高位直肠灌肠对骨盆骨折术后便秘患者肛肠动力学及肛门功能的影响

Effects of high rectal enema on the anarectal dynamics and anal function in patients with constipation after operation of pelvic fracture

目的观察高位直肠灌肠治疗骨盆骨折术后便秘的疗效及对患者肛肠动力学及肛门功能的影响。方法选择我院肛肠科2013年4月至2016年4月收治的90例骨盆骨折术后便秘患者作为研究对象,随机分为观察组与对照组,各45例。观察组应用开塞露进行高位直肠灌肠治疗,对照组采用开塞露传统塞肛治疗,比较两组起效时间、排便量、治疗前后肛管静息压(ARP)、直肠静息压(RRP)、直肠便意感觉容量(FDV)等肛肠动力学指标及肛门功能及不良反应发生率。结果观察组起效时间为(10.50±3.21)min,短于对照组;排便量为(145.61±23.22)g,高于对照组(均P<0.05)。两组治疗前的ARP、RRP及FDV差异均无统计学差异(P>0.05);治疗后两组ARP、RRP无明显变化(P>0.05),FDV均低于治疗前(P<0.05),但两组间差异无统计学意义(P>0.05)。两组治疗前的肛门功能评分差异无统计学意义(P>0.05),治疗后肛门功能评分均明显升高(P<0.05),同时观察组高于对照组(P<0.05)。观察组灌肠液外溢发生率为2.2%,低于对照组(13.3)(P<0.05)。结论高位直肠灌肠治疗骨盆骨折术后便秘具有起效快、利于粪便更快排尽的优点,利于患者肛门功能的改善,对肛肠动力学影响轻,操作简便,有临床推广价值。

Objective To observe the effect of high rectal enema in the treatment of constipation after operation of pelvic fracture and the effects on anorectal dynamics and anal function. Methods Ninety patients with constipation after operation of pelvic fracture who were treated in the anorectal department of our hospital from April2013 to April 2016 were divided into observation group and control group according to the random number table,45 cases in each. The observation group was treated by high rectal enema with Enema Glycerini while the control group was treated by traditional treatment with Enema Glycerini. The onset time, volume of defecation, anal canal resting pressure（ARP）, rectal resting pressure（RRP）, rectal feeling defecation volume（FDV） and other anorectal dynamic indexes before and after treatment, anal function and incidence of adverse reactions were compared between the two groups. Results The onset time of the observation group [（10.50±3.21） min] was shorter than that of the control group, and the volume of defecation [（145.61±23.22） g] was more than that of the control group（P〈0.05）. There were no significant differences in ARP, RRP and FDV between the two groups before treatment（P〈0.05）; After treatment, there were no significant changes of ARP and RRP in both groups（P〈0.05）. FDV were significantly lower than that before treatment（P〈0.05）, but there was no significant difference in FDV between the two groups after treatment（P〉0.05）. There were no significant differences in anal function score between the two groups before treatment（P〉0.05）. After treatment, the anal function scores of both groups were significantly increased（P〈0.05）, and the score of observation group was higher than that of control group（P〈0.05）. The incidence of enema liquid overflow in the observation group（2.2%） was lower than that in the control group（13.3%）（P〈0.05）. Conclusion High rectal enema has advantages of quick onset and good for defecation in the treatment of constipation after operation of pelvic fracture. It also can effectively prevent the incidence of enema liquid overflow. It is conductive to improving the anal function in patients and has little effect on anorectal dynamics. It is easy to operate, and is an ideal treatment.