女性气虚型功能性出口梗阻型便秘的测压特点分析

Analysis of pressure measurement characteristics of functional outlet obstruction constipation with deficiency of Qi in women

目的探讨女性气虚型功能性出口梗阻型便秘(OOC)患者肛门直肠动力及直肠感知功能的特点。方法回顾性分析南京市中医院2018年1月至2018年12月期间在便秘平台收治的53例OOC患者及60名健康志愿者的肛门直肠动力及直肠感知功能资料。结果53例患者的平均肛管静息压高于健康志愿者(t=4.985,P<0.01),平均最大收缩压低于健康志愿者(t=7.555,P<0.01)。直肠排便压中,所有患者的平均排便压也是低于健康志愿者的(t=4.297,P<0.01)。肛门括约肌长度OOC患者较女性健康者增长(t=4.825,P<0.01);不同合并症女性OOC患者肛管静息压与健康志愿者相比差异均有统计学意义(t前突=5.257,t会阴下降=6.091,t内套叠=4.23;P<0.05)。总体平均最大收缩压低于正常参考值,各型患者与健康志愿者差异均有统计学意义(t前突=6.277,t会阴下降=5.306,t内套叠=3.293;P<0.05);直肠排便压中,各型患者均表现排便压较低,但仅直肠前突及会阴下降与健康者相比差异均有统计学意义(t前突=3.313,t会阴下降=4.637,P均<0.05);患者排便阈值及平均排便阈值均高于健康志愿者,差异均有统计学意义(t=2.818,P<0.01)。虽然53例患者的平均初始阈值高于健康志愿者,但差异没有统计学意义(P>0.05)。最大耐受量与健康志愿者相比,差异也没有统计学意义(P>0.05);4种合并症便秘患者的初始阈值与健康志愿者相差不大,差异均无统计学意义(均P>0.05)。结论OOC动力特点主要表现为高肛管静息压,低收缩压,以及直肠低敏感性,这说明肛门外括约肌及盆底肌的收缩及协调功能障碍、直肠敏感性下降及对容量刺激的反应较迟钝可能是造成功能性便秘的重要原因。

Objective To investigate the characteristics of anorectal motility and rectal perception in female outlet obstruction constipation(OOC)patients.Methods The data of anorectal motility and rectal perception of 53 OOC patients and 60 healthy volunteers who admitted to the constipation platform of Nanjing Hospital of Traditional Chinese Medicine from January 2018 to December 2018 were retrospectively analyzed.Results The mean anal resting pressure of 53 patients was higher than the normal reference value(t=4.985,P<0.01).When the average maximum systolic blood pressure is lower than the normal reference value(t=7.555,P<0.01).In rectal bowel pressure,the average bowel pressure of all patients was also lower than the normal reference value(t=4.297,P<0.01);Anal sphincter length increased in OOC patients compared with healthy women(t=4.825,P<0.01);The differences of anal repose pressure between OOC patients with different complications and normal reference values were statistically significant(tprolapse=5.257,tperineal decline=6.091,tintusculation=4.23;P<0.05).The overall mean maximum systolic blood pressure was lower than the normal reference value,and the difference was statistically significant between all types of patients(tanterior process=6.277,tperineal decline=5.306,tintusculation=3.293;P<0.05),all types of patients showed low rectal pressure,but only the rectal prolapse and perineal decline were statistically significant compared with healthy patients(tprolapse=3.313,tperineal decline=4.637;P<0.05);Both the defecation threshold and the mean defecation threshold of the patients were higher than the normal reference value,and the differences were statistically significant(t=2.818,P<0.05).Although the mean initial threshold of 53 patients was higher than the normal reference value,the difference was not statistically significant(P>0.05).The difference between the maximum tolerance and the normal reference value was also not statistically significant(P>0.05).There was no significant difference between the initial threshold value and the normal reference value in patients with constipation of the 4 complications(P>0.05).Conclusion Outlet Obstruction Constipation dynamic characteristics are mainly manifested as high anorectal resting pressure,low systolic pressure,and low rectal sensitivity,which indicates that the contraction and coordination dysfunction of the external anal sphincter and pelvic floor muscles,decreased rectal sensitivity and slow response to volume stimulation may be an important cause of functional constipation.