慢性特发性便秘患者肛门直肠测压表现及西沙必利的疗效研究

Anorectal manometric abnormalities and effect of cisapride on patients with chronic idiopathic constipation

目的研究慢性特发性便秘（CIC）患者肛门直肠动力及直肠对容量刺激感觉的变化，同时观察西沙必利对CIC的疗效及对上述指标的影响。方法用肛门直肠测压法检测30例CIC患者，服用西沙必利前后的直肠动力及直肠对容量刺激感觉的变化。20名健康者作对照。结果肛门直肠括约肌最大收缩压降低（P＜0．05），引起直肠肛门抑制性反射的最小松弛容量（MRV）增大（P＜0．05），直肠内部容量刺激的排便阈值及疼痛阈值均明显增加（P＜0．01）；西沙必利10mg每日3次治疗4周可显著改善CIC患者上述异常改变（P＜0．01），增加CIC患者排便次数（P＜0．01），治疗总有效率为46，67％。结论CIC患者存在肛门直肠动力及内脏感觉异常，西沙必利可改善上述异常表现，对约半数CIC患者具有良好疗效。

Objective To investigate the abnormalities of anorectal motility,changes of rectal visceral perception to balloon distention and effect of cisapride on patients with chronic idiopathic constipation (CIC). Methods Anorectal manometry was carried out in 30 CIC patients by Synetics Visceral Stimulator combined with PcPolygraf before and after 10mg cisapride three times danly for 4 weeks. Twenty age-macthed controls were also studied before giving cisapride therapy. Results CIC patients showed lower anorectal sphincteric squeezing pressure (P<0.05), larger minimum relaxation volume to elicit the anorectal inhibitory reflux (P<0.05), hihger rectal defecation volume thresholds and higher rectal maximum tolerable volume thresholds (P<0.01) with respect to controls. All the abnormalities significantly improved and defecation frequency greatly increased with 4 weeks cisapride therapy (P<0.01). The total effective rate of cisapride was 46.67%. Conclusion Patients with CIC have both abnormal anorectal motility and rectal visceral perception to balloon distention. Cisapride can improve these and is effective in about half of the cases.