肉毒毒素注射治疗脊髓损伤出口梗阻型便秘的临床研究

发布时间：2018-01-19 03:31

本文关键词： 脊髓损伤神经源性肠道出口梗阻型排便障碍肉毒毒素　出处：《中国康复医学杂志》2017年02期 　论文类型：期刊论文

【摘要】：目的:研究肉毒毒素注射对脊髓损伤所致的出口梗阻型便秘的治疗效果。方法:对脊髓损伤后慢性便秘经系统肠道功能康复训练无效的86例患者,应用结肠传输试验、肛肠动力学检查等明确诊断为出口梗阻型并肛管压力过高的便秘患者25例,选择在肛门的1、5、7、11共4点将肉毒毒素注入肛门直肠环内,肉毒毒素用量32—48U;注射后1个月、3个月分别观察排便情况,注射后1个月复查肛肠动力学指标变化,分析其疗效。结果:25例患者的排便频率由注射前1.72±0.24次/周增加到第1个月的4.00±0.25次/周(P0.01)、第3个月的3.36±0.25次/周(P0.01);每次排便耗时由注射前29.60±1.83min减少到第1个月的15.52±1.29min(P0.01)、第3个月的21.20±1.77min(P0.01),需要栓剂及手掏大便等辅助排便方式的病例减少;肛管最大收缩压由注射前的171.34±27.09mmHg降至第1个月的112.09±31.09mmHg(P0.01);直肠-肛管弛缓反射异常例数由24例减为13例(P0.01),球囊迫出成功例数由3例增至16例(P0.01)。结论:肉毒毒素肛门直肠环注射对脊髓损伤出口梗阻型便秘是一个简便有效的治疗方法。
[Abstract]:Objective: to study the therapeutic effect of botulinum toxin injection on outlet obstructive constipation caused by spinal cord injury. Colonic transit test and anorectal dynamic examination were used to diagnose 25 patients with constipation with outlet obstruction and high anal pressure. (11) Botulinum toxin was injected into the anorectal ring at 4 points and the dosage of botulinum toxin was 32-48 U; Defecation was observed 1 month and 3 months after injection, and the changes of anorectal dynamics were reexamined 1 month after injection. Results the defecation frequency increased from 1.72 卤0.24 times per week before injection to 4.00 卤0.25 times per week at the first month (P0.01). In the third month, 3.36 卤0.25 times per week (P 0.01); The time of each defecation was reduced from 29.60 卤1.83 min before injection to 15.52 卤1.29 min (P0.01) in the first month. In the third month (21.20 卤1.77 min), the number of patients who needed suppositories and hand defecation and other auxiliary defecation methods was reduced. The maximum systolic pressure of anal canal decreased from 171.34 卤27.09mmHg before injection to 112.09 卤31.09mmHg at the first month. The number of abnormal rectoanal flaccid reflex was reduced from 24 to 13 (P 0.01). The number of successful cases was increased from 3 cases to 16 cases (P 0.01). Conclusion: botulinum toxin anorectal ring injection is a simple and effective method for the treatment of outlet obstruction constipation of spinal cord injury.
【作者单位】：广东省工伤康复医院颅脑损伤康复科;广东省工伤康复医院脊髓损伤康复科;广东省工伤康复医院放射科;广东省工伤康复医院外科;
【基金】：广东省医学科学基金资助项目(A2013482)
【分类号】：R651.2;R574.62;R493
【正文快照】： 脊髓损伤(spinal cord injury,SCI)是一个严重影响机体功能的疾病,其所致的运动、感觉和排尿等功能障碍受到人们的普遍重视。与之相比,SCI后肠道功能障碍或称神经源性肠道(neurogenic bowel dysfunction,NBD)并没有得到足够重视,其所致的排便障碍的处理目前仍然是一个极为棘手

【参考文献】