老年特发性便秘患者结肠、直肠和肛门动力学变化

Changes of colonic and anorectal dynamics in elderly patients with chronic idiopathic constipation

目的 探讨老年慢性特发性便秘 (CIC)患者结肠、直肠和肛门运动功能变化。方法 应用不透 X线标记物法 ,采用 8通道水灌注式消化道压力检测系统 ,对 5 9例老年慢性特发性便秘 (CIC)患者及 36例对照者进行结肠通过时间检查及直肠肛门压力测定。结果 1老年 CIC组全结肠及分段结肠通过时间较对照组明显延长(P<0 .0 5 ) ;2长期服用泻药的老年 CIC患者其全结肠通过时间较间断服药和不服药组明显延长 (P<0 .0 5 ) ;3老年 CIC患者最大缩榨压、模拟排便时肛管压力变化低于对照组 (P<0 .0 5 ) ,直肠初始感觉阈值、排便阈值和最大耐受容量均高于对照组 (P<0 .0 5 ) ,并有 2 8例 (4 7.5 % )老年 CIC患者模拟排便时出现肛管压力异常升高。结论 老年 CIC患者存在结肠动力学异常 ,与直肠低敏感。

Objective To investigate the colonic,anorectal dynamic abnormality in elderly patients with chronic idiopathic constipation(CIC).Methods 59 elderly patients with CIC and 36 elderly healthy subjects(EHS)were selected.Total and segmental colonic transit times were assessed radiographically using radiopaque markers.Anorectal pressure were measured with Medtronic PcPolygraf,which was a water perfused catheter system.Results Total and segmengal colonic transit times were significantly prolonged in elderly patients with CIC than EHS(P<0.05).Laxative use was associated with prolonged total and segmental transit times independent of patient group.Maximal squeezing pressure and the changes of anal pressure during defecation in elderly patients(EP)with CIC were lower than those in EHS(P<0.05).The rectal lowest volume of sensory threshold,the rectal threshold volume for desire to defecate and the rectal maximal volume of tolerance were highter than those in EHS(P<0.05).And there were 28(47.5%)of EP who had increasing anal pressure when defecation was stimulated.Conclusions There is abnormal colonic dynamics in elderly patients with CIC.CIC in elderly parients may be associated with lower sensitivity,higher tolerance and discoordination of annorectum during defecation