高龄老年功能性便秘患者三维高分辨肛门直肠测压及生物反馈治疗的应用

Application of three-dimensional high resolution anorectal manometry and biological feedback therapy in very elderly patients with functional constipation

目的探讨高龄老年功能性便秘患者三维高分辨肛门直肠测压特点及生物反馈治疗对其临床症状的改善情况。方法回顾性分析68例功能性便秘排便障碍型患者,其中高龄老年组(≥80岁)36例、非高龄老年组(60~79岁)32例,在生物反馈治疗前后行三维高分辨肛门直肠测压,比较参数并对比两组治疗前后症状评分。结果患者三维高分辨肛门直肠测压结果显示,模拟排便检测中肛门松弛率高龄老年组(2.44±33.81)%、较老年组(16.34±16.99)%降低(t=-2.047,P=0.049),直肠感觉阈值测试中排便阈值高龄老年组(103.44±42.01)ml、较非高龄老年组(77.22±41.85)ml升高(t=2.655,P=0.012);高龄老年患者生物反馈治疗后模拟排便中的肛门残余压(57.50±18.88)mmHg(1 mmHg=0.133 kPa)、较治疗前(64.84±25.82)mmHg降低,肛门直肠压力差负数绝对值(-29.64±15.98)mmHg、较治疗前(-39.47±19.45)mmHg缩小,肛门松弛率(10.53±29.35)%、较治疗前(2.44±33.81)%增加,差异均有统计学意义(t=3.342、-4.902、-3.209,P=0.002、0.000、0.003);临床症状评分结果显示,高龄老年组治疗后有效率为66.67%(24/36),非高龄老年组有效率为71.88%(23/32),两组差异无统计学意义(χ^(2)=0.760、P=0.860)。结论老年功能性便秘排便障碍型患者多存在直肠推进力不足和盆底肌不协调收缩,高龄老年患者排便障碍原因以模拟排便时肛门松弛率下降为主;生物反馈治疗主要通过降低模拟排便中肛门残余压、提高肛门松弛率使肛门直肠压力差负数绝对值缩小,从而改善高龄老年患者的排便困难症状。

Objective To investigate the characteristics of three-dimensional high resolution anorectal manometry and the effect of biological feedback therapy on the improvement of clinical symptoms in very elderly patients with chronic functional constipation.Methods A total of 68 cases with chronic functional constipation were divided into very elderly group(≥80 years old,n=36)and the elderly group(60-79 years old,n=32)in the retrospective analysis.Patients underwent the three-dimensional high resolution anorectal manometry before and after biological feedback therapy,and the related parameters and scores of constipation symptoms before and after treatment were compared between the two groups.Results The results of 3D high-resolution anorectal manometry showed that the anus relaxation rate in the simulated defecation test was lower and the bowel threshold in the rectal sensory threshold test was higher in the very elderly group than in the elderly group(2.44±33.81%vs.16.34±16.99%,103.44±42.01 ml vs.77.22±41.85 ml,t=-2.047 and 2.655,P=0.049 and 0.012).In the very elderly group,the post-biological feedback therapy versus pre-biological feedback therapy showed that anal residual pressure during simulated defecation was decreased,the absolute value of negative anorectal pressure difference was reduced and the anal relaxation rate was increased[57.50±18.88 mmHg(1 mmHg=0.133 kPa)vs.64.84±25.82 mmHg,-29.64±15.98 mmHg vs.-39.47±19.45 mmHg,10.53±29.35%vs.2.44±33.81%,t=3.342,-4.902 and-3.209,P=0.002,0.000 and 0.003].The scores of clinical symptom scale showed that there was no significant difference in the effective rate between the very elderly and elderly groups(66.67%or 24/36 vs.71.88%or 23/32,χ^(2)=0.760,P=0.860).Conclusions The elderly functional constipation patients with defecation disorder often have rectal propulsive insufficiency and dyscoordination of pelvic floor muscle contraction.The main cause of defecation disorder in very elderly patients is the decrease of anal relaxation rate during simulated defecation.Biological feedback therapy can improve the symptoms of defecation disorder in very elderly patients by reducing the anal residual pressure during simulated defecation,increasing the anal relaxation rate and reducing the absolute value of negative anorectal pressure difference.