慢性特发性便秘患者肛门直肠的感知阈值和动力学的改变

The sensitivity threshold and dynamic changes of the anus rectum in the patients with chronic idiopathic constipation

目的探讨慢性特发性便秘 (CIC)患者肛门直肠动力学特征 ,便秘的病因和发病机理。方法采用PCPolygrafHR高分辨多道胃肠功能测定仪检测 2 4例CIC患者的肛门直肠压力、直肠容量感知、疼痛阈值、耐受阈值及排便功能等指标 ,并与 12例健康人进行对照。结果CIC组直肠静息压、肛管括约肌静息压、最大缩窄压及肛管长度与对照组无显著性差异 ,但CIC患者的初始感觉、疼痛、排便等阈值 ,引起肛门直肠抑制反射的最低充气量和肛管内括约肌松弛压均高于正常对照组。模拟排便时 ,CIC组 33.33% (8/ 2 4 )的患者在直肠收缩时伴有肛管括约肌矛盾收缩。结论CIC患者直肠粘膜对容量刺激的反应性降低和排便时肛管括约肌的反向矛盾收缩可能是形成便秘的原因之一。

Objective To study the dynamic features of anus rectum in patients with chronic idiopathic constipation(CIC) and investigate the causes and mechanism of constipation. Methods Multichannel and high-resolution anus rectum function detector of PC Polygraf HR was applied in 24 patients with CIC for measurement of parameters such as anus rectal pressure, rectal volume sensitivity, pain liminal value, tolerance liminal value and defecation function, which were compared with those in 12 healthy subjects. Results There was no obvious difference in rectal resting pressure, anal canal sphincter resting pressure, rectal maximum contraction pressure and the length of anus canal between CIC group and control group, but the first rectal sensitivity, rectal defecation volume, pain liminal value, defecation liminal value, the lowest charging volume and anal cannal sphincter relaxing were higher in CIC group than those in control group. 33.3% patients had paradoxical contraction of internal sphincter during defecation. Conclusion The decreased reactivity of the rectal mucosa and paradoxical contractions of internal sphincter during defecation may be one of the causes of constipation.