骶神经磁刺激联合生物反馈治疗功能性排粪障碍的疗效观察

Effect of sacral nerve magnetic stimulation combined with biofeedback in the treatment of functional defecation disorders

目的观察骶神经磁刺激联合生物反馈(BF)治疗功能性排粪障碍(FDD)的临床疗效。方法选取2018年3月至2019年12月南京中医药大学附属苏州市中医医院收治的72例FDD患者为研究对象,随机将患者分为对照组和治疗组,每组各36例。对照组采用BF治疗,治疗组采用骶神经磁刺激联合BF治疗。比较两组治疗3个疗程后的临床疗效,以及治疗前后的便秘症状评分、生活质量、心理状态评分及肛管直肠压力。结果研究期间治疗组脱落2例,对照组脱落3例。治疗组总有效率高于对照组(P<0.05)。治疗前,两组6项便秘症状评分比较,差异均无统计学意义(均P>0.05)。治疗后,两组6项便秘症状评分均较组内治疗前下降(均P<0.05);治疗组排粪费力,排粪时间,下坠、不尽、胀感及腹胀评分均低于对照组(均P<0.05),两组粪便性状及排粪频率评分比较差异均无统计学意义(均P>0.05)。治疗前,两组PAC-QOL、SAS、SDS评分比较,差异均无统计学意义(均P>0.05)。治疗后,两组PAC-QOL、SAS、SDS评分较组内治疗前下降,治疗组PAC-QOL评分低于对照组(均P<0.05);两组SAS、SDS评分比较差异均无统计学意义(均P>0.05)。治疗前,两组肛管直肠测压各检测指标(AMSP、ARP、RSP、FSV、CRS、MTV)比较,差异均无统计学意义(均P>0.05)。治疗后,治疗组ARP、FSV、CRS及MTV较前下降,对照组FSV、CRS及MTV较前下降,治疗组FSV、CRS低于对照组,差异均有统计学意义(均P<0.05)。结论相比单用BF,骶神经磁刺激联合BF有助于提升临床治疗有效率,改善患者便秘与生活质量,对于降低直肠感觉阈值方面也有更为明显的效果。

Objectives To investigate the effect of sacral nerve magnetic stimulation combined with biofeedback in the treatment of functional defecation disorders.Methods Seventy-two patients with functional defecation disorders treated at the Suzhou Hospital of Traditional Chinese Medicine-Affiliated Hospital of Nanjing University of Chinese Medicine between March 2018 and December 2019 were recruited.Patients were randomly assigned to the control group and the treatment group with 36 patients in each group.Patients in the control group received biofeedback,and patients in the treatment group received sacral nerve magnetic stimulation combined with biofeedback.The efficacy after three courses of treatment was compared between the two groups.Constipation symptoms score,Patient Assessment of Constipation Quality of Life(PAC-QOL)questionnaire,and Self-Rating Anxiety Scale(SAS)/Self-Rating Depression Scale(SDS)were used to evaluate patients’symptoms,quality of life,and psychological status,respectively.Anorectal manometry was performed before and after treatment.Results There were two and three cases withdraw from this study in the treatment group and the control group,respectively.Overall efficacy was significantly higher in the treatment group than in the control group(P<0.05).Six constipation symptoms scores were similar between the two groups before treatment(P>0.05).After treatment,six symptoms scores decreased in both groups(P<0.05)with significantly lower scores of straining during bowel movements,duration of bowel movements,sensation of incomplete evacuation,and sensation of bloating in the treatment group(P<0.05)and similar scores of stool score and frequency of bowel movement between the two groups(P>0.05).PAC-QOL,SAS,and SDS before treatment were similar between the two groups(P>0.05).After treatment,PAC-QOL,SAS,and SDS decreased in both groups with significantly lower PAC-QOL in the treatment group(P<0.05)and similar SAS and SDS between the two groups(P>0.05).Anal maximum squeeze pressure(AMSP),anal resting pressure(ARP),rectal squeeze pressure(RSP),first sensation volume(FSV),constant rectal sensation(CRS),and maximum tolerable volume(MTV)before treatment were similar between the two groups(P>0.05).After treatment,ARP,FSV,CRS,and MTV decreased significantly in the treatment group,and FSV,CRS,and MTV decreased significantly in the control group(P<0.05).FSV and CRS were significantly lower in the treatment group(P<0.05).Conclusion Compared with biofeedback alone,sacral nerve magnetic stimulation combined with biofeedback could effectively improve clinical efficacy,alleviate constipation symptoms,improve quality of life,and lower rectal sensation threshold.