匹维溴铵治疗肠易激综合征的临床疗效及改变肛门直肠动力和内脏敏感性研究

Assessment of efficacy of pinaverium bromide in treatment of irritable bowel syndrome and its effect on visceral motility and sensitivity

目的 探讨匹维溴铵对肠易激综合征 (IBS)患者的疗效 ,及对腹泻型和便秘型IBS肛门直肠压力和内脏敏感性的影响。方法 按罗马Ⅱ标准选择 84例IBS患者 ,均予匹维溴铵 5 0mg口服 ,每日 3次。分别于服药前、服药 1周和 2周后对各种症状的改善情况进行评估。对 14例腹泻型IBS及 10例便秘型IBS患者分别于服药前和服药 2周后进行肛门直肠压力及直肠敏感性测定。结果 服用匹维溴铵 1周后 ,腹痛、腹胀和黏液便症状评分改善 ,差异有非常显著性 (各为 2 .13± 0 .36比 1.2 8± 0 .35 ,2 .4 9± 0 .73比 1.35± 0 .17,1.0 3± 0 .2 7比 0 .4 3± 0 .12 ,P <0 .0 1) ,腹泻、便秘及里急后重症状评分显著改善 (2 .4 2± 0 .33比 2 .10± 0 .2 7,2 .0 7± 0 .4 5比 1.6 7± 0 .36 ,1.98± 0 .2 9比 1.6 8± 0 .2 7,P <0 .0 5 )。服用2周后 ,除排便困难外 ,IBS各症状评分均改善 ,差异有非常显著性 (P <0 .0 1)。腹泻型IBS内脏感觉阈值、排便阈值及疼痛阈值均有非常显著提高 (2 4 .39± 12 .0 7比 4 9.88± 7.14 ,34.2 5± 14 .77比 6 8.93±2 1.82 ,70 .2 1± 18.17比 10 4 .6 9± 4 3.2 3,P <0 .0 1)。便秘型IBS肛管括约肌静息压减低 ,差异有非常显著性 (84 .37± 4 3.76比 71.4 7± 2 9.88,P <0 .0 1) ,收缩压和舒张?

Objective To investigate the therapeutic effects of pinaverium bromide on irritable bowel syndrome (IBS), and to study its effect on rectal visceral perception and anorectal manometry. Methods Eighty four patients with IBS received pinaverium bromide 50 mg t.i.d for 2 weeks. The score of symptoms was assessed before, after one week and 2 weeks of threatment. Rectal visceral perception thresholds, rectal compliance and anorectal manometry were measured before and after administration of pinaverium bromide. Results Pinaverium bromide 150 mg/d significantly improved the score of abdominal pain, abdominal distension and mucus stool(2.13±0.36 vs 1.28±0.35,2.49±0.73 vs 1.35±0.17,1.03±0.27 vs 0.43±0.12, P < 0.01), respectively, so did the score of diarrhea, constipation and tenesmus(2.42±0.33 vs 2.10± 0.27, 2.07±0.45 vs 1.67±0.36,1.98±0.29 vs 1.68±0.27, P <0.05). The symptoms of IBS improved significantly after 2 weeks of treatment( P <0.01), except the symptom of difficult defecation( P <0.05). The thresholds of visceral sensation volume, defecation volume and pain volume increased markedly in diarrhea predominant IBS(24.39±12.07 vs 49.88±7.14,34.25±14.77 vs 68.93±21.82,70.21±18.17 vs 104.69± 43.23, P <0.01). The alteration of anorectal resting pressure was measured in constipation predominant IBS(84.37±43.76 vs 71.47±29.88, P <0.01), so was the alteration of squeeze pressure and relaxation pressure in constipation predominant IBS(219.76±70.91 vs 122.28±57.56,58.43±44.58 vs 54.14± 21.97 , P < 0.01). Conclusion Pinaverium bromide can alleviate effectively symptoms such as abdominal pain, abdominal distention, constipation, and diarrhea of IBS, to ameliorate visceral hypersensitivity in diarrhea predominant IBS, and to regulate the disorder of anorectal motility in constipation predominant IBS.