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便秘药物的合理选择

便秘是一种常见病,发病率高,病因复杂。目前治疗便秘的药物种类繁多,各类药物有其不同的作用机制、疗效和不良反应。本文就各类便秘药物的特点和应用,以及特殊人群便秘药物的选择进行讨论,进而提高药物的合理应用。

乙状结肠造瘘术后肠瘘手术的护理体会一例

老年患者便秘的临床护理

【摘要】 目的 总结老年患者便秘的临床护理方法。 方法 将2007年5月-2009年5月收治的70岁以上老年患者62例随机分为对照组30例和观察组32例，所有患者按临床常规护理、调节饮食、增加活动量、腹部按摩，在此基础上对照组口服温脾汤，观察组采用便秘灸穴位敷贴，观察两组排便情况及不适症状。 结果 观察组不适症状明显少于对照组，两组治疗效果。 结论 便秘灸治疗老年患者便秘痛苦小、副作用少、使用方便，近期效果满意。

Distribution and Expression of Estrogen Receptor β Protein in Sigmoid Colon of Female Patients with Slow Transit Constipation

Objective To investigate the express of ERβ protein in female slow transit constipation (STC) patients. Methods Immunohistochemistry and Western blot technique were used to detect the distribution and expression of estrogen receptor β (ERβ) protein of 20 patients with STC and 20 aged-matched controls. Results ERβ expressions were detected in mucous layer, myenteric nerve plexus and submucous nerve plexus in two groups. In comparison with the control group, the expression of ERβ protein of STC group was much lower (Plt;0.01). The expression of ERβ protein of sigmoid colon in STC group was significantly lower than that in control group (Plt;0.05). Conclusion The expression of ERβ protein decreased in myenteric and submucous nerve plexus of sigmoid colon tissues may involve in the pathogenesis of STC.

The influencing factors of constipation after stroke: a meta-analysis

ObjectiveTo systematically evaluate the related factors of constipation in patients with stroke. MethodsCochrane 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. ResultsA 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.

The Change of Electromyophysiology of the Rat with Cathartic Colon

ObjectiveTo explore etiopathogenesis of slow transit constipation(STC). MethodsThe model of rat with “cathartic colon” was established, and the changes of colonic electromyography of the rat was examined. ResultsThe frequency and amplitude of slow wave in vivo of rats with cathartic colon was decreased markedly. Postmeal spike potential and duration was decreased, showing that gastrocolonic reflex of rats colon was decreased.ConclusionLong term abuse of stimulant laxuatives could damage enteric nervous system and accelerate the pathological changes of STC.

单吻合器行经肛门直肠膨出修补和直肠黏膜切除术治疗排便障碍综合征的临床疗效观察

目的对由于直肠前突引起的排便障碍综合征患者使用单吻合器行经肛门直肠膨出修补和直肠黏膜切除，并行术前、术后临床症状和功能评估，评价该方法的手术效果。 方法2010年8月-2013年12月对39例患有直肠前突经过至少4个月的保守治疗未见明显好转的女性患者采取单吻合器行经肛门直肠膨出修补和直肠黏膜切除术（TRREMS）治疗，并观察手术效果、并发症及复发率。 结果平均手术时间为（40.00±3.78）min，术中平均出血量（15.00±5.01）mL，全部患者术后住院观察24 h，均未见明显早期并发症，经随访12～24个月，3例出现手术相关并发症（7.69%），1例吻合口狭窄（2.56%），经扩肛治疗后，症状缓解，能自行排气排便，2例出现肛门周围疼痛不适（5.13%），疼痛评分3级，予以肛周局部外用药物治疗后疼痛缓解。术后排粪造影显示共4例（10.26%）存在直肠前突残留（均为Ⅰ级）。全部患者术后未出现出血、直肠阴道瘘、性交痛等并发症。 结论TRREMS手术治疗直肠前突引起的排便障碍综合征无论在解剖学上还是在功能评价上都是安全有效的，且术后并发症少，术后疼痛轻。

Stapled Transanal Rectal Resection Versus Transvaginal Procedure for Treatment of Rectocele

Objective Both stapled transanal rectal resection (STARR) and vaginal bridge repair are new operative techniques for treatment of rectocele transanal and transvaginal, respectively. In this study we observe the clinical outcomes for STARR as compared with vaginal bridge repair procedure. Methods The clinical data of 31 patients with obstructive defecation syndrome from January 2007 to May 2009 were retrospectively analyzed. The patients were divided into 2 groups according to different operative approach: STARR group (n=18) and bridge repair suture group (n=13). The clinical outcomes observed were operative time, blood loss, length of stay, cost of hospitalization, complication and the improvement of obstructed defecation syndrome. Results There was no difference in the age and severity in the patients of two groups. Evaluation of the clinical outcomes showed 16 (88.9%) patients in the STARR group and 6 (46.2%) in the bridge repair suture group reported improvement in symptoms (P=0.017). STARR had a shorter operative time (24.6 min vs. 33.2 min， Plt;0.01), less estimated blood loss (3.9 ml vs. 16.2 ml， Plt;0.01), more costly (10 743 yuan vs. 3 543 yuan, Plt;0.01) and a higher anal incontinenc rate but reversible. The length of stay was similar (average 6 d). Conclusion The stapled transanal rectal resection procedure is more superior to the vaginal bridge repair suture for improvement of obstructed defecation syndrome from rectocele, however, it has a higher cost and some patient with reversible slight anal incontinence after surgery.

Some Questions about the Diagnosis and Treatment of Chronic NonSpecific Constipation

1概述便秘是很常见的症状，在美国便秘的发生率为2%，英国为10%，日本为4%，我国天津为4.4%［1］，女性发病概率是男性的3倍。多数便秘患者可经药物治疗治愈或改善症状，少数为难治性。少数便秘患者经手术治疗效果较好。便秘不是一种病，而是多种疾病的一个症状，不同的患者有不同的含义，包括： ①大便量少、硬，排出困难； ②排便困难合并一些特殊的症候群，如长期用力排便、直肠胀感、排便不完全或依靠手法帮助排便； ③7天内排便次数少于2～3次。临床上常诊断为慢性顽固性便秘或特发性便秘，但其确切含义很难描述。“慢性”意指病史至少2年，或年幼时就发病； “特发性”说明我们对便秘的原因及流行病学了解不全面； “顽固性”意指经一般药物及非手术治疗很难奏效，常需手术治疗［2］。

Clinical Value of Health Education Applied to Unhealthy Lifestyle-caused Functional Constipation

ObjectiveTo explore the clinical effect of healthy education on functional constipation caused by unhealthy lifestyle, and to analyze the disadvantages affecting the curative effect. MethodsA total of 167 cases of functional constipation from February 2009 to February 2012 were included. All of the patients were followed up for one year. We collected clinical data of curative effect and influencing factors, determined the clinical value of healthy education, and analyzed the influence of different factors on the curative effect of healthy education. ResultsThe total curative effect after one-year follow-up was 84.4%. The curative effect in elderly patients was significantly higher than that in middle-aged ones (P<0.05). The curative effect in urban patients was remarkably higher than that in rural ones (P<0.05). And the curative effect of patients with college degree wass much higher than that in patients with education background of primary school or below (P<0.05). ConclusionHealthy education has important value on releasing and eliminating functional constipation caused by unhealthy lifestyle. And it needs individual education aimed at patients with different age, education degree, and domicile.