Exciting new features have been described concerning neurogenic bowel dysfunction,including interactions between the central nervous system,the enteric nervous system,axonal injury,neuronal loss,neurotransmission of n...Exciting new features have been described concerning neurogenic bowel dysfunction,including interactions between the central nervous system,the enteric nervous system,axonal injury,neuronal loss,neurotransmission of noxious and non-noxious stimuli,and the fields of gastroenterology and neurology.Patients with spinal cord injury,myelomeningocele,multiple sclerosis and Parkinson's disease present with serious upper and lower bowel dysfunctions characterized by constipation,incontinence,gastrointestinal motor dysfunction and altered visceral sensitivity.Spinal cord injury is associated with severe autonomic dysfunction,and bowel dysfunction is a major physical and psychological burden for these patients.An adult myelomeningocele patient commonly has multiple problems reflecting the multisystemic nature of the disease.Multiple sclerosis is a neurodegenerative disorder in which axonal injury,neuronal loss,and atrophy of the central nervous system can lead to permanent neurological damage and clinical disability.Parkinson's disease is a multisystem disorder involving dopaminergic,noradrenergic,serotoninergic and cholinergic systems,characterizedby motor and non-motor symptoms.Parkinson's disease affects several neuronal structures outside the substantia nigra,among which is the enteric nervous system.Recent reports have shown that the lesions in the enteric nervous system occur in very early stages of the disease,even before the involvement of the central nervous system.This has led to the postulation that the enteric nervous system could be critical in the pathophysiology of Parkinson's disease,as it could represent the point of entry for a putative environmental factor to initiate the pathological process.This review covers the data related to the etiology,epidemiology,clinical expression,pathophysiology,genetic aspects,gastrointestinal motor dysfunction,visceral sensitivity,management,prevention and prognosis of neurogenic bowel dysfunction patients with these neurological diseases.Embryological,morphological and experimental studies on animal models and humans are also taken into account.展开更多
The aim of this review is to offer dietary advice for individuals with spinal cord injury(SCI)and neurogenic bowel dysfunction.With this in mind,we consider health conditions that are dependent on the level of lesion ...The aim of this review is to offer dietary advice for individuals with spinal cord injury(SCI)and neurogenic bowel dysfunction.With this in mind,we consider health conditions that are dependent on the level of lesion including skeletal muscle atrophy,autonomic dysreflexia and neurogenic bladder.In addition,SCI is often associated with a sedentary lifestyle,which increases risk for osteoporosis and diseases associated with chronic low-grade inflammation,including cardiovascular and chronic kidney diseases.The Mediterranean diet,along with exercise and dietary supplements,has been suggested as an anti-inflammatory intervention in individuals with SCI.However,individuals with chronic SCI have a daily intake of whole fruit,vegetables and whole grains lower than the recommended dietary allowance for the general population.Some studies have reported an increase in neurogenic bowel dysfunction symptoms after high fiber intake;therefore,this finding could explain the low consumption of plant foods.Low consumption of fibre induces dysbiosis,which is associated with bothendotoxemia and inflammation.Dysbiosis can be reduced by exercise and diet in individuals with SCI.Therefore,to summarize our viewpoint,we developed a Mediterranean diet-based diet and exercise pyramid to integrate nutritional recommendations and exercise guidelines.Nutritional guidelines come from previously suggested recommendations for military veterans with disabilities and individuals with SCI,chronic kidney diseases,chronic pain and irritable bowel syndrome.We also considered the recent exercise guidelines and position stands for adults with SCI to improve muscle strength,flexibility and cardiorespiratory fitness and to obtain cardiometabolic benefits.Finally,dietary advice for Paralympic athletes is suggested.展开更多
目的:检索并整合脊髓损伤患者神经源性肠道功能障碍(Neurogenic Bowel Dysfunction,NBD)管理最佳证据,为医护人员提供参考。方法:依次检索UpToDate、BMJ Best Practice、JBI、Cochrane Library、国际指南协作网、美国国立指南库、美国...目的:检索并整合脊髓损伤患者神经源性肠道功能障碍(Neurogenic Bowel Dysfunction,NBD)管理最佳证据,为医护人员提供参考。方法:依次检索UpToDate、BMJ Best Practice、JBI、Cochrane Library、国际指南协作网、美国国立指南库、美国脊髓损伤协会、PubMed、Embase、Web of Science、中国知网、万方等数据库,关于脊髓损伤患者NBD管理文献,包括临床决策、临床实践指南、证据总结、系统评价、专家共识、随机对照试验,检索时限为建库至2022年4月15日,双人对文献质量进行评价。结果:共纳入18篇文献,从肠道功能评估、营养支持、非药物干预、药物干预、康复锻炼、教育支持6个方面归纳出22条证据。结论:该研究总结了脊髓损伤患者NBD管理最佳证据,医护人员应结合临床情景与患者意愿进行临床应用。展开更多
目的观察次髎穴埋线治疗脊髓损伤后神经源性肠道功能障碍(便秘型)的临床疗效。方法将74例脊髓损伤后神经源性肠道功能障碍(便秘型)患者随机分为研究组38例和对照组36例。两组均接受常规治疗同时,研究组采用次髎穴埋线治疗,对照组采用口...目的观察次髎穴埋线治疗脊髓损伤后神经源性肠道功能障碍(便秘型)的临床疗效。方法将74例脊髓损伤后神经源性肠道功能障碍(便秘型)患者随机分为研究组38例和对照组36例。两组均接受常规治疗同时,研究组采用次髎穴埋线治疗,对照组采用口服乳果糖治疗。比较两组治疗前后排便频率、排便时间、Wexner便秘评分、神经源性肠道功能障碍(neurogenic bowel dysfunction,NBD)评分及便秘患者生活质量量表(patient-assessment of constipation quality of life,PAC-QOL)各项评分,并对并发症发生率进行评价。结果两组治疗后排便频率较同组治疗前均显著提高,排便时间均显著缩短,PAC-QOL各项评分均显著降低,差异均具有统计学意义(P<0.05)。研究组治疗后排便频率、排便时间及PAC-QOL各项评分与对照组比较,差异均具有统计学意义(P<0.05)。两组治疗2、4周后Wexner便秘评分及NBD评分较同组治疗前均显著降低,差异均具有统计学意义(P<0.05)。研究组治疗2、4周后Wexner便秘评分及NBD评分均明显低于对照组,两组比较差异均具有统计学意义(P<0.05)。研究组治疗期间并发症发生率为5.3%,对照组为5.6%,两组比较差异无统计学意义(P>0.05)。结论对脊髓损伤后神经源性肠道功能障碍(便秘型)患者采取次髎穴埋线治疗,可提升排便频率,缩短排便时间,改善肠道功能障碍与便秘症状,提高患者生活质量,安全性好。展开更多
目的对国内外脊髓损伤神经源性肠道功能障碍相关指南进行质量评价和内容分析,为临床开展以证据为基础的脊髓损伤神经源性肠道功能障碍护理实践提供参考。方法系统检索BMJ Best Practice、国际指南协作网、美国国立指南文库、英国国家临...目的对国内外脊髓损伤神经源性肠道功能障碍相关指南进行质量评价和内容分析,为临床开展以证据为基础的脊髓损伤神经源性肠道功能障碍护理实践提供参考。方法系统检索BMJ Best Practice、国际指南协作网、美国国立指南文库、英国国家临床医学研究所、苏格兰校际指南网、安大略省注册护士协会、美国脊髓损伤学会、美国残疾退伍军人协会、医脉通临床指南库、PubMed、Web of Science、CINAHL、Cochrane Library、Ovid数据库、万方、中国知网、中华医学期刊全文数据库中的相关指南,采用AGREEⅡ对纳入的循证指南进行质量评价,采用JBI的专家共识评价标准对专家共识类指南进行质量评价,运用内容分析法整合指南的推荐意见。结果最终纳入10篇文献,其中6篇循证指南,4篇专家共识类指南。3篇循证指南的质量评价结果为A级,3篇结果为B级。10篇指南内容分析汇总为分类、护理目标、评估、基础肠道护理、药物护理、肠道灌洗、电和磁刺激、并发症预防、健康教育和护理记录10个主题27条推荐意见。结论本研究整合了脊髓损伤神经源性肠道功能障碍相关指南中护理相关内容,总结10个主题,内容丰富,整体质量较高,部分争议内容有待进一步研究。国内脊髓损伤神经源性肠道功能障碍护理指南欠缺,需组建多学科小组构建符合国内临床情境的护理指南。展开更多
目的通过CiteSpace软件对脊髓损伤后神经源性肠功能障碍相关研究科学知识图谱进行分析。方法检索2000年1月1日—2022年9月4日Web of Science核心数据库中关于脊髓损伤后神经源性肠功能障碍的文献,采用CiteSpace 5.7.R2软件,分别绘制作...目的通过CiteSpace软件对脊髓损伤后神经源性肠功能障碍相关研究科学知识图谱进行分析。方法检索2000年1月1日—2022年9月4日Web of Science核心数据库中关于脊髓损伤后神经源性肠功能障碍的文献,采用CiteSpace 5.7.R2软件,分别绘制作者、机构、关键词的知识图谱,对关键词进行共现、聚类、时间区域统计分析,并绘制图谱。结果共纳入Web of Science核心文献928篇。国外核心学者主要有EMMANUEL A、KLAUS KROGH、K KROGH,国外核心机构为Aarhus Univ Hosp、Univ Michigan、Univ British Columbia、Univ Coll London Hosp。高频次关键词主要有脊髓损伤、便秘、管理、功能障碍、生活质量、大便失禁、神经源性肠道、神经性膀胱功能障碍及神经源性肠功能障碍。结论国外脊髓损伤后神经源性肠功能障碍相关研究开展较早且相对成熟,国内该领域尚处于起步阶段,建议国内加强相关研究。本文梳理该领域的研究前沿及趋势,对今后研究具有指导意义。展开更多
文摘Exciting new features have been described concerning neurogenic bowel dysfunction,including interactions between the central nervous system,the enteric nervous system,axonal injury,neuronal loss,neurotransmission of noxious and non-noxious stimuli,and the fields of gastroenterology and neurology.Patients with spinal cord injury,myelomeningocele,multiple sclerosis and Parkinson's disease present with serious upper and lower bowel dysfunctions characterized by constipation,incontinence,gastrointestinal motor dysfunction and altered visceral sensitivity.Spinal cord injury is associated with severe autonomic dysfunction,and bowel dysfunction is a major physical and psychological burden for these patients.An adult myelomeningocele patient commonly has multiple problems reflecting the multisystemic nature of the disease.Multiple sclerosis is a neurodegenerative disorder in which axonal injury,neuronal loss,and atrophy of the central nervous system can lead to permanent neurological damage and clinical disability.Parkinson's disease is a multisystem disorder involving dopaminergic,noradrenergic,serotoninergic and cholinergic systems,characterizedby motor and non-motor symptoms.Parkinson's disease affects several neuronal structures outside the substantia nigra,among which is the enteric nervous system.Recent reports have shown that the lesions in the enteric nervous system occur in very early stages of the disease,even before the involvement of the central nervous system.This has led to the postulation that the enteric nervous system could be critical in the pathophysiology of Parkinson's disease,as it could represent the point of entry for a putative environmental factor to initiate the pathological process.This review covers the data related to the etiology,epidemiology,clinical expression,pathophysiology,genetic aspects,gastrointestinal motor dysfunction,visceral sensitivity,management,prevention and prognosis of neurogenic bowel dysfunction patients with these neurological diseases.Embryological,morphological and experimental studies on animal models and humans are also taken into account.
基金Supported by the Project AMAMP(2019-2021),No.M_D GCOM REG2019002167303-12-2019funded by Ministero della Difesa,Italyfunded as a visiting professor by Sapienza,University of Rome,No.Prot.n.008164526-09-2019。
文摘The aim of this review is to offer dietary advice for individuals with spinal cord injury(SCI)and neurogenic bowel dysfunction.With this in mind,we consider health conditions that are dependent on the level of lesion including skeletal muscle atrophy,autonomic dysreflexia and neurogenic bladder.In addition,SCI is often associated with a sedentary lifestyle,which increases risk for osteoporosis and diseases associated with chronic low-grade inflammation,including cardiovascular and chronic kidney diseases.The Mediterranean diet,along with exercise and dietary supplements,has been suggested as an anti-inflammatory intervention in individuals with SCI.However,individuals with chronic SCI have a daily intake of whole fruit,vegetables and whole grains lower than the recommended dietary allowance for the general population.Some studies have reported an increase in neurogenic bowel dysfunction symptoms after high fiber intake;therefore,this finding could explain the low consumption of plant foods.Low consumption of fibre induces dysbiosis,which is associated with bothendotoxemia and inflammation.Dysbiosis can be reduced by exercise and diet in individuals with SCI.Therefore,to summarize our viewpoint,we developed a Mediterranean diet-based diet and exercise pyramid to integrate nutritional recommendations and exercise guidelines.Nutritional guidelines come from previously suggested recommendations for military veterans with disabilities and individuals with SCI,chronic kidney diseases,chronic pain and irritable bowel syndrome.We also considered the recent exercise guidelines and position stands for adults with SCI to improve muscle strength,flexibility and cardiorespiratory fitness and to obtain cardiometabolic benefits.Finally,dietary advice for Paralympic athletes is suggested.
文摘目的:检索并整合脊髓损伤患者神经源性肠道功能障碍(Neurogenic Bowel Dysfunction,NBD)管理最佳证据,为医护人员提供参考。方法:依次检索UpToDate、BMJ Best Practice、JBI、Cochrane Library、国际指南协作网、美国国立指南库、美国脊髓损伤协会、PubMed、Embase、Web of Science、中国知网、万方等数据库,关于脊髓损伤患者NBD管理文献,包括临床决策、临床实践指南、证据总结、系统评价、专家共识、随机对照试验,检索时限为建库至2022年4月15日,双人对文献质量进行评价。结果:共纳入18篇文献,从肠道功能评估、营养支持、非药物干预、药物干预、康复锻炼、教育支持6个方面归纳出22条证据。结论:该研究总结了脊髓损伤患者NBD管理最佳证据,医护人员应结合临床情景与患者意愿进行临床应用。
文摘目的观察次髎穴埋线治疗脊髓损伤后神经源性肠道功能障碍(便秘型)的临床疗效。方法将74例脊髓损伤后神经源性肠道功能障碍(便秘型)患者随机分为研究组38例和对照组36例。两组均接受常规治疗同时,研究组采用次髎穴埋线治疗,对照组采用口服乳果糖治疗。比较两组治疗前后排便频率、排便时间、Wexner便秘评分、神经源性肠道功能障碍(neurogenic bowel dysfunction,NBD)评分及便秘患者生活质量量表(patient-assessment of constipation quality of life,PAC-QOL)各项评分,并对并发症发生率进行评价。结果两组治疗后排便频率较同组治疗前均显著提高,排便时间均显著缩短,PAC-QOL各项评分均显著降低,差异均具有统计学意义(P<0.05)。研究组治疗后排便频率、排便时间及PAC-QOL各项评分与对照组比较,差异均具有统计学意义(P<0.05)。两组治疗2、4周后Wexner便秘评分及NBD评分较同组治疗前均显著降低,差异均具有统计学意义(P<0.05)。研究组治疗2、4周后Wexner便秘评分及NBD评分均明显低于对照组,两组比较差异均具有统计学意义(P<0.05)。研究组治疗期间并发症发生率为5.3%,对照组为5.6%,两组比较差异无统计学意义(P>0.05)。结论对脊髓损伤后神经源性肠道功能障碍(便秘型)患者采取次髎穴埋线治疗,可提升排便频率,缩短排便时间,改善肠道功能障碍与便秘症状,提高患者生活质量,安全性好。
文摘目的对国内外脊髓损伤神经源性肠道功能障碍相关指南进行质量评价和内容分析,为临床开展以证据为基础的脊髓损伤神经源性肠道功能障碍护理实践提供参考。方法系统检索BMJ Best Practice、国际指南协作网、美国国立指南文库、英国国家临床医学研究所、苏格兰校际指南网、安大略省注册护士协会、美国脊髓损伤学会、美国残疾退伍军人协会、医脉通临床指南库、PubMed、Web of Science、CINAHL、Cochrane Library、Ovid数据库、万方、中国知网、中华医学期刊全文数据库中的相关指南,采用AGREEⅡ对纳入的循证指南进行质量评价,采用JBI的专家共识评价标准对专家共识类指南进行质量评价,运用内容分析法整合指南的推荐意见。结果最终纳入10篇文献,其中6篇循证指南,4篇专家共识类指南。3篇循证指南的质量评价结果为A级,3篇结果为B级。10篇指南内容分析汇总为分类、护理目标、评估、基础肠道护理、药物护理、肠道灌洗、电和磁刺激、并发症预防、健康教育和护理记录10个主题27条推荐意见。结论本研究整合了脊髓损伤神经源性肠道功能障碍相关指南中护理相关内容,总结10个主题,内容丰富,整体质量较高,部分争议内容有待进一步研究。国内脊髓损伤神经源性肠道功能障碍护理指南欠缺,需组建多学科小组构建符合国内临床情境的护理指南。
文摘目的通过CiteSpace软件对脊髓损伤后神经源性肠功能障碍相关研究科学知识图谱进行分析。方法检索2000年1月1日—2022年9月4日Web of Science核心数据库中关于脊髓损伤后神经源性肠功能障碍的文献,采用CiteSpace 5.7.R2软件,分别绘制作者、机构、关键词的知识图谱,对关键词进行共现、聚类、时间区域统计分析,并绘制图谱。结果共纳入Web of Science核心文献928篇。国外核心学者主要有EMMANUEL A、KLAUS KROGH、K KROGH,国外核心机构为Aarhus Univ Hosp、Univ Michigan、Univ British Columbia、Univ Coll London Hosp。高频次关键词主要有脊髓损伤、便秘、管理、功能障碍、生活质量、大便失禁、神经源性肠道、神经性膀胱功能障碍及神经源性肠功能障碍。结论国外脊髓损伤后神经源性肠功能障碍相关研究开展较早且相对成熟,国内该领域尚处于起步阶段,建议国内加强相关研究。本文梳理该领域的研究前沿及趋势,对今后研究具有指导意义。
