【摘要】：研究背景:帕金森病(Parkinson'sdisease,PD)是一組以靜止性震顫、肌強直、運動遲緩、姿勢步態(tài)異常等運動癥狀為主的神經(jīng)系統(tǒng)慢性變性疾病。近幾年來,隨著人們對PD的了解逐步深入,人們對PD非運動癥狀(non-motor symptoms,NMS)有了一系列新的認識。國內(nèi)外研究發(fā)現(xiàn),在帕金森便秘中出口梗阻型便秘占絕大多數(shù)。目前僅應用改善胃腸動力藥物來治療PD便秘,因此應該尋求一個針對便秘分型的根本治療手段,從而減輕患者痛苦。高分辨率肛門直腸測壓(High resolution Anorectal Manometry)是采取動靜力學結(jié)合的手段研究各段腸道與肛管(包括盆底)不同狀態(tài)下的各種運動方式。它可以測量患者靜息、收縮、排便狀態(tài)下直腸肛管壓力變化,從而反映出三種狀態(tài)下肛管、直腸、盆底各肌群功能以及協(xié)調(diào)功能。研究目的:分析帕金森便秘患者肛腸測壓特點,根據(jù)測壓結(jié)果對帕金森便秘進行分型,從而探討帕金森便秘的機制,以期為肉毒素及生物反饋治療提供理論依據(jù)。研究方法:選取來自于大連醫(yī)科大學附屬第一醫(yī)院符合英國腦庫及羅馬III診斷標準的15例帕金森便秘患者作為帕金森便秘組(Parkinson Defecatory Disorder,PDD),符合羅馬III診斷標準并排除胃腸疾病的24例患者作為功能性便秘組(Functional Defecatory Disorder,FDD)。按照 Hoehn-Yahr 分期(2014 年中國帕金森病治療指南)將PDD組分為早期(H-Y1-2期)、晚期(H-Y2.5,3.0期)。收集兩組患者臨床資料,包括起病年齡、性別、疾病病程等。采用高分辨率肛門直腸測壓對兩組患者進行參數(shù)測評。將兩組患者按照HRAM分為兩型:①直腸推進力不足:直腸力排壓70mmHg,伴或不伴肛管矛盾運動,或肛管松弛率≤20%;②肛管矛盾運動:直腸力排壓≥70mmHg,且肛管矛盾運動(肛門內(nèi)外括約肌及恥骨直腸肌異常收縮所致肛管殘余壓肛管靜息壓)或肛管松弛率≤20%(肛管松弛率=肛管靜息壓-肛管殘余壓/肛管靜息壓×100%)。采用SPSS 23.0統(tǒng)計學軟件進行分析。各項指標進行正態(tài)性檢驗,計量資料符合正態(tài)分布數(shù)據(jù)用x±s表示,采用獨立樣本t檢驗;計數(shù)資料以例數(shù)表示,采用卡方檢驗。以P0.05為差異有統(tǒng)計學意義。研究結(jié)果:帕金森便秘組15例(男12例,女3例),年齡(66.6±7.3)歲;功能性便秘組24例(男17例,女7例),年齡(70.7±8.9)歲。兩組患者年齡、性別、便秘病程差異無統(tǒng)計學意義(P0.05)。PDD組15例中,10例以直腸推進力不足為主(66.7%),4例以肛管矛盾運動為主(26.7%),1例測量參數(shù)未見明顯異常(6.7%)。FDD組24例中,4例以直腸推進力不足為主(16.7%),18例以肛管矛盾運動為主(75%),2例測量參數(shù)未見明顯異常(8.3%)。PDD組以直腸推進力不足型為主,FDD組以肛管矛盾運動型為主,兩者存在顯著統(tǒng)計學差異(χ2=10.207,P0.05。PDD組肛門最大收縮壓(Maximum Squeeze Pressure,MSP)及直腸力排壓、直腸壓力增加明顯低于FDD組,差異有統(tǒng)計學意義;兩組直腸靜息壓、肛管靜息壓、持續(xù)收縮時間、排便時肛管剩余壓及直腸感覺閾值差異均無統(tǒng)計學意義(P0.05)。15例PDD患者根據(jù)H-Y分期分為早晚期,其中早期(H-Y 1.0～2.0)7例,晚期(H-Y 2.5,3.0)8例。PDD組早晚期靜息態(tài)、收縮態(tài)、排便態(tài)、直腸感覺功能等各個參數(shù)差異無統(tǒng)計學意義。研究結(jié)論:1.帕金森便秘患者以直腸推進力不足為主,功能性便秘患者以肛管矛盾運動為主;2.帕金森便秘患者最大縮榨壓、直腸力排壓、直腸壓力增加較功能性便秘患者明顯減少,結(jié)果有統(tǒng)計學差異;3.帕金森便秘患者便秘的原因是直腸推進力不足以及肌張力所致的盆底矛盾運動;4.帕金森早晚期肛腸測壓結(jié)果無明顯差異,提示肛門直腸動力異�？梢源嬖谟谂两鹕缙�。
[Abstract]:BACKGROUND: Parkinson's disease (PD) is a group of chronic degenerative diseases of the nervous system characterized by quiescent tremor, myotonia, bradykinesia, postural gait abnormalities and other motor symptoms. High resolution Anorectal Manometry (HRAM) It can measure the pressure changes of recto-anal canal in resting, contracting and defecating state, thus reflecting the functions of anal canal, rectum and pelvic floor muscle groups and coordination in three states. Methods: 15 cases of Parkinson's constipation were selected from the First Affiliated Hospital of Dalian Medical University, which met the diagnostic criteria of British Brain Bank and Roman III. Patients with senile constipation were classified as Parkinson Defecatory Disorder (PDD) according to the Rome III diagnostic criteria and excluding gastrointestinal diseases as Functional Defecatory Disorder (FDD). Phase (H-Y2.5, 3.0). The clinical data of the two groups were collected, including onset age, sex, course of disease and so on. 20%; 2) Anal contradictory movement: rectal force drainage pressure (> 70mmHg), and anal contradictory movement (anal residual pressure caused by abnormal contraction of anal internal and external sphincter and puborectal muscle) or anal relaxation rate (> 20%) (anal relaxation rate = anal resting pressure - Anal residual pressure / anal resting pressure (> 100%). The results showed that there were 15 cases (12 males, 3 females) in Parkinson's constipation group and 24 cases (17 males) in functional constipation group. There was no significant difference in age, sex and course of constipation between the two groups (P 0.05). Among the 15 cases in PDD group, 10 cases (66.7%) were mainly rectal insufficiency, 4 cases (26.7%) were anal contradictory motion, and 1 case (6.7%) had no significant abnormality in measurement parameters. Anal contradictory movement was predominant in 18 cases (75%) and no significant abnormality was found in 2 cases (8.3%). In PDD group, rectal insufficiency was predominant, while in FDD group, rectal contradictory movement was predominant. There were significant differences between the two groups (_2 = 10.207, P 0.05). There was no significant difference in rectal resting pressure, anal resting pressure, persistent contraction time, residual anal pressure during defecation and rectal sensory threshold between the two groups (P 0.05). Fifteen patients with PDD were divided into early and late stages according to H-Y staging, including 7 cases in early stage (H-Y 1.0-2.0) and 8 cases in late stage (H-Y 2.5, 3.0). There was no significant difference in resting state, systolic state, defecation state, rectal sensory function and other parameters. Conclusion: 1. Parkinson's constipation patients with insufficient rectal propulsion, functional constipation patients with anal contradictory movement mainly; 2. Parkinson's constipation patients with maximum compression, rectal pressure, rectal pressure increased than functional constipation. Parkinson's constipation was caused by insufficient rectal propulsion and pelvic floor contradictory movement caused by muscle tone; 4. There was no significant difference in the results of early and late Parkinson's anorectal manometry, suggesting that anorectal motility abnormalities may exist in early Parkinson's disease.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R742.5;R574.62
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本文編號：2226692