自适应与固定式生物反馈治疗出口梗阻型便秘的疗效比较

Comparison of efficacy of adaptive biofeedback training with fixed biofeedback training in treatment of patients with outlet obstruction constipation

目的比较自适应式生物反馈与固定式生物反馈治疗出口梗阻型便秘(OOC)的疗效。方法纳入OOC患者120例,按患者来院就诊次序分成两组,其中奇数序列患者编入自适应式生物反馈组,偶数序列患者编入固定式生物反馈组,每组各60例。因失访及中途退出32例,最终88例OOC患者进入研究,其中自适应式生物反馈组48例,固定式生物反馈组40例。完成8周的生物反馈治疗后,比较两组患者肛直肠功能(直肠肛门抑制反射阈、肛管静息压、模拟排便时直肠肛管压力梯度、矛盾性收缩和模拟排便时肛管松弛)、便秘临床症状积分、临床总有效率和总满意率。结果治疗前两组患者肛直肠功能和便秘临床症状积分比较差异均无统计学意义(均P>0.05);治疗后自适应式生物反馈组患者较固定式生物反馈组患者模拟排便时直肠肛管压力梯度增加,矛盾性收缩减少,便秘临床症状积分减少,临床总有效率和总满意率上升(均P<0.05)。治疗后同组患者直肠肛门抑制反射阈、矛盾性收缩和便秘临床症状积分较治疗前明显减少,模拟排便时直肠肛管压力梯度和肛管松弛较治疗前明显增加,差异均有统计学意义(均P<0.05)。结论自适应式生物反馈治疗OOC疗效优于固定式生物反馈。

Objective To compare the clinical efficacy of adaptive biofeedback training（ABF）with fixed biofeedback training（FBF） in patients with outlet obstruction constipation（OOC）. Methods Patients with OOC diagnosed by Rome Ⅲ were randomly divided into ABF group and FBF group. The total scores of clinical symptoms, clinical efficacy, self evaluation of satisfaction and anal rectum function were compared between two groups before and after 8 weeks treatment. A total of 88 cases of eligible OOC patients were enrolled in the study, including 48 cases receiving ABF and 40 cases receiving FBF. Results There were no significant differences in total scores of clinical symptoms and anal rectum function between two groups before treatment（all P〈0.05）. After 8 weeks of treatment, the anal resting pressure had no significant changes（P〈0.05）, but total scores of clinical symptoms, anorectum inhibitory reflex value and paradoxical contraction significantly decreased（all P〈0.01）, while rectal anal pressure gradient and anal relaxation during simulation defecation significantly increased（both P〈0.01）. Furthermore, in ABF group, the rectal anal pressure gradient and anal relaxation during simulation defecation, clinical efficacy and self evaluation of satisfaction were increased, and paradoxical contraction and total scores of clinical symptoms were decreased more markedly than FBF group after 8 weeks of treatment（all P〈0.05）. There were no significant differences in anal resting pressure and anorectum inhibitory reflex value between two groups after 8 weeks of treatment（all P〈0.05）. Conclusion The ABF has better efficacy and more advantages than FBF in treatment of patients with outlet obstruction constipation.