老年慢性便秘患者合并毒血症的临床分析

Clinical Characteristics of Chronic Constipation in Elderly Patientscomplicated toxemia

目的探讨老年慢性便秘患者临床特点及合并毒血症可能的危险因素。方法采用回顾性研究方法,选取2016年3月至2019年3月在黄冈市中心医院诊疗的老年慢性便秘患者作为研究对象,依据是否出现轻度毒血症症状分为毒血症组和非毒血症组。分析并比较两组患者性别、年龄、体重、吸烟、饮酒、教育程度、临床症状、饮食习惯、运动习惯、女性生育史、实验室指标,合并高血压、冠心病、卒中、缺血性肠病等心脑血管疾病情况。结果入选老年慢性便秘患者415例,临床症状表现为排便费力319例(76.9%),29例出现轻度毒血症症状(6.99%)。毒血症组女性患者比例(75.9%)、腹胀比例(65.5%)、便秘时间>2年比例(79.3%)高于非毒血症组,差异有统计学意义(P<0.05)。毒血症组WBC(9.17±3.26)×10^9/L、D-二聚体[(8.67±3.76)mg/L]显著高于非毒血症组,差异有统计学意义(P<0.001)。毒血症组缺血性肠病及冠心病发生率高于非毒血症组,差异有统计学意义(P<0.05)。单因素分析老年慢性便秘患者出现心脑血管疾病与缺血性肠病的危险因素及OR值,合并毒血症是发生缺血性肠病及冠心病的危险因素,其OR值分别是(OR=7.788,95%CI 3.037~19.974)及(OR=2.489,95%CI 1.155~5.363)。结论老年慢性便秘患者最常见的临床症状为排便费力,轻度毒血症症状较常见。毒血症的发生可能与性别、腹胀、便秘时间有关。对于老年慢性便秘患者,合并毒血症可能是发生缺血性肠病及冠心病的发生的危险因素。

Objective To investigate clinical characteristics of chronic constipation in elderly patients and analyze possible risk factors in the development of toxemia.Methods A retrospective study was performed on the elderly patients who visited Huanggang Central Hospital because of chronic constipation between March 2016 and March 2019.These patients were divided into the toxemic and non-toxemic groups by the presence of signs and symptoms of mild toxemia.This study presented a comparative analysis on the toxemic and non-toxemic groups to explore their differences in gender ratio,age,weight,smoking,drinking,eating habits,exercise habits,education level,clinical symptoms,childbearing history(applied to female patients),relevant laboratory indicators,presence of cardiovascular and cerebrovascular diseases.Results This study involved 415 elderly patients with chronic constipation,among whom 319(76.9%)complained of excessive straining with bowel movements;29(6.99%)were diagnosed with mild toxemia.Proportions of female patients,abdominal distention cases,and patients with a history of constipation for over 2 years were 75.9%,65.5%,and 88.2% in the toxemic group, whereas those in the non-toxemic group were 56.2%,37.3%,and 79.3%,respectively.The differences exhibited statistical significance(P<0.05).WBC and D-Dimer in the toxemic group were significantly higher than in the non-toxemic group [(9.17±3.26)×10^9/Lvs.(5.49±2.86)×10^9/L;(8.67±3.76)mg/Lvs.(6.10±4.86)mg/L;P<0.001].Compared to the non-toxemic counterpart,the toxemic group had a greater risk of ischemic intestinal disease and coronary artery disease,with the difference showing statistical significance(P<0.05);ANOVA was conducted to determine risk factors and odds ratios of cardiovascular and cerebrovascular diseases that occurred in the elderly with chronic constipation.Results Showed that complicated toxemia might induce ischemic intestinal disease and coronary artery disease[(OR=7.788,95%CI 3.037~19.974);(OR=2.489,95%CI 1.155~5.363)].Conclusion Most elderly patients with chronic constipation experience excessive straining during bowel movements,while mild toxemia is also a common symptom in these cases.Toxemia in the elderly with chronic constipation appears to be associated with gender,abdominal distention,and duration of constipation.For elderly patients,complicated toxemia should be viewed as a risk factor for ischemic intestinal disease and coronary artery disease in elderly patients with chronic constipation.