肠道综合物理疗法对不完全性脊髓损伤患者便秘的影响

Effect of intestinal comprehensive physical therapy on constipation in patients with incomplete spinal cord injury

目的:通过3种方法的对比观察肠道综合物理疗法对不完全性脊髓损伤患者便秘的影响。方法:选取符合入组条件的不完全性脊髓损伤患者30例,随机分为A、B、C 3组各10例。在常规干预的基础上,A组进行生物反馈电刺激治疗,B组进行肠道运动疗法治疗,C组进行肠道综合物理疗法(生物反馈电刺激结合肠道运动疗法)的治疗,治疗前后比较神经源性肠道功能障碍(NBD)评分量表、Wexner便秘评分量表、便秘患者生活质量量表评分(PAC-QOL)、便秘患者症状自评量表评分(PAC-SYM)、乳果糖及开塞露用量、肛门直肠测压等指标,分析评估疗效。结果:治疗4周后,3组的NBD、Wexner便秘,PAC-QOL及PAC-SYM评分均较治疗前有明显减少(P<0.01),乳果糖及开塞露用量均较治疗前有明显减少(P<0.01),肛门收缩压较治疗前有明显增加(P<0.01),直肠容量感觉阈值较治疗前有明显减少(P<0.05),肛门静息压治疗前后差异无统计学意义;治疗后,C组各项量表评分、乳果糖及开塞露用量均较A、B组有明显减少(P<0.05),A、B组间差异无统计学意义,直肠测压各项指标3组间比较差异无统计学意义。结论:3种方法均可改善不完全脊髓损伤患者的便秘症状,肠道综合物理疗法比单独生物反馈电刺激及肠道运动疗法对不完全性脊髓损伤后便秘的改善作用更显著。

Objective:To observe the effect of intestinal comprehensive physical therapy on constipation in patients with incomplete spinal cord injury by comparing three methods.Methods:A total of 30 patients with incomplete spinal cord injury who were eligible for inclusion were randomly divided into three groups:A,B and C.On the basis of routine intervention,group A received biofeedback electric stimulation,group B received intestinal exercise therapy,and group C received intestinal comprehensive physical therapy(biofeedback electric stimulation combined with intestinal exercise therapy).The treatment was given once a day,five days a week for four weeks.Before and after treatment,we compared the neurogenic intestinal dysfunction(NBD)score scale,Wexner constipation score scale,PAC-QOL scale,PAC-SYM scale,the dosage of lactulose and glycerine enema,the anorectal manometry and other indicators,and analyzed and evaluated the efficacy.Results:After treatment,the scores of various scales,the dosage of lactulose and glycerine enema in the three groups were significantly reduced(P<0.01),the anal systolic pressure was significantly increased(P<0.01),and the rectal volume perception threshold was significantly reduced(P<0.05)as compared with those before treatment.There was no statistically significant difference in the anal resting pressure before and after treatment(P>0.05).After treatment,the scores of various scales,the dosage of lactulose and glycerine enema in group C were significantly lower than those in group A and group B(P<0.05).There was no significant difference between group A and group B(P>0.05).There was no significant difference among the three groups in the indicators of rectal manometry(P>0.05).Conclusion:The three methods can improve the constipation symptoms of patients with incomplete spinal cord injury.Intestinal comprehensive physical therapy is more effective than biofeedback electrical stimulation and intestinal exercise therapy alone in improving constipation after incomplete spinal cord injury.