生物反馈治疗排便障碍型便秘的疗效预测因素分析

Predictive factors associated with satisfactory outcomes of biofeedback therapy in patients with dyssynergic defecation

目的探讨排便障碍型便秘(dyssynergic defecation,DD)病人生物反馈(biofeedback,BF)治疗的疗效预测因子。方法回顾性分析在火箭军总医院2014年1月至2016年9月接受BF治疗的70例DD病人的临床资料,定义治疗后的便秘评分(constipation scoring system,CSS)下降>50%为疗效满意,对治疗前收集的可能影响BF疗效的因素进行单因素和多因素分析,分析影响BF疗效的独立预测因素。结果 70例病人中有34例(48.6%)获得满意疗效。单因素分析发现,初感觉阈值低(≤60ml)和最大耐受容量值低(≤70ml)的病人,BF治疗后获得满意疗效的比例显著增高(P<0.05)。多因素分析结果显示,初感觉阈值低(P=0.019,OR=5.167,95%CI:1.039~20.390)是BF治疗后疗效满意的唯一独立预测因子。结论直肠初感觉阈值高的DD病人BF疗效较不满意,对此类病人可能需采用合适的治疗策略来提高BF的疗效。

Objective To investigate the predictive factors associated with satisfactory outcomes of biofeedback therapy in patients with dyssynergic defecation（DD）.Methods Patients with DD undergoing biofeedback therapy during January 2014 to September 2016 in General Hospital of the PLA Rocket Force were retrospectively enrolled in this study.Patients＇ characteristics,anorectal manometry data and constipation score were recorded.The outcome was considered satisfactory if the constipation score was decreased by〉50%.Univariate and multivariate analyses were conducted to assess the independent predictors associated with satisfactory outcomes.Results A total of 70 cases were enrolled and 34（48.6%）cases had satisfactory outcomes.Univariate analysis showed that patients with low threshold volumes for first sensation（≤60 mL）or for maximum discomfort（≤170 mL）had significantly higher incidence of satisfactory outcomes（P〈0.05）.Multivariate logistics analysis demonstrated that low threshold volumes for first sensation（≤60 mL）was the only independent predictive factor（P=0.019,OR=5.167,95%CI1.039-20.390）.Conclusions Low threshold volumes for first sensation（≤60 mL）was an independent predictive factor associated with satisfactory outcome of biofeedback therapy in patients with DD.