肌电介导生物反馈治疗功能性排便障碍的疗效研究

摘要

Objective It is to assess the curative effect of electromyographic biofeedback on functional defecation disorders and to explore its effective factors. Methods Sixty-four patients with functional defecation disorders were treated with electromyography-hased audiovisual feedback, and biofeedback was performed by an independent researcher. All patients were followed up prospectively with a validated bowel function questionnaire from which a symptom index was created. Anorectal manometry testing was performed before and at completion of training to investigate the changes of anorectal dynamics. Gastrointestinal symptoms rating scale was also accomplished before the treatment. Results At six months. there were sixty-four patients who completed the treatment and following-up, with no side effects. Total effective rates of six-week and six-month were 77％and 72％ respectively. The numher of patients with abnormal evacuation atonic reflex was 48 cases which had dropped obviously to 11 cases after the treatment ( 77％ ). Compared with indexes before treatment, there was significant reduction in resting anal pressure, rectum first sensation volume, anal functional length and inhibitory reflex volume at completion of training ( P ＜ 0. 05 ). The treatment effect of patients who had completed fifteen times or more lasted for six months. Neither age, sex,laxative-treated, enema, duration of symptoms, history of anorectal operation. GSRS. nor anorectal physiology parameters affected outcome success, compared with those who had no improvement in symptoms ( P ＞ 0. 05 ). Conclusion Biofeedhack should be recommended as first-line treatment in the management of functional defecation disorders, and the success rate is significantly related to the patient's willingness to complete treatment.%目的 评价肌电介导生物反馈治疗功能性排便障碍的临床疗效并探讨其影响因素.方法 对64例功能性排便障碍患者进行肌电介导生物反馈治疗,6周的治疗由独立的生物反馈治疗师实施.治疗前和随访期间由患者详细记录每天的问卷调查表.治疗前后进行肛管直肠测压检查,了解肛肠动力学变化情况.治疗前行胃肠道症状评分.结果 64例完成治疗并获随访6个月,没有不良事件发生.治疗后6周和6个月的有效率分别是77%和72%.排便弛缓反射异常48例,治疗6周后,37例(77%)排便弛缓反射异常患者恢复正常.与治疗前比较,肛管静息压、初次排便感的直肠容量、有效肛管长度、肛管直肠抑制反射阈值均有明显降低.治疗15次以上的患者其治疗效果持续6个月,患者的年龄、性别、病程、既往使用缓泻剂或灌肠、既往肛肠手术史、胃肠症状评分以及肛肠动力学相关参数对疗效无显著影响.结论 生物反馈疗法应推荐作为治疗功能性排便障碍的一线疗法,治疗次数和患者的意志力是影响治疗效果的关键因素.