乳果糖与莫沙必利治疗老年患者慢性功能性便秘及伴随症状的前瞻性随机对照研究

Lactulose and mosapride in treatment of chronic functional constipation and its concomitant symptoms in the elderly:a prospective randomized controlled trial

目的评价乳果糖与莫沙必利对老年患者慢性功能性便秘及其伴随症状的临床疗效。方法选取2019年2月至6月复旦大学附属华东医院就诊的老年慢性功能性便秘患者80例,根据随机数表法随机分为乳果糖组和莫沙必利组,每组患者40例。乳果糖组予每天口服乳果糖1次,每次15ml,疗程为4周。莫沙必利组予以每天口服枸橼酸莫沙必利片3次,每次5mg,疗程为4周。分别在干预前后记录2组的Wexner便秘评分、焦虑自测量表(SAS)评分及抑郁自测量表(SDS)评分。对比分析2组患者治疗便秘的疗效及临床症状等改善情况。采用SPSS 23.0软件进行数据分析。根据数据类型,组间比较分别采用t检验、秩和检验及χ^(2)检验。结果乳果糖组治疗便秘总有效率为75%(30/40),高于莫沙必利组35%(14/40),差异有统计学意义(P<0.05)。乳果糖组在改善排便频率评分[0(0,1)和1(0,1)分]、排便困难评分[1(1,2)和2(1.25,3)分]、腹痛评分[1(0,2)和2(1,2)分]、排便时间评分[1(1,2)和2(1,2)分]方面优于莫沙必利组(均P<0.05)。乳果糖组中焦虑和(或)抑郁状态占比较干预前降低[52.50%(21/40)和25.00%(10/40),P<0.05];莫沙必利组与干预前比较,差异无统计学意义[70.00%(28/40)和52.50%(21/40)]。结论乳果糖可改善老年慢性功能性便秘患者的临床症状,降低便秘相关的焦虑、抑郁评分。

Objective To evaluate the clinical efficacy of lactulose and mosapride in treatment of senile chronic functional constipation and its concomitant symptoms.Methods A total of 80 elderly patients with chronic functional constipation admitted in our hospital from February to June 2019 were prospectively recruited and randomly divided into lactulose group(n=40)and mosapride group(n=40).The patients in the lactulose group took lactulose orally once a day,15 ml each time for 4 weeks,and those in the mosapride group took Moxapride citratetablet orally 3 times a day,5 mg each time for 4 weeks.Wexner constipation score,and scores of selfrating anxiety scale(SAS)and self-rating depression scale(SDS)were recorded in the 2 groups before and after intervention,and the efficiency and changes in clinical signs and symptoms were compared between them.SPSS statistics 23.0 was used for statistical analysis.Intergroup comparison was performed using student′s t test,rank sum test or Chi-square test depending on data types.Results The total effective rate for constipation was 75%(30/40)in the lactulose group,which was significantly higher than that of the mosapride group[35%(14/40),P<0.05].Lactulose treatment resulted in better scores in defecation frequency[0(0,1)vs 1(0,1)points],defecation difficulty[1(1,2)vs 2(1.25,3)points],abdominal pain[1(0,2)vs 2(1,2)points],and defecation time[1(1,2)vs 2(1,2)points]when compared with mosapride treatment(all P<0.05).What′s more,the proportions of the patients having anxiety and/or depression were decreased from 52.50%(21/40)before treatment to 25.00%(10/40)after lactulose treatment(P<0.05),but there was no such change in the mosapride group[70.00%(28/40)vs 52.50%(21/40),P>0.05].Conclusion To the elderly patients with chronic functional constipation,lactulose significantly alleviates their clinical symptoms and reduces their SAS and SDS scores simultaneously.