替加色罗对老年功能性便秘患者肛门直肠动力和直肠感觉功能的影响

The effects of tegaserod on anorectal motility and rectal sensation in elderly patients with functional constipation .

目的研究老年功能性便秘(简称便秘)患者肛门直肠动力和直肠感觉功能改变及替加色罗的影响。方法采用瑞典CTD-SYNECTICS公司生产的PC-Polygraf HR高分辨多道胃肠功能消化道检测仪,对便秘患者(老年30例、非老年22例)和健康对照者(老年28例、非老年20例)肛门直肠动力和直肠感觉功能进行检测,同时便秘患者给予替加色罗口服(商品名:泽马可,北京诺华制药有限公司制造,6mg,2次／d),两周后复查肛门直肠动力和直肠感觉功能。结果(1)老年便秘患者直肠最低敏感量、最大耐受性、最大顺应性和模拟大便直肠及括约肌同步收缩发生率分别为(200±61)ml、(280±69)m1、(40．5±10．8)ml／kPa、46．7％,高于老年对照组(95±31)ml、(205±78) ml、(32．9±12．9)ml／kPa、14．2％;非老年便秘组上述指标[(140±52)ml、(250±58)ml、(38．6±12．3)ml／kPa、36．2％]亦高于非老年对照组[(75±38)ml、(190±50)ml、(30．8±15．2)ml／kPa、0．0％],均为P<0．01;(2)老年和非老年对照组肛门括约肌压力分别为(4．9±0．8)kPa和(6.6±1．3)kPa,缩窄压为(9．3±1．6)kPa和(13．3±1．9)kPa,老年对照组低于非老年对照组(均为P< 0．01);(3)老年和非老年便秘组服药后直肠最低敏感量、最大耐受性、最大顺应性和模拟大便直肠及括约肌同步收缩发生率明显低于服药前(P<0．01)。结论(1)老年功能性便秘患者直肠对容量刺激存在低敏感、高耐受、高顺应性,且肛门、直肠的协调收缩功能紊乱;(2)健康老年人直肠对容量刺激敏感性降低,肛门自控能力减弱;(3)替加色罗有改善功能性便秘患者直肠感觉功能及促进肛门、直肠协调收缩作用。

Objective To study the anoreetal motility and rectal sensation in elderly patients with functional constipation and the effects of tegaserod on anoreetal motility and rectal sensation. Methods Thirty elderly patients and 22 non-elderly patients with functional constipation （EFC, NEFC）, 28 elderly healthy subjects （EHS）, 20 non-elderly healthy subjects （NEHS） were enrolled in the study. The patients with functional constipation were given oral administration of tegaserod （6 rag, Bid）. After two weeks tegaserod treatment, the anorectal motility and rectal sensation of the patients with functional constipation were detected by Medtronic PC-Polygraf HR （made by Sweden） . Results （1） The rectal lowest volume of sensory threshold, the maximal volume of tolerance, maximal compliance and the morbidity of anorectal synchronous contraction when excretive action was imitated were （200 ± 61 ） ml, （280 ± 69 ） ml, （40.5 ± 10.8 ） ml/kPa, 46.7 % in EFC, （ 140 ± 52 ） ml, （250±58）ml, （38.6±12.3） ml/kPa, 36.2% inNEFC. They were higher than those inEHS（95± 31）ml,（205±78）ml,（32.9±12.9）ml/ kPa,14.2% and those in NEHS（75± 38）ml,（190±50）ml, （30.8± 15.2）ml/ kPa, 0. 0%（P〈0. 01）. （2） The pressure of anal sphincter and the maximal squeeze pressure inEHSwere （4.9±0.8）kPa and （9.3± 1.6）kPa . They were lower than those in HS （6.6±1.3） kPa and （13.3±1. 9）kPa（P〈0.01）. （3）After tegaserod treatment, the rectal lowest volume of sensory threshold , the maximal volume of tolerance, maximal compliance and the morbidity of anorectal synchronous contraction when excretive action was imitated in NEFC. They were lower than those in EHS and NEHS before treatment （ P〈0.01 ）. Conclusions （1） Lower sensitivity, higher tolerance and compliance of rectum and the disturbances of anorectal coordinating contraction may be associated with elderly functional constipation. （2） There are lower sensitivity of rectum and weaken anal automatic control function in elderly healthy subjects. （3） Tagasterod may improve the rectal sensation and the function of anorectal coordinating contraction in the patients with functional constipation.