功能性便秘患者肛直肠动力和感觉功能、精神心理状况及生物反馈训练的研究
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摘要
功能性便秘(functional constipation,FC)是一种常见的功能性胃肠病,通常分为4型:传输时间正常型(NormalTransit Constipation,NTC)、慢传输型(SlowTransit Constipation,STC)、出口梗阻型(Outlet Obstructive Constipation,OOC)和混合型(Mixed type Constipation,MC)。综合国内外文献报道,FC在普通人群中发病率为4%~17%,总的趋势是西方高于东方,女性高于男性,老年人高于年轻人。值得关注的是,近几年青少年的患病率也在不断上升。随着便秘人群的逐渐增多,其对人类健康的危害性越来越突出,因此,对FC的研究日益受到重视。
到目前为止,FC的病因和发病机制尚不十分明确。近年来的研究提示FC患者往往同时存在病理生理和心理方面的功能失调。目前,脑肠轴学说和盆底肌功能障碍学说在消化道动力研究中最具活力,均认为精神心理状况异常是导致肛直肠动力和感觉功能失调的重要原因。生物反馈训练是一种新兴的心理行为疗法,在改善FC症状方面较为显著,但在改善盆底肌功能方面的研究甚少,且生物反馈通过何种机制来改善FC症状仍未得到证实。
本研究旨在观察FC患者及其各亚型间肛直肠动力和感觉功能的变化,分析FC患者肛直肠功能与精神心理状况之间的关系,探讨FC可能的发病机制;并尝试研究生物反馈是否是通过改善肛直肠功能来改善FC症状,以期为生物反馈治疗FC提供理论依据。
研究目的
1.探讨各型FC患者肛直肠动力及感觉功能的变化。
2.探讨FC患者精神心理状况,并分析其与肛直肠功能间的关系。
3.探讨生物反馈训练对FC患者症状、肛直肠功能和精神心理状况的影响。
研究内容与方法
1.根据结肠转运时间(Colon transit time,CTT)和传输指数(Transit index,TI)对71例FC患者进行分型,采用肛门直肠测压法、Zung的焦虑自评量表(self-rating anxiety scales,SAS)和抑郁自评量表(self-rating depressivescales,SDS)测定肛直肠动力、感觉功能及精神心理状况,并分析SAS、SDS得分与肛直肠动力、感觉功能的关系;同时选择30例健康人作对照组。
2.对60例FC患者行生物反馈训练,完成1个疗程后,再行肛门直肠测压和SAS、SDS量表测定,对干预前后的两组资料进行统计学分析和处理,分析生物反馈训练对FC患者便秘症状、肛直肠动力和感觉功能及精神心理状况的影响。
研究结果
1. FC组肛直肠功能异常,以感觉迟钝为主:与对照组相比,肛管静息压降低(P<0.05),初始感觉阈值、排便感觉阈值和最大耐受容量增高(P<0.01)。
2.各型FC患者肛直肠功能表现有差异:与对照组相比:NTC组肛管静息压降低(P<0.05),初始感觉阈值、排便感觉阈值和最大耐受容量增高(P<0.01);OOC组初始感觉阈值、排便感觉阈值和最大耐受容量增高(P<0.01);STC组最大耐受容量增高(P<0.05);MC组各参数差异无统计学意义(P>0.05)。组间比较:NTC组和OOC组在初始感觉阈值上均高于STC组和MC组(P<0.05),但各组间差异无统计学意义。
3. FC患者心理健康水平较低:与对照组相比,存在明显的焦虑和抑郁心理(40.99±9.79 vs. 28.75±4.09,51.46±11.58 vs. 32.67±7.17,P<0.01)。
4. FC患者焦虑、抑郁水平与肛直肠功能存在相关性:SAS、SDS得分与肛门缩榨压呈负相关(P<0.05),与初始感觉阈值、排便感觉阈值和最大耐受容量均呈正相关(P<0.05)。
5.生物反馈训练后,FC患者临床症状改善:症状总积分显著降低(P<0.01),71.7%(43/60)的患者显效,18.3%(11/60)的患者有效,总有效率为90.0%,总满意度为96.7%。
6.生物反馈训练后,FC患者心理健康水平提高:SAS、SDS得分较干预前显著降低,差异有统计学意义(P<0.01)。
7.对治疗前后均完成肛直肠功能检测的36例患者分析发现:肛管静息压、缩榨压、排便压、初始感觉阈值、排便感觉阈值、最大耐受容量差异均无统计学意义(P>0.05)。
研究结论
FC患者肛直肠功能异常,尤以感觉迟钝为主,且与焦虑、抑郁情绪密切相关,此机制可能参与了FC的发病。
生物反馈训练可以改善FC患者症状、精神心理状况,但对肛直肠功能是否有改善仍需扩大样本进一步研究。
Background:
Functional constipation (FC) is one kind of common gastrointestinal disease.Accordng toAGA, four types of FC were divided:normal transit constipation(NTC),slow transit constipation(STC),outlet obstructive constipation(OOC),and mixed typeconstipation(MC).The preva1ence of FC varies from 4 to l7 percent in ordinarypeople with the genera1 tendency that it is more common in the West than in theEast,in female than in male, and in the old than in the young according to thedomestic and international related reports. What deserves to be noticed is that themorbidity of young people has been rising up too. The studies on FC have attractedmuch attention with the growing number of its patients day by day because it hasbecome increasinglyharmful to human beings.
So far, the pathogen and the mechanism of FC are not all clear yet. Recent research suggested that physiological and psychological problems often coexist inpatients with constipation. Recently, study on pelvic bottom function obstacle andbrain-gut axis is considered most promising. Biofeedback training is a newpsychological treatment, which improves symptoms greatly. However, few study onimproving pelvic bottom function and psychological condition bybiofeedback.This paper is to explore the difference of anorectal motility, rectal sensation, andpsychological condition among types of FC, analyze the relationship betweenanorectal function and psychological condition, and investigate the mechanism ofbiofeedback.
Objectives:
1. To explore the difference of anorectal motility, rectal sensation, andpsychological condition among types of FC.
2. To analyze the relationship between anorectal function and psychologicalcondition.
3. To investigate the mechanism of biofeedback on anorectal motility andpsychological condition.
Materials and Methods:
1. Seventy-one FC patients were categorized according to Colon transittime(CTT) and Transit index(TI). Thirty healthy people were included as controls.Anorectal manometry and Zung’self-rating anxiety scales (SAS) and self-ratingdepressive scales (SDS) for psychological condition were carried out in all subjects toinvestigate the anorectal motility, rectal sensation and psychological condition inpatients and the controls.And the relationship between psychological condition andanorectal function was also analized.
2. Sixty patients were received biofeedback training. After accomplishingtreatment, assess clinical symptoms, SAS, SDS, and anorectal motility again.Statistics and analyses the parameters before and after biofeedback.
Results:
1. FC patients showed abnormal anorectal motility and sensation. Comparedwith controls, FC patients had lower anal resting pressure (P<0.05), higher firstdefecation sensation, defecation thresholds and maximal volume of tolerance(P<0.01).
2. Four types of FC displayed different anorectal characteristic. NTC type hadlower anal resting pressure (P<0.05), higher first defecation sensation, defecationthresholds and maximal volume of tolerance (P<0.01). OOC type had higher firstdefecation sensation, defecation thresholds and maximal volume of tolerance(P<0.01). STC had higher maximal volume of tolerance (P<0.05). MC had nosignificant difference among them (P>0.05).Compared with each type, NTC and OOC both showed higher first sensationthan STC and MC (P<0.05).
3. Patients with FC present poor psychological health: The SAS and SDSscores were significantly higher in FC patients than those in controls (40.99±9.79 vs.28.75±4.09,51.46±11.58 vs. 32.67±7.17,P<0.01).
4. Anorectal function of patients was associated with anxiety and depression.SAS and SDS were negative related to squeezing pressure, and were positive relatedto first defecation sensation, defecation thresholds and maximal volume of tolerance(P<0.05).
5. After biofeedback training, clinical symptom was greatly improved: 71.7%(43/60)of patients were greatlyeffective, 18.3%(11/60)of patients were effective, the total effective rate was 90.0%, and the total satisfaction was 96.7%.
6. After biofeedback training, FC patients improved their psychologicalcondition (P<0.01).
7. As to 36 FC patients who received anorectal manometry before and afterbiofeedback, we didn’t found anysignificant difference between them.
Conclusions:
FC patients have abnormal anorectal function that correlated to anxiety anddepression, which maybe induce FC.
Biofeedback training can effectively improve not only clinical symptoms butalso their psychological condition. But it is also need further investigation onanorectal function.
到目前为止,FC的病因和发病机制尚不十分明确。近年来的研究提示FC患者往往同时存在病理生理和心理方面的功能失调。目前,脑肠轴学说和盆底肌功能障碍学说在消化道动力研究中最具活力,均认为精神心理状况异常是导致肛直肠动力和感觉功能失调的重要原因。生物反馈训练是一种新兴的心理行为疗法,在改善FC症状方面较为显著,但在改善盆底肌功能方面的研究甚少,且生物反馈通过何种机制来改善FC症状仍未得到证实。
本研究旨在观察FC患者及其各亚型间肛直肠动力和感觉功能的变化,分析FC患者肛直肠功能与精神心理状况之间的关系,探讨FC可能的发病机制;并尝试研究生物反馈是否是通过改善肛直肠功能来改善FC症状,以期为生物反馈治疗FC提供理论依据。
研究目的
1.探讨各型FC患者肛直肠动力及感觉功能的变化。
2.探讨FC患者精神心理状况,并分析其与肛直肠功能间的关系。
3.探讨生物反馈训练对FC患者症状、肛直肠功能和精神心理状况的影响。
研究内容与方法
1.根据结肠转运时间(Colon transit time,CTT)和传输指数(Transit index,TI)对71例FC患者进行分型,采用肛门直肠测压法、Zung的焦虑自评量表(self-rating anxiety scales,SAS)和抑郁自评量表(self-rating depressivescales,SDS)测定肛直肠动力、感觉功能及精神心理状况,并分析SAS、SDS得分与肛直肠动力、感觉功能的关系;同时选择30例健康人作对照组。
2.对60例FC患者行生物反馈训练,完成1个疗程后,再行肛门直肠测压和SAS、SDS量表测定,对干预前后的两组资料进行统计学分析和处理,分析生物反馈训练对FC患者便秘症状、肛直肠动力和感觉功能及精神心理状况的影响。
研究结果
1. FC组肛直肠功能异常,以感觉迟钝为主:与对照组相比,肛管静息压降低(P<0.05),初始感觉阈值、排便感觉阈值和最大耐受容量增高(P<0.01)。
2.各型FC患者肛直肠功能表现有差异:与对照组相比:NTC组肛管静息压降低(P<0.05),初始感觉阈值、排便感觉阈值和最大耐受容量增高(P<0.01);OOC组初始感觉阈值、排便感觉阈值和最大耐受容量增高(P<0.01);STC组最大耐受容量增高(P<0.05);MC组各参数差异无统计学意义(P>0.05)。组间比较:NTC组和OOC组在初始感觉阈值上均高于STC组和MC组(P<0.05),但各组间差异无统计学意义。
3. FC患者心理健康水平较低:与对照组相比,存在明显的焦虑和抑郁心理(40.99±9.79 vs. 28.75±4.09,51.46±11.58 vs. 32.67±7.17,P<0.01)。
4. FC患者焦虑、抑郁水平与肛直肠功能存在相关性:SAS、SDS得分与肛门缩榨压呈负相关(P<0.05),与初始感觉阈值、排便感觉阈值和最大耐受容量均呈正相关(P<0.05)。
5.生物反馈训练后,FC患者临床症状改善:症状总积分显著降低(P<0.01),71.7%(43/60)的患者显效,18.3%(11/60)的患者有效,总有效率为90.0%,总满意度为96.7%。
6.生物反馈训练后,FC患者心理健康水平提高:SAS、SDS得分较干预前显著降低,差异有统计学意义(P<0.01)。
7.对治疗前后均完成肛直肠功能检测的36例患者分析发现:肛管静息压、缩榨压、排便压、初始感觉阈值、排便感觉阈值、最大耐受容量差异均无统计学意义(P>0.05)。
研究结论
FC患者肛直肠功能异常,尤以感觉迟钝为主,且与焦虑、抑郁情绪密切相关,此机制可能参与了FC的发病。
生物反馈训练可以改善FC患者症状、精神心理状况,但对肛直肠功能是否有改善仍需扩大样本进一步研究。
Background:
Functional constipation (FC) is one kind of common gastrointestinal disease.Accordng toAGA, four types of FC were divided:normal transit constipation(NTC),slow transit constipation(STC),outlet obstructive constipation(OOC),and mixed typeconstipation(MC).The preva1ence of FC varies from 4 to l7 percent in ordinarypeople with the genera1 tendency that it is more common in the West than in theEast,in female than in male, and in the old than in the young according to thedomestic and international related reports. What deserves to be noticed is that themorbidity of young people has been rising up too. The studies on FC have attractedmuch attention with the growing number of its patients day by day because it hasbecome increasinglyharmful to human beings.
So far, the pathogen and the mechanism of FC are not all clear yet. Recent research suggested that physiological and psychological problems often coexist inpatients with constipation. Recently, study on pelvic bottom function obstacle andbrain-gut axis is considered most promising. Biofeedback training is a newpsychological treatment, which improves symptoms greatly. However, few study onimproving pelvic bottom function and psychological condition bybiofeedback.This paper is to explore the difference of anorectal motility, rectal sensation, andpsychological condition among types of FC, analyze the relationship betweenanorectal function and psychological condition, and investigate the mechanism ofbiofeedback.
Objectives:
1. To explore the difference of anorectal motility, rectal sensation, andpsychological condition among types of FC.
2. To analyze the relationship between anorectal function and psychologicalcondition.
3. To investigate the mechanism of biofeedback on anorectal motility andpsychological condition.
Materials and Methods:
1. Seventy-one FC patients were categorized according to Colon transittime(CTT) and Transit index(TI). Thirty healthy people were included as controls.Anorectal manometry and Zung’self-rating anxiety scales (SAS) and self-ratingdepressive scales (SDS) for psychological condition were carried out in all subjects toinvestigate the anorectal motility, rectal sensation and psychological condition inpatients and the controls.And the relationship between psychological condition andanorectal function was also analized.
2. Sixty patients were received biofeedback training. After accomplishingtreatment, assess clinical symptoms, SAS, SDS, and anorectal motility again.Statistics and analyses the parameters before and after biofeedback.
Results:
1. FC patients showed abnormal anorectal motility and sensation. Comparedwith controls, FC patients had lower anal resting pressure (P<0.05), higher firstdefecation sensation, defecation thresholds and maximal volume of tolerance(P<0.01).
2. Four types of FC displayed different anorectal characteristic. NTC type hadlower anal resting pressure (P<0.05), higher first defecation sensation, defecationthresholds and maximal volume of tolerance (P<0.01). OOC type had higher firstdefecation sensation, defecation thresholds and maximal volume of tolerance(P<0.01). STC had higher maximal volume of tolerance (P<0.05). MC had nosignificant difference among them (P>0.05).Compared with each type, NTC and OOC both showed higher first sensationthan STC and MC (P<0.05).
3. Patients with FC present poor psychological health: The SAS and SDSscores were significantly higher in FC patients than those in controls (40.99±9.79 vs.28.75±4.09,51.46±11.58 vs. 32.67±7.17,P<0.01).
4. Anorectal function of patients was associated with anxiety and depression.SAS and SDS were negative related to squeezing pressure, and were positive relatedto first defecation sensation, defecation thresholds and maximal volume of tolerance(P<0.05).
5. After biofeedback training, clinical symptom was greatly improved: 71.7%(43/60)of patients were greatlyeffective, 18.3%(11/60)of patients were effective, the total effective rate was 90.0%, and the total satisfaction was 96.7%.
6. After biofeedback training, FC patients improved their psychologicalcondition (P<0.01).
7. As to 36 FC patients who received anorectal manometry before and afterbiofeedback, we didn’t found anysignificant difference between them.
Conclusions:
FC patients have abnormal anorectal function that correlated to anxiety anddepression, which maybe induce FC.
Biofeedback training can effectively improve not only clinical symptoms butalso their psychological condition. But it is also need further investigation onanorectal function.
引文
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[22] Chan AO, Cheng C,Hui WM, et al.Differing coping mechanisms, stresslevel and anorectal physiology in patients with functional constipation[J].WorldJ Gastroenterol, 2005,11 (34):5362-5366
[23]查慧,谢小平,侯晓华.不同类型便秘患者直肠敏感性的差异[J].临床内科杂志,2006,23(5):317-319
[24]吕红,钱家鸣.精神心理因素在功能性胃肠疾病中的作用[M].//周吕,柯美云.神经胃肠病学与动力:基础与临床.北京:北京科学出版社,2005:116-142
[1] Longstreth GF,ThompsonWG,ChevWD,et al.Functional boweldisorders[J].Gastroenterology,2006,130(5):1486
[2] Chan AOO, Cheng C, Hui WM, et al. Differing coping mechanisms, stress leveland anorectal physiology in patients with functional constipation[J]. World JGastroenterol,2005,11(34):5362-5366
[3]王长虹,丛中.常用心理测验量表(附录).临床心理治疗学[M].北京:人民军医出版社,2001: 575-578
[4]赵志泉,张红杰.生物反馈和功能性胃肠疾病[M].//周吕,柯美云.神经胃肠病学与动力:基础与临床.北京:北京科学出版社,2005:810-830
[5] Palsson OS,Heymen S,Whitehead WE.Biofeedback treatment for functionalanorectal disorders: a comprehensive efficacy review[J].Appl PsychophysicalBiofeedback, 2004;29(3):153-174
[6] Steven Heymen,Yolanda Scarlet,Kenneth Jones ,et al.Randomized ControlledTrail Shows Biofeedback To Be Superior To Alternative Treatments for PatientWith Pelvic Dyssenergia-Type Constipation[J]. Gastroenterology, 2005;128Suppl 2: A266
[7] Sunic-Omejc M,Mihanovic M,BilicA ,Jurcic D,Restek-Petrovic B,MaricN,Dujsin M.Efficiency of biofeedback therapy for chronic constipation inchildren[J].CollAntropol, 2002,26 supppl:93-101
[8] ChanAO,Cheng C,HuiWM,HuWH,Wong NY, Lam KF,WongWM,Lai KC,Lam SK, Wong BC. Differing coping mechanisms, stress level andanorectal physiologyin patients with functional constipation[J]. World JGastroenterol,2005,Sep 14;11(34):5362-5366
[9]徐海姗,姜铀,战敏,等.慢性特发性便秘患者肛门直肠动力及精神心理因素的研究[J].临床内科杂志,2001,18(9):379-381
[10] Emmanuel AV, Kamm MA. Response to a behavioural treatment, biofeedback,in constipated patients is associated with improved gut transit and autonomicinnervation[J].Gut,2001,49 (2):214-249
[11] Mason HJ,Serrano-Ikkos E,Kamm MA.Psychological state and quality of lifein patients having behavioral treatment (biofeedback) for intractableconstipation[J].Am J Gastroenterol,2002,97 (12):3154-3159
[12]朱芬芬,林征,林琳.护理干预对功能性便秘患者临床症状及生活质量的影响[J].中华护理杂志,2008,43(5):424-426
[1] Longstreth GF,Thompson WG,Chev WD,et al.Functional boweldisorders[J].Gastroenterology,2006,130(5):1486
[2] Kouraklis G , Andromanakos N , Anorectal incontinence:aetiolgy,pathophysiologyand evaluation[J].Acta Chir Belg,2004,(1):81-91
[3] Gladman MA,Scott SM,Chan CL,Williams NS,Lunniss PJ.Rectalhyposensitivity: prevalence and clinical impact in patients with intractableconstipation and fecal incontinence[J]. Dis Colon Rectum,2003 Feb,46(2):238-46
[4] Czerwionka-Szaflarska M,Zielińska-Duda H,Mierzwa G,Drewa S.The valueof anorectal manometry as differentiated organic and functional disorders inchildren and youth with chronic constipation[J].Pol Merkur Lekarski,2006 Oct,21(124):319-324
[5] ChanAO,Cheng C,HuiWM,et al. Differing coping mechanisms, stress leveland anorectal physiology in patients with functional constipation[J].World JGastroenterol,2005,Sep 14,11(34):5362-5366
[6] Karlbom U,Lundin E,GrafW,et al.Anorectal physiologyin relation to clinicalsubgroups of patients with severe constipation[J].Colorectal Dis,2004,6:343-349
[7] Zar S,BensonMJ,KumarD. Rectal afferent hypersensitivityand compliance inirritable bowel syndrome: differences between diarrhoeapre dominant andconstipation predominant subgroups[J].Eur J Gastroenterol Hepatol,2006,18:151-158
[8]Azpiroz F,Enck P,WhiteheadWE ,Anorectal functional testing review ofcollective experience[J].Am J Gastroenterol,2002,97(2):232-240
[9] Palsson OS,Heymen S,Whitehead WE.Biofeedback treatment for functionalanorectal disorders: a comprehensive efficacy review[J].Appl PsychophysicalBiofeedback,2004,29(3):153-174
[10] Steven Heymen,Yolanda Scarlet,Kenneth Jones ,et al.Randomized ControlledTrail Shows Biofeedback To Be Superior To Alternative Treatments for PatientWith Pelvic Dyssenergia-Type Constipation[J]. Gastroenterology,2005,128Suppl 2: A266
[11] Sunic-Omejc M,Mihanovic M,BilicA ,et al.Efficiencyof biofeedback therapyfor chronic constipation in children[J].CollAntropol,2002,26 supppl:93-101
[12] Jun Wang,Mao-Hong Luo,Qing-Hui Qi ,et al.Prospective study ofbiofeedback retraining in patients with chronic idiopathic functionalconstipation[J].World J Gastroenterology,2003,9(9):2109-2113
[13] Chiarioni G,Salandini L,WhiteheadWE.Biofeedback benefits onlypatientswith outlet dysfunction, not patients with isolated slow transitconstipation[J].Gastroenterology,2005,129:86-97
[14]Wiesel PH, Dorta G,Cuypers P,et al.Patient satisfaction after biofeedbackfor constipation and pelvic floor dyssynergia[J].Swiss MedWkly,2001 Mar 24,131(11-12):152-156
[15] Battaglia E,SerraAM,Buonafede G,et al. Long-term studyon the effects ofvisual biofeedback and muscle training as a therapeutic modality in pelvic floordyssynergia and slow-transit constipation[J]. Dis Colon Rectum,2004 Jan,47(1):90-95
[16] Rao SS,Seaton K,Miller M,et al.Randomized controlled trial of biofeedback,sham feedback, and standard therapy for dyssynergic defecation [J] . ClinGastroenterol Hepatol,2007 Mar;5(3):331-338
[17] Heymen , Jones KR, Scarlett Y,et al.Biofeedback treatment ofconstipation :a critical review[J].Dis Colon Rectum,2003,46:1208-1217
[18]WhiteheadWE,Heymen S,Schuster MM.Motilityas a therapeutic modality:biofeedback treatment of gastrointestinal disorders. In: Schuster MM, CrowellMD, Koch KL, eds. Schuster atlas of gastrointestinal motility in health anddisease. 2nd ed. Hamilton: BC Decker Inc,2002:381–397
[19] Brown SR,Donati D,Seow-Choen F,et al.Biofeedback avoids surgery inpatients with slow-transit constipation: report of four cases[J].Dis ColonRectum,2001 May,44(5):737-740
[20] EmmauelAV,Kamm MA.Response to a behavioural treatment ,biofeedback ,in constipated patients is associated with outlet dysfunction , not patients withimproved gut transit and autonomi innervation[J].Gastroenterology,2005,1129:86
[21] Chiarioni G,Whitehead WE,Pezza V, et al..Biofeedback is superior tolaxatives for normal transit constipation due to pelvic floordyssynergia[J].Gastroenterology,2006,130:657-664
[22] Rao SS,Kinkade KJ,Schulze KS,et al.Biofeedback therapy(bt) for dyssynergicconstipation - randomized controlled trial[J]. Gastroenterology,2005,28 Suppl2: A269
[23] Lin Zheng,Lin lin,Zhang Hongjie,et al.Social,psychosocial and behaviorcharacteristics of patients with functional constipation and the follow-up of theeffects of biofeedback therapy[J].Chinese J Clinical Rehabilitation,2004,9(28):67-69
[24] Jorge JM,Habr-Gama A,Wexner SD.Biofeedbacktherapy in the colon andrectal practice[J].Appl Psychophysical Biofeedback:2003 Mar,28(1):47-61
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[20]夏瑾,陈建永,潘峰等.功能性便秘患者社会心理状况分析及护理对策[J].中华护理杂志,2006,41(3):207-210
[21]李学锋,邹益友.出口梗阻型便秘患者的肛门直肠动力学与精神心理因素研究[J].世界华人消化杂志,2005,13(1):128-129
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[24]吕红,钱家鸣.精神心理因素在功能性胃肠疾病中的作用[M].//周吕,柯美云.神经胃肠病学与动力:基础与临床.北京:北京科学出版社,2005:116-142
[1] Longstreth GF,ThompsonWG,ChevWD,et al.Functional boweldisorders[J].Gastroenterology,2006,130(5):1486
[2] Chan AOO, Cheng C, Hui WM, et al. Differing coping mechanisms, stress leveland anorectal physiology in patients with functional constipation[J]. World JGastroenterol,2005,11(34):5362-5366
[3]王长虹,丛中.常用心理测验量表(附录).临床心理治疗学[M].北京:人民军医出版社,2001: 575-578
[4]赵志泉,张红杰.生物反馈和功能性胃肠疾病[M].//周吕,柯美云.神经胃肠病学与动力:基础与临床.北京:北京科学出版社,2005:810-830
[5] Palsson OS,Heymen S,Whitehead WE.Biofeedback treatment for functionalanorectal disorders: a comprehensive efficacy review[J].Appl PsychophysicalBiofeedback, 2004;29(3):153-174
[6] Steven Heymen,Yolanda Scarlet,Kenneth Jones ,et al.Randomized ControlledTrail Shows Biofeedback To Be Superior To Alternative Treatments for PatientWith Pelvic Dyssenergia-Type Constipation[J]. Gastroenterology, 2005;128Suppl 2: A266
[7] Sunic-Omejc M,Mihanovic M,BilicA ,Jurcic D,Restek-Petrovic B,MaricN,Dujsin M.Efficiency of biofeedback therapy for chronic constipation inchildren[J].CollAntropol, 2002,26 supppl:93-101
[8] ChanAO,Cheng C,HuiWM,HuWH,Wong NY, Lam KF,WongWM,Lai KC,Lam SK, Wong BC. Differing coping mechanisms, stress level andanorectal physiologyin patients with functional constipation[J]. World JGastroenterol,2005,Sep 14;11(34):5362-5366
[9]徐海姗,姜铀,战敏,等.慢性特发性便秘患者肛门直肠动力及精神心理因素的研究[J].临床内科杂志,2001,18(9):379-381
[10] Emmanuel AV, Kamm MA. Response to a behavioural treatment, biofeedback,in constipated patients is associated with improved gut transit and autonomicinnervation[J].Gut,2001,49 (2):214-249
[11] Mason HJ,Serrano-Ikkos E,Kamm MA.Psychological state and quality of lifein patients having behavioral treatment (biofeedback) for intractableconstipation[J].Am J Gastroenterol,2002,97 (12):3154-3159
[12]朱芬芬,林征,林琳.护理干预对功能性便秘患者临床症状及生活质量的影响[J].中华护理杂志,2008,43(5):424-426
[1] Longstreth GF,Thompson WG,Chev WD,et al.Functional boweldisorders[J].Gastroenterology,2006,130(5):1486
[2] Kouraklis G , Andromanakos N , Anorectal incontinence:aetiolgy,pathophysiologyand evaluation[J].Acta Chir Belg,2004,(1):81-91
[3] Gladman MA,Scott SM,Chan CL,Williams NS,Lunniss PJ.Rectalhyposensitivity: prevalence and clinical impact in patients with intractableconstipation and fecal incontinence[J]. Dis Colon Rectum,2003 Feb,46(2):238-46
[4] Czerwionka-Szaflarska M,Zielińska-Duda H,Mierzwa G,Drewa S.The valueof anorectal manometry as differentiated organic and functional disorders inchildren and youth with chronic constipation[J].Pol Merkur Lekarski,2006 Oct,21(124):319-324
[5] ChanAO,Cheng C,HuiWM,et al. Differing coping mechanisms, stress leveland anorectal physiology in patients with functional constipation[J].World JGastroenterol,2005,Sep 14,11(34):5362-5366
[6] Karlbom U,Lundin E,GrafW,et al.Anorectal physiologyin relation to clinicalsubgroups of patients with severe constipation[J].Colorectal Dis,2004,6:343-349
[7] Zar S,BensonMJ,KumarD. Rectal afferent hypersensitivityand compliance inirritable bowel syndrome: differences between diarrhoeapre dominant andconstipation predominant subgroups[J].Eur J Gastroenterol Hepatol,2006,18:151-158
[8]Azpiroz F,Enck P,WhiteheadWE ,Anorectal functional testing review ofcollective experience[J].Am J Gastroenterol,2002,97(2):232-240
[9] Palsson OS,Heymen S,Whitehead WE.Biofeedback treatment for functionalanorectal disorders: a comprehensive efficacy review[J].Appl PsychophysicalBiofeedback,2004,29(3):153-174
[10] Steven Heymen,Yolanda Scarlet,Kenneth Jones ,et al.Randomized ControlledTrail Shows Biofeedback To Be Superior To Alternative Treatments for PatientWith Pelvic Dyssenergia-Type Constipation[J]. Gastroenterology,2005,128Suppl 2: A266
[11] Sunic-Omejc M,Mihanovic M,BilicA ,et al.Efficiencyof biofeedback therapyfor chronic constipation in children[J].CollAntropol,2002,26 supppl:93-101
[12] Jun Wang,Mao-Hong Luo,Qing-Hui Qi ,et al.Prospective study ofbiofeedback retraining in patients with chronic idiopathic functionalconstipation[J].World J Gastroenterology,2003,9(9):2109-2113
[13] Chiarioni G,Salandini L,WhiteheadWE.Biofeedback benefits onlypatientswith outlet dysfunction, not patients with isolated slow transitconstipation[J].Gastroenterology,2005,129:86-97
[14]Wiesel PH, Dorta G,Cuypers P,et al.Patient satisfaction after biofeedbackfor constipation and pelvic floor dyssynergia[J].Swiss MedWkly,2001 Mar 24,131(11-12):152-156
[15] Battaglia E,SerraAM,Buonafede G,et al. Long-term studyon the effects ofvisual biofeedback and muscle training as a therapeutic modality in pelvic floordyssynergia and slow-transit constipation[J]. Dis Colon Rectum,2004 Jan,47(1):90-95
[16] Rao SS,Seaton K,Miller M,et al.Randomized controlled trial of biofeedback,sham feedback, and standard therapy for dyssynergic defecation [J] . ClinGastroenterol Hepatol,2007 Mar;5(3):331-338
[17] Heymen , Jones KR, Scarlett Y,et al.Biofeedback treatment ofconstipation :a critical review[J].Dis Colon Rectum,2003,46:1208-1217
[18]WhiteheadWE,Heymen S,Schuster MM.Motilityas a therapeutic modality:biofeedback treatment of gastrointestinal disorders. In: Schuster MM, CrowellMD, Koch KL, eds. Schuster atlas of gastrointestinal motility in health anddisease. 2nd ed. Hamilton: BC Decker Inc,2002:381–397
[19] Brown SR,Donati D,Seow-Choen F,et al.Biofeedback avoids surgery inpatients with slow-transit constipation: report of four cases[J].Dis ColonRectum,2001 May,44(5):737-740
[20] EmmauelAV,Kamm MA.Response to a behavioural treatment ,biofeedback ,in constipated patients is associated with outlet dysfunction , not patients withimproved gut transit and autonomi innervation[J].Gastroenterology,2005,1129:86
[21] Chiarioni G,Whitehead WE,Pezza V, et al..Biofeedback is superior tolaxatives for normal transit constipation due to pelvic floordyssynergia[J].Gastroenterology,2006,130:657-664
[22] Rao SS,Kinkade KJ,Schulze KS,et al.Biofeedback therapy(bt) for dyssynergicconstipation - randomized controlled trial[J]. Gastroenterology,2005,28 Suppl2: A269
[23] Lin Zheng,Lin lin,Zhang Hongjie,et al.Social,psychosocial and behaviorcharacteristics of patients with functional constipation and the follow-up of theeffects of biofeedback therapy[J].Chinese J Clinical Rehabilitation,2004,9(28):67-69
[24] Jorge JM,Habr-Gama A,Wexner SD.Biofeedbacktherapy in the colon andrectal practice[J].Appl Psychophysical Biofeedback:2003 Mar,28(1):47-61