老年特发性便秘患者直肠肛门动力学变化及心理评价

摘要

To investigate what anorectal dynamic abnormality and psychological factors exits in elderly patients with chronic idiopathic constipation (CIC), study was performed in 59 elderly patients with CIC and 36 elderly healthy subjects(EHS).Anorectal pressure was measured with Medtronic PcPolygraf,which was a water perfused catheter system.All subjests completed a self-rated inventory assessing psychological distress including depression(SDS) and anxiety(SAS). Maximal squeezing pressure and the changes in 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(RLSTV),the rectal threshold volume for desire to defecate and the rectal maximal volume of tolerance were higher in EP than those in EHS(P＜0.05). There were 28(47.5%) of EP who had increasing anal pressure when defecation was stimulated.The scores of SDS and SAS were higher in EP than those in EHS(P＜0.05). It suggested that elderly patients with CIC may be associated with lower sensitivity,higher tolerance and discoordination of annorectum during defecation.Both depression and anxiety were associated with abnormal dynamics in EP with CIC.%探讨老年慢性特发性便秘（CIC）患者直肠肛门运动功能变化及其与心理因素的关系。采用瑞典Medtronic公司生产的8通道水灌注式消化道压力检测系统、Zung抑郁自评量表（SDS）及焦虑自评量表（SAS）对59例患者及36例老年对照者进行直肠肛门压力测定及心理状况分析。结果发现，老年CIC患者最大缩榨压、模拟排便时肛管压力变化低于老年对照组（P＜0.05），直肠初始感觉阈值、排便阈值和最大耐受容量均高于老年对照组（P＜0.05），并有28例（47.5％）CIC患者模拟排便时出现肛管压力异常升高。老年CIC患者SDS、SAS标准总分均明显高于老年对照组（P＜0.05）。说明老年CIC患者与直肠低敏感、高耐受及排便时直肠肛管运动不协调有关，抑郁情绪和焦虑情绪与老年CIC患者肠道运动功能异常有关。