 and December 2001. Thirty-one （male 12 and female 19） healthy volunteers from the Gupinggang community were taken as the controls between December 200 and April 2001. All the subjects were attend our investigation voluntarily.②The patients were treated with Orion PC/4 EMG Biofeedback Training System for 3 times, 50 to 60 minutes once for a total 10 to 15 courses at our Gastrointestinal Motility Center, and they were also trained at home.The time for training and times of training was different in different people.③Symptom checklist 90 （SCL-90, the test is scored for 90 symptoms,including nine clinical subscales as follows： somatization of affection,obsessive-compulsive symptoms, interpersonal sensitivity, depression,anxiety, hostility, phobic anxiety, paranoid ideation, and psychoticism）, the Hospital Anxiety and Depression （HAD, used to assess the anxiety and depress status of the outpatients and inpatients, including fourteen items,scored from 1 to 4）, and the Life Event Scale were completed by these 44 patients and 31 healthy subjects to access their psychosocial characteristics. All tests were scored before the treatment. ④All patients were also asked to make a global assessment. Before treatment, assessment included the history, the bowel habit, diet and the influence on the life.After treatment and at one year after follow-up, the investigation included the treatment effect by stating whether their bowel problems were worse,unaltered, or better than before treatment. The follow-up investigation was finished by phone, letter or call-at. ⑤The inter-group measurement data were done using single-factor analysis of variance and t test, and enumeration data were detected by χ^2 analysis.RESULTS： ①The 44 functional constipation patients and 31 healthy subjects were all finished the study. ②The SCL： The total score, the mean scores of the global symptom index and eight of the nine clinical subscales （somatization of affection, obsessive-compulsive symptoms, interpersonal sensitivity, depression, anxiety, phobic anxiety, paranoid ideation, and psychoticism） of the SCL were significantly higher in patients with functional constipation than those of normal controls（t=2.687,P 〈 0.01）. The negative items were more in the former than in the later （t=2.687,P 〈 0.01）.③The Hospital Anxiety and .Depression： The total scores of anxiety and depression constipated patients were significantly higher than those of healthy controls（t=3.875, 3.274, P 〈 0.01）. ④The assessment results of life events： Seven of them were related to retire and death of parents, 6 with change of job, and 5 each related with dissension, removal of house and employment of their children. ⑤ Follow-up of biofeedback： After biofeedback, the success rate was about 82%（36/44） at a short term. After a long-term follow-up, 48%（21/44） felt that their constipation was relived; 18%（8/44） had good constipation sometimes, and should taken cathartic often; but 34% （15/44） of the patients were unremarkably improved. ⑥The cognition of correlative factors related to constipation： The patients who thought constipation was related to diet were the most, 14 cases （32%）, those who thought constipation was related to other symptoms were the least, 3 cases （7%）. ⑦The influence of constipation on quality of life：About 61%（27/44） of the patients complained that constipation had a strong impact on their quality of life, and 7%（3/44） complained that constipation had little influence on their quality of life. ⑧The confidence of the patients：Nineteen of the patients （43%） had confidence in the treatment of constipation, 5 of them （11%） had no confidence in the treatment of constipation.CONCLUSION： ①The patients with functional constipation reported more psychological distress than healthy subjects did, especially anxiety and depress. ② The onset or worsening of functional constipation in patients is always related to some life events. ③93% of the patients complained that constipation had a strong impact of different degree on their quality of life. ④48% of the patients had a significant success rate after a long-term follow-up （over 1 year）. ⑤The factors concerning the constipation is considered to diet mostly, and most of patients have confidence in the treatment of constipation.