生物反馈治疗功能性便秘的远期疗效随访与分析

  本文关键词：生物反馈治疗功能性便秘的远期疗效随访与分析，由笔耕文化传播整理发布。

        功能性便秘（FunctionalConstipation,FC）是临床最常见的慢性功能性胃肠道疾病之一。流行病学资料显示全世界范围内受便秘困扰的人群在0.7%～79%不等，平均约为16%，且发病率呈逐年上升趋势，严重影响了患者的生理、心理状况和生活质量。传统的药物及手术治疗疗效不佳，且不良反应和并发症较多。因此，寻找有效的治疗FC的方法已经成为一个亟待解决的问题。生物反馈（Biofeedback,BF）作为一种新兴的行为疗法，安全、简便、治疗费用低、无副作用，已广泛应用于FC的临床治疗。国内外研究已经证实BF治疗FC的近期疗效满意，有效率为62.4%～86%，其疗效与患者的治疗依从性密切相关。本课题组前期研究也证实，BF联合综合护理干预治疗FC的总有效率高达90%，其中护理干预对提高患者BF治疗的依从性起着不可或缺的作用。然而FC是一种慢性疾病，症状持续至少2年，BF的疗效能否被长期保持是研究者较为关注的问题。但目前有关BF远期疗效的报道较少，国内尚未见报道。本研究随访2005年5月~2010年5月就诊于本院胃肠动力中心并接受BF治疗联合综合护理干预的FC患者，从临床症状、客观生理参数、心理状况、生活质量和患者满意度等方面进行综合疗效评价，旨在进一步明确BF治疗FC的远期疗效及其影响因素，建立疗效随访体系，并形成计算机软件系统，以期为FC的临床诊疗、后期随访及延续性护理干预提供依据，为亚太地区慢性便秘诊治指南的制定提供参考。研究目的1.评价BF治疗FC的远期疗效及影响因素，为临床诊疗及护理干预的实施提供依据。2.建立FC患者治疗随访管理系统，以期利用现代数据库技术管理FC临床数据，规范随访程序与内容，为FC患者延续性护理干预评估与评价体系建立提供基础。研究内容与方法1.对2005年5月~2010年5月在我院胃肠动力中心行BF治疗且资料完整的120例FC患者进行随访，采用临床症状积分、ZUNG焦虑/抑郁自评量表（SAS/SDS）、简明健康调查问卷（SF-36）、结肠传输试验和肛门直肠测压方法评价远期疗效。选择32个可能对BF远期疗效产生影响的非重复性特征性因素，进行单因素和多因素分析，筛选出主要的疗效影响因素。2.根据随访结果并结合临床诊疗需要，完成功能性便秘患者治疗随访管理系统的需求分析和架构设计；采用MySQL后台数据库、VS2008前台开发工具和C#语言进行程序编写，实现系统的功能，进行性能测试与分析，最终投入临床应用。研究结果1．120例入组患者中共随访到110例（随访率91.67%），有效问卷109份，男46例，女63例，年龄20~83（50.9±19.1）岁，，病程10.2±8.2年，BF治疗10.7±4.9次，随访时间13~70（36.4±12.7）个月。2．109例FC患者BF治疗后1～6年随访时，症状积分和SAS/SDS得分均显著低于BF治疗前（P＜0.01），SF-36得分除生理功能维度外，其他各维度得分均显著高于BF治疗前（P＜0.01）；45.9%（50/109）的患者疗效很好，14.7%（16/109）的患者疗效好，10.1%（11/109）的患者疗效一般，总有效率为70.7%，总满意率为62.4%。3．17例FC患者在BF治疗后1～6年随访时，48h结肠排空率明显高于BF治疗前（P＜0.05），72h结肠排空率虽较BF治疗前高，但差异无统计学意义（P＞0.05）。4．35例FC患者在BF治疗后1～6年随访时，力排时肛管剩余压明显低于BF治疗前（P＜0.05），存在协同动作障碍的患者比率明显降低（P＜0.05），其他动力和感觉参数无明显变化（P＞0.05）。5．BF治疗后1～6年随访时，FC患者症状积分高于BF治疗后（P＜0.01），远期疗效较BF治疗后即时疗效有所下降（70.7%VS93.6%）。6．BF治疗后1-2年、2-4年和4年以上时段临床症状积分、SAS/SDS得分和SF-36得分差异均无统计学意义（P＞0.05）。7．单因素和多因素分析结果显示，家庭训练依从性、社会支持利用度和病程是影响BF远期疗效的主要因素。8．完成了功能性便秘患者治疗随访管理数据库系统的设计、应用程序的开发与测试，并已投入临床应用。研究结论BF不仅能持续改善FC患者的临床症状，还能纠正肛直肠生理功能障碍，减轻焦虑抑郁水平，提高生活质量，远期疗效肯定，可作为FC的首选治疗方法。提高患者家庭训练依从性、对社会支持的利用度和鼓励早期治疗是提高BF远期疗效的关键。功能性便秘患者治疗随访管理数据库系统实现了设计功能，为功能性便秘的临床诊疗和随访提供了切实可靠的数据支持和决策依据，具有良好的实用价值和应用前景。

    Background:Functional constipation (FC) is one of the most common clinical chronic functional gastrointestinal diseases. The epidemiological data shows that worldwide populations plagued by constipation ranging from0.7%to79%, an average of about16%, and the incidence rate showed an increasing trend. The traditional medical and surgical treatment do not work well, and course more adverse reactions and complications. Therefore, to find effective treatment of FC, has become an urgent problem.Biofeedback therapy as a new kind of behavior therapy, safe, simple, low cost of treatment, no side effects, has been widely used in clinical treatment of FC. It has been reported that the effective rate of biofeedback was from62.4%t to86%. Its efficacy and patient compliance are closely related. Preliminary studies of our group also confirmed that the total efficiency of BF treatment joint nursing intervention of FC is up to90%. Nursing intervention to improve treatment compliance of patients with BF plays an integral role. FC is a chronic disease, the symptoms continue for at least2years. Researchers concern about the efficacy of BF can be long maintained. However, there are few reports on long-term efficacy of BF in domestic.FC patients received BF pius nursing intervention in May2005to May2010 were followed up in this research. Comprehensive efficacy evaluation from the clinical symptoms, objective physiological parameters, psychological status, quality of life and patient satisfaction of them was studied in order to clear the long-term efficacy and its influencing factors. And then we can establish a follow-up system for efficacy and create a computer software system to manage the process. This research can provide the basis for clinical diagnosis and treatment, follow-up and continuity of nurse intervention of FC. And it also provides a reference for the formulation of the guidelines for the diagnosis and treatment of chronic constipation of the Asia-Pacific region.Objectives:1. To investigate retrospectively the long-term efficacy and the influencing factors of biofeedback treatment for FC patients.2. To establish a management system for managing treatment and follow-up of FC patients and use modern database technology to manage clinical data of FC in order to assist clinical and research work.Materials and Methods:1. From May2005to May2010,120FC patients undergone biofeedback therapy in our hospital were followed up. Long-term efficacy of biofeedback treatment was evaluated by a bowel symptom score, colonic transit test and anorectal manometry. Thirty two independent risk factors of long-term efficacy were analyzed using univariate analysis and multivariable linear regression model.2. Blueprint of the data structure was designed and accomplished based on the resolution of data flow of FC after requirements. Performance test and analysis was carried out for clinical application.Results:1. One hundred and ten patients (91.7%) were able to be followed up and109effective questionnaires were collected. The mean follow-up time was (36.4±12.7) months.2. The score of clinical symptoms and SAS/SDS in follow-up period were significantly lower than that in baseline (P<0.01). The scores of all subcategories of SF-36except physical functioning were higher than those in baseline (P<0.01).45.9%(50/109) of patients were greatly effective,14.7%(16/109) of patients were good effective,14.7%(16/109) of patients were general effective, the total effective rate was70.7%, and the total satisfaction was62.4%.3. The colonic emptying rate of48h and72h was higher than those in baseline (P<0.05).4. The residual pressure of anal was lower than that in baseline (P<0.05), and the number of patient with dyssynergia was significantly reduced (P<0.05).5. The score of clinical symptoms in follow-up period was higher than that after biofeedback (P<0.01), The long-term efficacy of biofeedback therapy for FC was lower than that in short-term (70.7%VS93.6%).6. There were no significant differences in the Clinical symptom scores, the score of SAS/SDS and SF-36at1-2years,2-4years and more than4years after patients received BF (P>0.05).7. The univariate and multivariate analysis showed that the significant influencing factors were treatment compliance, social support and illness duration.8. The database and the application including user defined quering utilities were finished and applied to clinic usage.Conclusion:Biofeedback therapy provided sustained improvement of clinical symptom and anorectal function in constipated subjects. Treatment compliance, social support and illness duration were the most important factors influencing the long-term efficacy. The application system, which can provide support for clinical real-time decision, will increase the efficiency of data management of functional constipation and analysis. It can helpful for clinical doctors and researchers.

          生物反馈治疗功能性便秘的远期疗效随访与分析

中文摘要5-8英文摘要8-10前言11-14第一部分 生物反馈治疗功能性便秘的远期疗效及影响因素分析14-37    对象与方法14-20    结果20-32    讨论32-37第二部分 功能性便秘患者治疗随访管理系统的设计与实现37-56    材料和方法37-38    系统的分析与设计38-47    系统功能的实现47-54    讨论54-56小结56-57参考文献57-61综述61-69    参考文献65-69附录69-77攻读学位期间发表的学术论文目录77-78致谢78

  本文关键词：生物反馈治疗功能性便秘的远期疗效随访与分析，由笔耕文化传播整理发布。