生物反馈训练对不同类型的功能性便秘的治疗研究
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摘要
功能性便秘(Functional Constipation，FC)是一种常见的消化道疾病，人群患病率高达4％，尤其老年患者患病率可达20％左右。由于对疾病认识的进一步提高，以及社会生活方式和饮食结构等的改变，发病率在逐年增高，且向年轻化发展。该病的病因复杂，机制不明确，且影响因素众多，对该病采用的传统药物治疗往往疗效不佳，并且长期用药致使药物的毒副作用增加，患者的经济负担加重。生物反馈治疗是一种安全、有效的非药物治疗方法，国内外从上世纪八十年代开始研究，但对各种不同类型的便秘的治疗疗效缺乏足够的客观临床资料。本研究的目的在于比较生物反馈治疗前后患者结肠通过时间和肌电图检查的各项客观指标，评价生物反馈训练对各种不同类型功能性便秘患者的疗效。
研究目的：
采用结肠通过时间和肌电图检查对功能性便秘进行分型，评价生物反馈训练对不同类型功能性便秘患者的疗效。
研究方法：
选择在我院胃肠动力中心就诊、符合罗马Ⅱ标准的24名功能性便秘患者(女性20例，男性4例)，详细询问病史进行临床评估，记录排便次数和粪便性状，并对伴随症状做出临床积分，应用X线检查结肠通过时间和肌电图检查对患者进行分型。所有患者在门诊接受生物反馈训练治疗，症状改善后继续家庭训练，完成2～4个疗程治疗后再行临床评估、结肠通过时间检查和肌电图检查，对治疗前后的
南京医科大学硕士学位论文
两组资料进行统计学分析和处理。
研究结果：
24例患者平均年龄 3 7．04岁，平均病程 6．8年，经钡灌肠和／或电
子肠镜、肛J门指检排除了肠道及肛直肠器质性病变。所有患者在门诊
平均治疗6次，症状改善并掌握正确排便动作后继续家庭治疗。
l、结肠通过时间和B几电图检查分型：出口梗阻型便秘 14例，慢
传输型便秘STF卜 正常传输型5例。
2、治疗后除2例患者临床症状来改善外，其余患者临床症状均
有不同程度改善，对粪便性状和排便次数的统计总有效率达 gi．67O，
伴随症状 平均 总积分治 疗前为7．04 t O．33，治疗后为I．92 t 0．“，明
显下降（P、O．05）好疗的总有效率为引石7％。
3、出口梗阻型便秘患者结肠通过时间检测，72小时标志物排出
散治 疗后（18．85ti．”）较治 疗前（6．35t5．94）明显增加（P＜0．05）；
慢传输型便秘结肠通过时间较治疗前亦明显缩短，72小时标志物排
出数在治 疗后（19 t 14．75）较治 疗前（O．6 t 6．引）明显增加，但无
统计学意义（P功力5）。
4、肌电图检查显示治疗前存在肛I刁矛盾运动的患者在治疗后矛
盾运动均有不同程度的改善。出口梗阻型便秘患者的腹部和肛门外括
约肌的收缩幅度均有不同程度的增加而松弛幅度降低（P刃．05）；慢
传输型便秘患者和正常传输患者的腹部和肛门外括约肌的收缩幅度
也有不同程度的增加，且松弛幅度降低，但无统计学意义（P＞0刀5）。
研究结论：
l、经过结肠通过时间和B几电图检查分型，功能性便秘的主要类
型是出口梗阻型（58．33％＊
工 生物反馈训练治疗对各种类型的功能性便秘治疗均有效。
3、生物反馈训练可对腹部肌群和盆底肌进行再训练，并可促进
南京医科大学硕士学位论文
肠道蠕动，而且安全无任何毒副作用，该方法可作为功能性便秘的首
选治疗方法。
Background: The function constipation is one kind of common gastrointestinal disease, and incidence of crowd reaches 4%, particularly in old age can reach about 20%. With the change of social life style and the diet composition, and more knowing of the functional disease, the incidence gets higher year by year, and the age of patients is getting younger than before. Etiology is complicated, the mechanism is not clear, and the influence factor is multitudinous, so the effect of traditional medicinal curative is not obvious, a long period of using medicines may causes the poisonous side-effect, and the financial burden of patient is heavy. Biofeedback treatment is a safe, effective, cheap and non-pharmaceuticals method, it has developed many years on abroad, and studies to some extent in internal recent years, but the curing effect of the various difference types is short of objective clinical parameters.
Objective: Classify the type of functional constipation by colonic transit time test and electromyographic examination, and assess the effect of biofeedback treatment.
Method: 24 patients who treatment at our gastrointestinal motility center and fit Rome II standard(20 female,4male) were identified. Inquire history and assess bowel frequency and shape, quadrature the accompanying symptom, classify patients by way of the colonic transit time and electromyograph. All patients accept the biofeedback training in
the clinic, and keep on training at home after the symptom improved. After accomplishing 2~4 sessions, assessing bowel symptoms and checking colonic transit time and electromyography again. Stastic and analyse the parameters before and after therapy.
Result: 24 patients average age 37.04 years old, and the average course of disease is 6.8 years, through barium enema and electronic colonoscopy get rid of the intestinal and anal orgnic disease. All patients therapy 5.95 times in clinic, and continues training at home
1.Through colonic transit time and electromyograohy check, 14 patients are outlet obstructive constipation, 5 patients are slow transir constipation, others are normal transit constipation.
2. After curing, except the clinical symptom of 2 patients is not
improved, the clinical symptom of the other patients all has the different
degree improved. 91.67% of patients' bowel frequency and shape
improved, the intrgral of accompany symptoms descend (7.04 + 0.33/1.92
+ .045), the efficiency is 91.67%.
3.Checking colonic transit time of the outlet obstructive constipations, after therapy, the number of markers blow off increased(6.35 + 5.94/18.85 + 1.29).To the slow transit constipation, the number of markers also increase(0.6 + 6.51/19.0 + 14.75, P>0.05) ,but no stastics meaning.
4. Electromyography check show that contradiction motion improved after therapy. Amplitude of belly and anal contractions has different level increase, relax amplitude reduced, it has statistics meaning to OOC(P<0.05),but no meaning to STC(P>0.05).
Conclusion:
1 .The mainly type of functional constipation is OOC through colonic
transit time and electromyography check.
2. Biofeedback treatment is effect to every type , though it should useful to outlet obstructive constipation from its principle.
3. Biofeedback treatment can rehabitiation the belly muscle and basin muscles, also can promote colon movements. It is safety and no any side-effect, this method can regard as the most important way to cure functional constipation.
研究目的：
采用结肠通过时间和肌电图检查对功能性便秘进行分型，评价生物反馈训练对不同类型功能性便秘患者的疗效。
研究方法：
选择在我院胃肠动力中心就诊、符合罗马Ⅱ标准的24名功能性便秘患者(女性20例，男性4例)，详细询问病史进行临床评估，记录排便次数和粪便性状，并对伴随症状做出临床积分，应用X线检查结肠通过时间和肌电图检查对患者进行分型。所有患者在门诊接受生物反馈训练治疗，症状改善后继续家庭训练，完成2～4个疗程治疗后再行临床评估、结肠通过时间检查和肌电图检查，对治疗前后的
南京医科大学硕士学位论文
两组资料进行统计学分析和处理。
研究结果：
24例患者平均年龄 3 7．04岁，平均病程 6．8年，经钡灌肠和／或电
子肠镜、肛J门指检排除了肠道及肛直肠器质性病变。所有患者在门诊
平均治疗6次，症状改善并掌握正确排便动作后继续家庭治疗。
l、结肠通过时间和B几电图检查分型：出口梗阻型便秘 14例，慢
传输型便秘STF卜 正常传输型5例。
2、治疗后除2例患者临床症状来改善外，其余患者临床症状均
有不同程度改善，对粪便性状和排便次数的统计总有效率达 gi．67O，
伴随症状 平均 总积分治 疗前为7．04 t O．33，治疗后为I．92 t 0．“，明
显下降（P、O．05）好疗的总有效率为引石7％。
3、出口梗阻型便秘患者结肠通过时间检测，72小时标志物排出
散治 疗后（18．85ti．”）较治 疗前（6．35t5．94）明显增加（P＜0．05）；
慢传输型便秘结肠通过时间较治疗前亦明显缩短，72小时标志物排
出数在治 疗后（19 t 14．75）较治 疗前（O．6 t 6．引）明显增加，但无
统计学意义（P功力5）。
4、肌电图检查显示治疗前存在肛I刁矛盾运动的患者在治疗后矛
盾运动均有不同程度的改善。出口梗阻型便秘患者的腹部和肛门外括
约肌的收缩幅度均有不同程度的增加而松弛幅度降低（P刃．05）；慢
传输型便秘患者和正常传输患者的腹部和肛门外括约肌的收缩幅度
也有不同程度的增加，且松弛幅度降低，但无统计学意义（P＞0刀5）。
研究结论：
l、经过结肠通过时间和B几电图检查分型，功能性便秘的主要类
型是出口梗阻型（58．33％＊
工 生物反馈训练治疗对各种类型的功能性便秘治疗均有效。
3、生物反馈训练可对腹部肌群和盆底肌进行再训练，并可促进
南京医科大学硕士学位论文
肠道蠕动，而且安全无任何毒副作用，该方法可作为功能性便秘的首
选治疗方法。
Background: The function constipation is one kind of common gastrointestinal disease, and incidence of crowd reaches 4%, particularly in old age can reach about 20%. With the change of social life style and the diet composition, and more knowing of the functional disease, the incidence gets higher year by year, and the age of patients is getting younger than before. Etiology is complicated, the mechanism is not clear, and the influence factor is multitudinous, so the effect of traditional medicinal curative is not obvious, a long period of using medicines may causes the poisonous side-effect, and the financial burden of patient is heavy. Biofeedback treatment is a safe, effective, cheap and non-pharmaceuticals method, it has developed many years on abroad, and studies to some extent in internal recent years, but the curing effect of the various difference types is short of objective clinical parameters.
Objective: Classify the type of functional constipation by colonic transit time test and electromyographic examination, and assess the effect of biofeedback treatment.
Method: 24 patients who treatment at our gastrointestinal motility center and fit Rome II standard(20 female,4male) were identified. Inquire history and assess bowel frequency and shape, quadrature the accompanying symptom, classify patients by way of the colonic transit time and electromyograph. All patients accept the biofeedback training in
the clinic, and keep on training at home after the symptom improved. After accomplishing 2~4 sessions, assessing bowel symptoms and checking colonic transit time and electromyography again. Stastic and analyse the parameters before and after therapy.
Result: 24 patients average age 37.04 years old, and the average course of disease is 6.8 years, through barium enema and electronic colonoscopy get rid of the intestinal and anal orgnic disease. All patients therapy 5.95 times in clinic, and continues training at home
1.Through colonic transit time and electromyograohy check, 14 patients are outlet obstructive constipation, 5 patients are slow transir constipation, others are normal transit constipation.
2. After curing, except the clinical symptom of 2 patients is not
improved, the clinical symptom of the other patients all has the different
degree improved. 91.67% of patients' bowel frequency and shape
improved, the intrgral of accompany symptoms descend (7.04 + 0.33/1.92
+ .045), the efficiency is 91.67%.
3.Checking colonic transit time of the outlet obstructive constipations, after therapy, the number of markers blow off increased(6.35 + 5.94/18.85 + 1.29).To the slow transit constipation, the number of markers also increase(0.6 + 6.51/19.0 + 14.75, P>0.05) ,but no stastics meaning.
4. Electromyography check show that contradiction motion improved after therapy. Amplitude of belly and anal contractions has different level increase, relax amplitude reduced, it has statistics meaning to OOC(P<0.05),but no meaning to STC(P>0.05).
Conclusion:
1 .The mainly type of functional constipation is OOC through colonic
transit time and electromyography check.
2. Biofeedback treatment is effect to every type , though it should useful to outlet obstructive constipation from its principle.
3. Biofeedback treatment can rehabitiation the belly muscle and basin muscles, also can promote colon movements. It is safety and no any side-effect, this method can regard as the most important way to cure functional constipation.
引文
1、罗金燕，龚均等，胃肠动力与疾病。西安：陕西科技出版社，1996：1
2、Dougls AD. The functional gastrointestinal disorder (2nd edition) Mclean,Virginia: Degnon Associates, 2000:382
3、Sonnenberg A, Koch TR. Epidemiology of constipation in the United States. Dis Colon Rectumn. 1989;32(1): 1～8.
4、戴菲，罗金燕，龚均等．慢性便秘的流行病学调查．陕西医药杂志，1996，25(s：s)：67
5、Wong ML, Wee S et al. Sociademorgraphic and lifestyle factors associated with constipation in an elderly Asian community. Am J Gastroenterol. 1999;94(5): 1283～1291
6、Stark ME Challenging problems presenting as constipation. Am J Gastroenteral. 1999;94(3):567～574
7、郑树 大肠癌高发现场病因筛查方法及早诊早治的研究。中国肿瘤 1996：5(5)：18～19
8、Stark ME Challenging problems presenting as constipation. Am J Gastroenteral. 1999;94(3):567～574
9、Lock GR, Pemberton JH, Philips SF AGA technical review of constipation. Gastroenterology 2000; 119:1766～1778
10、Thompson WG, Longstreth GF, Drossman DA et al Functinal bowel disorders and functional abdominal pain Gut 1999;45 Suppl Ⅱ: Ⅱ43～Ⅱ47
11、方秀才，柯美云，胡品津等 聚乙二醇4000治疗成人功能性便秘疗效及安全性的评价。中国新药杂志 2002；11(6)：479～483
12、侯晓华主编 消化道运动学 北京 科学技术出版社 1997；405～406
13、Miller NE Biofeedback and self regulation Science 1969;163:434
14、Hatch JP Biofeedback and Self regulation 1985;10(4):289
15、Bleijenberg G, Kuijpers HC, Treatment of the spastic pelvic floor syndrome with biofeedback Dis Colon Rectum 1987;30:108～11
16、屈承瑞，孙秀兰 生物反馈和自身调节国外医学生物工程分册 1988 11：3：166～169
17、莫平 生物反馈训练治疗便秘的现状与展望 国外医学．物理医学与康复医学 2000；20(2)：51～55
18、罗金燕 胃肠动力与慢性功能型便秘 中国实用内科杂志 2001；10(21)：582～584
19、陈延，戴菲，罗金燕等 不透X线标记物检测胃肠道运动的临床应用 实用放射学杂志 2001；17(9)：647～650
20、Nyam Dc, Pemberton JH, Iistrup DM et al Long-trem results of surgery for chornic constipation. Dis Colon Rectum 1997;40:273～279
21、Engel BT, Nikoomanesh P, Schuster MM. Operant conditioning of rectosohincteric responses in the treatment of fecal incontinence. N Engl J Med 1974:290:646
22、Weber J et al Biofeedback training for constipation in adults and children. Dis Colon Rectum 1987;30(6):844～846
23、Kawimba BM et al Outlet obstruction (anismus) managed by biofeedback. Gut, 1991;32(10): 1175～1179
24、Wexner SD et al results of biofeedback in constipation: a prospective study. Dis colon Rectum 1992;35:145～150
25、萧树东主编 消化病学新理论与新技术 上海科技教育出版社 1999：340～341
26、Rao-ss et al Effects of biofeedback therapy on anorectal function in obstructive defecation Dig-Dis-Sci 1997;42(11):2197～2205
27、Ho YH et al Clinical and physiologic effects of biofeedback in outlet obstructive constipation Dis Colon Rectum 1996;39(4):520～524
28、Bartolo DC Functional obstructive defecation. Eur J Gastroenterol Hepatol 1994;6:971～974
29、Bartram CI, Tumbull GK, Lennard-Jones JE. Evacuation proctography: an investgation of rectal expulsion in 20 subjects without defecatory disturbance. Gastrointest Radiol 1988; 13:72～80
30、Girona J et al Biofeedback Langenbecks Arch Chir Suppl Rongressbd. 1997;114:921～923
31、Wald A Slow transit constipation Curr Treat gastroenterol 2002 Aug;5(4):279～283
32、Chiotakakon Faliakon E, Kamm MA, Roy AJ et al Biofeedback provide long-term benefit for patient with intractable slow and normal transit constipation Gut 1998 Apr; 42(4):517～521
33、Snape WJ. Role of colonic motility in guiding therapy in patients with constipation, Dig Dis 1997; 15(Supple 1): 104～111
34、Narducci F, Bassotti G, Gaburri M et al. Twenty-four hour manometric recording of colonic motor activity in healthy man. Gut 1987;28:17～25
35、Bassotti G, Crowell MD, Whitehead WE. Contractile activity of the human colon:lessons from 24 hour studies. Gut 1993;34:129～133
36、Emmanuel AV, Ramn MA. Response to a beheavioural treatment,
biofeedback in constipated patients is assiocated with improved gut stra transit and autonomic innervation. Gut 2001;Aug;49(2):214～219
37、周吕，柯美云 主编 胃肠动力学基础与临床 科学技术出版社 1999：1
2、Dougls AD. The functional gastrointestinal disorder (2nd edition) Mclean,Virginia: Degnon Associates, 2000:382
3、Sonnenberg A, Koch TR. Epidemiology of constipation in the United States. Dis Colon Rectumn. 1989;32(1): 1～8.
4、戴菲，罗金燕，龚均等．慢性便秘的流行病学调查．陕西医药杂志，1996，25(s：s)：67
5、Wong ML, Wee S et al. Sociademorgraphic and lifestyle factors associated with constipation in an elderly Asian community. Am J Gastroenterol. 1999;94(5): 1283～1291
6、Stark ME Challenging problems presenting as constipation. Am J Gastroenteral. 1999;94(3):567～574
7、郑树 大肠癌高发现场病因筛查方法及早诊早治的研究。中国肿瘤 1996：5(5)：18～19
8、Stark ME Challenging problems presenting as constipation. Am J Gastroenteral. 1999;94(3):567～574
9、Lock GR, Pemberton JH, Philips SF AGA technical review of constipation. Gastroenterology 2000; 119:1766～1778
10、Thompson WG, Longstreth GF, Drossman DA et al Functinal bowel disorders and functional abdominal pain Gut 1999;45 Suppl Ⅱ: Ⅱ43～Ⅱ47
11、方秀才，柯美云，胡品津等 聚乙二醇4000治疗成人功能性便秘疗效及安全性的评价。中国新药杂志 2002；11(6)：479～483
12、侯晓华主编 消化道运动学 北京 科学技术出版社 1997；405～406
13、Miller NE Biofeedback and self regulation Science 1969;163:434
14、Hatch JP Biofeedback and Self regulation 1985;10(4):289
15、Bleijenberg G, Kuijpers HC, Treatment of the spastic pelvic floor syndrome with biofeedback Dis Colon Rectum 1987;30:108～11
16、屈承瑞，孙秀兰 生物反馈和自身调节国外医学生物工程分册 1988 11：3：166～169
17、莫平 生物反馈训练治疗便秘的现状与展望 国外医学．物理医学与康复医学 2000；20(2)：51～55
18、罗金燕 胃肠动力与慢性功能型便秘 中国实用内科杂志 2001；10(21)：582～584
19、陈延，戴菲，罗金燕等 不透X线标记物检测胃肠道运动的临床应用 实用放射学杂志 2001；17(9)：647～650
20、Nyam Dc, Pemberton JH, Iistrup DM et al Long-trem results of surgery for chornic constipation. Dis Colon Rectum 1997;40:273～279
21、Engel BT, Nikoomanesh P, Schuster MM. Operant conditioning of rectosohincteric responses in the treatment of fecal incontinence. N Engl J Med 1974:290:646
22、Weber J et al Biofeedback training for constipation in adults and children. Dis Colon Rectum 1987;30(6):844～846
23、Kawimba BM et al Outlet obstruction (anismus) managed by biofeedback. Gut, 1991;32(10): 1175～1179
24、Wexner SD et al results of biofeedback in constipation: a prospective study. Dis colon Rectum 1992;35:145～150
25、萧树东主编 消化病学新理论与新技术 上海科技教育出版社 1999：340～341
26、Rao-ss et al Effects of biofeedback therapy on anorectal function in obstructive defecation Dig-Dis-Sci 1997;42(11):2197～2205
27、Ho YH et al Clinical and physiologic effects of biofeedback in outlet obstructive constipation Dis Colon Rectum 1996;39(4):520～524
28、Bartolo DC Functional obstructive defecation. Eur J Gastroenterol Hepatol 1994;6:971～974
29、Bartram CI, Tumbull GK, Lennard-Jones JE. Evacuation proctography: an investgation of rectal expulsion in 20 subjects without defecatory disturbance. Gastrointest Radiol 1988; 13:72～80
30、Girona J et al Biofeedback Langenbecks Arch Chir Suppl Rongressbd. 1997;114:921～923
31、Wald A Slow transit constipation Curr Treat gastroenterol 2002 Aug;5(4):279～283
32、Chiotakakon Faliakon E, Kamm MA, Roy AJ et al Biofeedback provide long-term benefit for patient with intractable slow and normal transit constipation Gut 1998 Apr; 42(4):517～521
33、Snape WJ. Role of colonic motility in guiding therapy in patients with constipation, Dig Dis 1997; 15(Supple 1): 104～111
34、Narducci F, Bassotti G, Gaburri M et al. Twenty-four hour manometric recording of colonic motor activity in healthy man. Gut 1987;28:17～25
35、Bassotti G, Crowell MD, Whitehead WE. Contractile activity of the human colon:lessons from 24 hour studies. Gut 1993;34:129～133
36、Emmanuel AV, Ramn MA. Response to a beheavioural treatment,
biofeedback in constipated patients is assiocated with improved gut stra transit and autonomic innervation. Gut 2001;Aug;49(2):214～219
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