The influencing factors of constipation after stroke: a meta-analysis_West China Medical Journal

Authors：

LIAO Xiaoqin ¹ , LIN Hongyuan ² ,  PENG Shanling ³

1. School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350001, P. R. China;
2. School of Nursing, Fujian Medical University, Fuzhou, Fujian 350108, P. R. China;
3. Department of Nursing, the 900th Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army, Fuzhou, Fujian 350001, P. R. China;

Corresponding author：

PENG Shanling, Email: psl30@163.com

Keywords：

Stroke; constipation; influencing fctors; meta-analysis

DOI：

10.7507/1002-0179.202103230

Video：

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Objective To systematically evaluate the related factors of constipation in patients with stroke. Methods Cochrane Library, PubMed, Web of Science, Embase, CNKI, VIP, Wanfang and China Biomedical Literature Database were searched by computer, and the retrieval time was set to May 2022. Case-control studies, cohort studies and cross-sectional studies on stroke and constipation were selected. Meta-analysis was performed using RevMan 5.3 software. Results A total of 13 studies involving 2 834 patients were included. Meta-analysis showed that age [odds ratio (OR) =2.54, 95% confidence interval (CI) (1.36, 3.73), P<0.001], lesion location [OR=1.98, 95%CI (1.27, 3.11), P=0.003], National Institutes of HealthStroke Scale score [OR=0.40, 95%CI (0.10, 0.70), P=0.010], hemiplegia [OR=4.31, 95%CI (2.59, 7.17), P<0.001], dysphagia [OR=2.32, 95%CI (1.27, 4.25), P=0.006], antidepressants [OR=2.33, 95%CI (1.62, 3.34), P<0.001], BI score [OR=−17.08, 95%CI (−33.07, −1.08), P=0.04], eating pattern [OR=4.18, 95%CI (1.16, 15.09), P=0.030], drinking water volume ≥800 mL [OR=0.30, 95%CI (0.19, 0.46), P<0.001] might be the influencing factors of constipation in patients after stroke. The results of sensitivity analysis showed that age, education level, diabetes, smoking, stroke type, lesion location, diuretic and BI score might be the influencing factors of constipation after stroke (P<0.05). The results of bias analysis suggest that publication bias is less likely. Conclusions There are many risk factors for constipation in patients with stroke. Current evidence shows that age, diabetes, smoking and other 11 factors may be risk factors for stroke constipation, while high education level and drinking water ≥800 mL may be protective factors, and the other influencing factors have not been determined and need further study.

Citation： LIAO Xiaoqin, LIN Hongyuan, PENG Shanling. The influencing factors of constipation after stroke: a meta-analysis. West China Medical Journal, 2022, 37(6): 902-908. doi: 10.7507/1002-0179.202103230 Copy

1.	Algra A, Wermer MJ. Stroke in 2016: stroke is treatable, but prevention is the key. Nat Rev Neurol, 2017, 13(2): 78-79.
2.	Li J, Yuan M, Liu Y, et al. Incidence of constipation in stroke patients: a systematic review and meta-analysis. Medicine (Baltimore), 2017, 96(25): e7225.
3.	Sumida K, Molnar MZ, Potukuchi PK, et al. Constipation and risk of death and cardiovascular events. Atherosclerosis, 2019, 281: 114-120.
4.	高雁鸿, 李建梅, 粟茂, 等. 疏肝调气配穴针刺治疗卒中后慢传输型便秘及对患者胃肠激素水平的影响. 中国针灸, 2017, 37(2): 125-129.
5.	Zhai J, Mu W, Si J, et al. Acupuncture for constipation in patients with stroke: protocol of a systematic review and meta-analysis. BMJ Open, 2018, 8(3): e020400.
6.	Cheng J, Li L, Xu F, et al. Poststroke constipation is associated with impaired rectal sensation. Am J Gastroenterol, 2020, 115(1): 105-114.
7.	Bharucha AE, Pemberton JH, Locke GR 3rd. American gastroenterological association technical review on constipation. Gastroenterology, 2013, 144(1): 218-238.
8.	Wald A, Bharucha AE, Cosman BC, et al. ACG clinical guideline: management of benign anorectal disorders. Am J Gastroenterol, 2014, 109(8): 1141-1157.
9.	Wells G, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. (2010)[2021-03-01]. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
10.	曾宪涛, 刘慧, 陈曦, 等. Meta 分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
11.	张艳华, 李晓玲, 李增宁. 国内恶性肿瘤患者营养不良影响因素 Meta 分析. 中国临床保健杂志, 2020, 23(5): 649-655.
12.	Bracci F, Badiali D, Pezzotti P, et al. Chronic constipation in hemiplegic patients. World J Gastroenterol, 2007, 13(29): 3967-3972.
13.	Lim SF, Ong SY, Tan YL, et al. Incidence and predictors of new-onset constipation during acute hospitalisation after stroke. Int J Clin Pract, 2015, 69(4): 422-428.
14.	Lin CJ, Hung JW, Cho CY, et al. Poststroke constipation in the rehabilitation ward: incidence, clinical course and associated factors. Singapore Med J, 2013, 54(11): 624-629.
15.	Yi JH, Chun MH, Kim BR, et al. Bowel function in acute stroke patients. Ann Rehabil Med, 2011, 35(3): 337-343.
16.	卞静, 杨怡尧, 易兰, 等. 轻型卒中后排便障碍危险因素分析. 实用医学杂志, 2017, 33(22): 3729-3733.
17.	张鑫. 脑卒中后发生便秘的原因、影响因素及护理对策. 解放军护理杂志, 2011, 28(20): 33-35.
18.	戚胜, 董立焕, 成杰, 等. 脑卒中后急性应激障碍患者发生便秘的影响因素. 中国健康心理学杂志, 2017, 25(9): 1335-1339.
19.	杨宇, 钟代曲, 沈盈盈, 等. 急性脑卒中病人排便情况的影响因素分析. 护理研究, 2018, 32(24): 3870-3874.
20.	王丽. 脑卒中后便秘与认知功能的相关性及其干预研究. 广州: 南方医科大学, 2013.
21.	苏永静, 张小燕, 曾进胜, 等. 生存分析模型在卒中患者便秘预测中的应用. 护理学杂志, 2009, 24(7): 1-4.
22.	邓国华. 脑卒中便秘的相关因素分析和预测. 现代医药卫生, 2008, 24(15): 2266-2267.
23.	靳京. 某康复医院神经内科患脑卒中后遗症患者便秘现况调查与分析. 长春: 吉林大学, 2018.
24.	Mounsey A, Raleigh M, Wilson A. Management of constipation in older adults. Am Fam Physician, 2015, 92(6): 500-504.
25.	季德江. “醒神通调肠胃”针刺法治疗缺血性脑卒中后便秘的临床疗效评价研究. 银川: 宁夏医科大学, 2020.
26.	Pasanen ME. Evaluation and treatment of colonic symptoms. Med Clin North Am, 2014, 98(3): 529-547.
27.	马婷, 邓莉莹, 唐朝. 邵阳市社区缺血性脑卒中患者服药与功能锻炼依从性调查. 中国预防医学杂志, 2020, 21(12): 1269-1273.
28.	Savin Z, Kivity S, Yonath H, et al. Smoking and the intestinal microbiome. Arch Microbiol, 2018, 200(5): 677-684.
29.	Bauer PV, Duca FA. Targeting the gastrointestinal tract to treat type 2 diabetes. J Endocrinol, 2016, 230(3): R95-R113.
30.	Yamada E, Namiki Y, Takano Y, et al. Clinical factors associated with the symptoms of constipation in patients with diabetes mellitus: a multicenter study. J Gastroenterol Hepatol, 2018, 33(4): 863-868.
31.	Rosen DR, Inaba K, Oh PJ, et al. Outpatient laparoscopic appendectomy: feasible in a public county hospital?. J Am Coll Surg, 2017, 224(5): 862-867.
32.	Birimoglu Okuyan C, Bilgili N. Effect of abdominal massage on constipation and quality of life in older adults: a randomized controlled trial. Complement Ther Med, 2019, 47: 102219.
33.	Li LJ, Yao XM, Guan BY, et al. Persistent depression is a predictor of quality of life in stroke survivors: results from a 5-year follow-up study of a Chinese cohort. Chin Med J (Engl), 2019, 132(18): 2206-2212.
34.	McRae MP. Effectiveness of fiber supplementation for constipation, weight loss, and supporting gastrointestinal function: a narrative review of meta-analyses. J Chiropr Med, 2020, 19(1): 58-64.
35.	Christodoulides S, Dimidi E, Fragkos KC, et al. Systematic review with meta-analysis: effect of fibre supplementation on chronic idiopathic constipation in adults. Aliment Pharmacol Ther, 2016, 44(2): 103-116.
36.	中华医学会消化病学分会胃肠动力学组, 功能性胃肠病协作组. 中国慢性便秘专家共识意见 (2019, 广州). 中华消化杂志, 2019, 39(9): 577-598.
37.	袁景, 林桦, 沈宏华, 等. 脑卒中后便秘治疗进展. 中国实用神经疾病杂志, 2016, 19(11): 96-98.
38.	邱涛, 熊瑛, 吴红梅. 老年 2 型糖尿病患者发生便秘的因素及抬臀干预的影响. 中国老年学杂志, 2020, 40(23): 4940-4944.
39.	Solismaa A, Kampman O, Lyytikäinen LP, et al. Genetic polymorphisms associated with constipation and anticholinergic symptoms in patients receiving clozapine. J Clin Psychopharmacol, 2018, 38(3): 193-199.

1. Algra A, Wermer MJ. Stroke in 2016: stroke is treatable, but prevention is the key. Nat Rev Neurol, 2017, 13(2): 78-79.
2. Li J, Yuan M, Liu Y, et al. Incidence of constipation in stroke patients: a systematic review and meta-analysis. Medicine (Baltimore), 2017, 96(25): e7225.
3. Sumida K, Molnar MZ, Potukuchi PK, et al. Constipation and risk of death and cardiovascular events. Atherosclerosis, 2019, 281: 114-120.
4. 高雁鸿, 李建梅, 粟茂, 等. 疏肝调气配穴针刺治疗卒中后慢传输型便秘及对患者胃肠激素水平的影响. 中国针灸, 2017, 37(2): 125-129.
5. Zhai J, Mu W, Si J, et al. Acupuncture for constipation in patients with stroke: protocol of a systematic review and meta-analysis. BMJ Open, 2018, 8(3): e020400.
6. Cheng J, Li L, Xu F, et al. Poststroke constipation is associated with impaired rectal sensation. Am J Gastroenterol, 2020, 115(1): 105-114.
7. Bharucha AE, Pemberton JH, Locke GR 3rd. American gastroenterological association technical review on constipation. Gastroenterology, 2013, 144(1): 218-238.
8. Wald A, Bharucha AE, Cosman BC, et al. ACG clinical guideline: management of benign anorectal disorders. Am J Gastroenterol, 2014, 109(8): 1141-1157.
9. Wells G, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. (2010)[2021-03-01]. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
10. 曾宪涛, 刘慧, 陈曦, 等. Meta 分析系列之四: 观察性研究的质量评价工具. 中国循证心血管医学杂志, 2012, 4(4): 297-299.
11. 张艳华, 李晓玲, 李增宁. 国内恶性肿瘤患者营养不良影响因素 Meta 分析. 中国临床保健杂志, 2020, 23(5): 649-655.
12. Bracci F, Badiali D, Pezzotti P, et al. Chronic constipation in hemiplegic patients. World J Gastroenterol, 2007, 13(29): 3967-3972.
13. Lim SF, Ong SY, Tan YL, et al. Incidence and predictors of new-onset constipation during acute hospitalisation after stroke. Int J Clin Pract, 2015, 69(4): 422-428.
14. Lin CJ, Hung JW, Cho CY, et al. Poststroke constipation in the rehabilitation ward: incidence, clinical course and associated factors. Singapore Med J, 2013, 54(11): 624-629.
15. Yi JH, Chun MH, Kim BR, et al. Bowel function in acute stroke patients. Ann Rehabil Med, 2011, 35(3): 337-343.
16. 卞静, 杨怡尧, 易兰, 等. 轻型卒中后排便障碍危险因素分析. 实用医学杂志, 2017, 33(22): 3729-3733.
17. 张鑫. 脑卒中后发生便秘的原因、影响因素及护理对策. 解放军护理杂志, 2011, 28(20): 33-35.
18. 戚胜, 董立焕, 成杰, 等. 脑卒中后急性应激障碍患者发生便秘的影响因素. 中国健康心理学杂志, 2017, 25(9): 1335-1339.
19. 杨宇, 钟代曲, 沈盈盈, 等. 急性脑卒中病人排便情况的影响因素分析. 护理研究, 2018, 32(24): 3870-3874.
20. 王丽. 脑卒中后便秘与认知功能的相关性及其干预研究. 广州: 南方医科大学, 2013.
21. 苏永静, 张小燕, 曾进胜, 等. 生存分析模型在卒中患者便秘预测中的应用. 护理学杂志, 2009, 24(7): 1-4.
22. 邓国华. 脑卒中便秘的相关因素分析和预测. 现代医药卫生, 2008, 24(15): 2266-2267.
23. 靳京. 某康复医院神经内科患脑卒中后遗症患者便秘现况调查与分析. 长春: 吉林大学, 2018.
24. Mounsey A, Raleigh M, Wilson A. Management of constipation in older adults. Am Fam Physician, 2015, 92(6): 500-504.
25. 季德江. “醒神通调肠胃”针刺法治疗缺血性脑卒中后便秘的临床疗效评价研究. 银川: 宁夏医科大学, 2020.
26. Pasanen ME. Evaluation and treatment of colonic symptoms. Med Clin North Am, 2014, 98(3): 529-547.
27. 马婷, 邓莉莹, 唐朝. 邵阳市社区缺血性脑卒中患者服药与功能锻炼依从性调查. 中国预防医学杂志, 2020, 21(12): 1269-1273.
28. Savin Z, Kivity S, Yonath H, et al. Smoking and the intestinal microbiome. Arch Microbiol, 2018, 200(5): 677-684.
29. Bauer PV, Duca FA. Targeting the gastrointestinal tract to treat type 2 diabetes. J Endocrinol, 2016, 230(3): R95-R113.
30. Yamada E, Namiki Y, Takano Y, et al. Clinical factors associated with the symptoms of constipation in patients with diabetes mellitus: a multicenter study. J Gastroenterol Hepatol, 2018, 33(4): 863-868.
31. Rosen DR, Inaba K, Oh PJ, et al. Outpatient laparoscopic appendectomy: feasible in a public county hospital?. J Am Coll Surg, 2017, 224(5): 862-867.
32. Birimoglu Okuyan C, Bilgili N. Effect of abdominal massage on constipation and quality of life in older adults: a randomized controlled trial. Complement Ther Med, 2019, 47: 102219.
33. Li LJ, Yao XM, Guan BY, et al. Persistent depression is a predictor of quality of life in stroke survivors: results from a 5-year follow-up study of a Chinese cohort. Chin Med J (Engl), 2019, 132(18): 2206-2212.
34. McRae MP. Effectiveness of fiber supplementation for constipation, weight loss, and supporting gastrointestinal function: a narrative review of meta-analyses. J Chiropr Med, 2020, 19(1): 58-64.
35. Christodoulides S, Dimidi E, Fragkos KC, et al. Systematic review with meta-analysis: effect of fibre supplementation on chronic idiopathic constipation in adults. Aliment Pharmacol Ther, 2016, 44(2): 103-116.
36. 中华医学会消化病学分会胃肠动力学组, 功能性胃肠病协作组. 中国慢性便秘专家共识意见 (2019, 广州). 中华消化杂志, 2019, 39(9): 577-598.
37. 袁景, 林桦, 沈宏华, 等. 脑卒中后便秘治疗进展. 中国实用神经疾病杂志, 2016, 19(11): 96-98.
38. 邱涛, 熊瑛, 吴红梅. 老年 2 型糖尿病患者发生便秘的因素及抬臀干预的影响. 中国老年学杂志, 2020, 40(23): 4940-4944.
39. Solismaa A, Kampman O, Lyytikäinen LP, et al. Genetic polymorphisms associated with constipation and anticholinergic symptoms in patients receiving clozapine. J Clin Psychopharmacol, 2018, 38(3): 193-199.

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