本文關鍵詞：生物反饋治療功能性便秘的遠期療效隨訪與分析，由筆耕文化傳播整理發(fā)布。

        功能性便秘（FunctionalConstipation,FC）是臨床最常見的慢性功能性胃腸道疾病之一。流行病學資料顯示全世界范圍內受便秘困擾的人群在0.7%～79%不等，平均約為16%，且發(fā)病率呈逐年上升趨勢，嚴重影響了患者的生理、心理狀況和生活質量。傳統(tǒng)的藥物及手術治療療效不佳，且不良反應和并發(fā)癥較多。因此，尋找有效的治療FC的方法已經成為一個亟待解決的問題。生物反饋（Biofeedback,BF）作為一種新興的行為療法，安全、簡便、治療費用低、無副作用，已廣泛應用于FC的臨床治療。國內外研究已經證實BF治療FC的近期療效滿意，有效率為62.4%～86%，其療效與患者的治療依從性密切相關。本課題組前期研究也證實，BF聯(lián)合綜合護理干預治療FC的總有效率高達90%，其中護理干預對提高患者BF治療的依從性起著不可或缺的作用。然而FC是一種慢性疾病，癥狀持續(xù)至少2年，BF的療效能否被長期保持是研究者較為關注的問題。但目前有關BF遠期療效的報道較少，國內尚未見報道。本研究隨訪2005年5月~2010年5月就診于本院胃腸動力中心并接受BF治療聯(lián)合綜合護理干預的FC患者，從臨床癥狀、客觀生理參數(shù)、心理狀況、生活質量和患者滿意度等方面進行綜合療效評價，旨在進一步明確BF治療FC的遠期療效及其影響因素，建立療效隨訪體系，并形成計算機軟件系統(tǒng)，以期為FC的臨床診療、后期隨訪及延續(xù)性護理干預提供依據(jù)，為亞太地區(qū)慢性便秘診治指南的制定提供參考。研究目的1.評價BF治療FC的遠期療效及影響因素，為臨床診療及護理干預的實施提供依據(jù)。2.建立FC患者治療隨訪管理系統(tǒng)，以期利用現(xiàn)代數(shù)據(jù)庫技術管理FC臨床數(shù)據(jù)，規(guī)范隨訪程序與內容，為FC患者延續(xù)性護理干預評估與評價體系建立提供基礎。研究內容與方法1.對2005年5月~2010年5月在我院胃腸動力中心行BF治療且資料完整的120例FC患者進行隨訪，采用臨床癥狀積分、ZUNG焦慮/抑郁自評量表（SAS/SDS）、簡明健康調查問卷（SF-36）、結腸傳輸試驗和肛門直腸測壓方法評價遠期療效。選擇32個可能對BF遠期療效產生影響的非重復性特征性因素，進行單因素和多因素分析，篩選出主要的療效影響因素。2.根據(jù)隨訪結果并結合臨床診療需要，完成功能性便秘患者治療隨訪管理系統(tǒng)的需求分析和架構設計；采用MySQL后臺數(shù)據(jù)庫、VS2008前臺開發(fā)工具和C#語言進行程序編寫，實現(xiàn)系統(tǒng)的功能，進行性能測試與分析，最終投入臨床應用。研究結果1．120例入組患者中共隨訪到110例（隨訪率91.67%），有效問卷109份，男46例，女63例，年齡20~83（50.9±19.1）歲，，病程10.2±8.2年，BF治療10.7±4.9次，隨訪時間13~70（36.4±12.7）個月。2．109例FC患者BF治療后1～6年隨訪時，癥狀積分和SAS/SDS得分均顯著低于BF治療前（P＜0.01），SF-36得分除生理功能維度外，其他各維度得分均顯著高于BF治療前（P＜0.01）；45.9%（50/109）的患者療效很好，14.7%（16/109）的患者療效好，10.1%（11/109）的患者療效一般，總有效率為70.7%，總滿意率為62.4%。3．17例FC患者在BF治療后1～6年隨訪時，48h結腸排空率明顯高于BF治療前（P＜0.05），72h結腸排空率雖較BF治療前高，但差異無統(tǒng)計學意義（P＞0.05）。4．35例FC患者在BF治療后1～6年隨訪時，力排時肛管剩余壓明顯低于BF治療前（P＜0.05），存在協(xié)同動作障礙的患者比率明顯降低（P＜0.05），其他動力和感覺參數(shù)無明顯變化（P＞0.05）。5．BF治療后1～6年隨訪時，F(xiàn)C患者癥狀積分高于BF治療后（P＜0.01），遠期療效較BF治療后即時療效有所下降（70.7%VS93.6%）。6．BF治療后1-2年、2-4年和4年以上時段臨床癥狀積分、SAS/SDS得分和SF-36得分差異均無統(tǒng)計學意義（P＞0.05）。7．單因素和多因素分析結果顯示，家庭訓練依從性、社會支持利用度和病程是影響B(tài)F遠期療效的主要因素。8．完成了功能性便秘患者治療隨訪管理數(shù)據(jù)庫系統(tǒng)的設計、應用程序的開發(fā)與測試，并已投入臨床應用。研究結論BF不僅能持續(xù)改善FC患者的臨床癥狀，還能糾正肛直腸生理功能障礙，減輕焦慮抑郁水平，提高生活質量，遠期療效肯定，可作為FC的首選治療方法。提高患者家庭訓練依從性、對社會支持的利用度和鼓勵早期治療是提高BF遠期療效的關鍵。功能性便秘患者治療隨訪管理數(shù)據(jù)庫系統(tǒng)實現(xiàn)了設計功能，為功能性便秘的臨床診療和隨訪提供了切實可靠的數(shù)據(jù)支持和決策依據(jù)，具有良好的實用價值和應用前景。

    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.

          生物反饋治療功能性便秘的遠期療效隨訪與分析

中文摘要5-8英文摘要8-10前言11-14第一部分 生物反饋治療功能性便秘的遠期療效及影響因素分析14-37    對象與方法14-20    結果20-32    討論32-37第二部分 功能性便秘患者治療隨訪管理系統(tǒng)的設計與實現(xiàn)37-56    材料和方法37-38    系統(tǒng)的分析與設計38-47    系統(tǒng)功能的實現(xiàn)47-54    討論54-56小結56-57參考文獻57-61綜述61-69    參考文獻65-69附錄69-77攻讀學位期間發(fā)表的學術論文目錄77-78致謝78

  本文關鍵詞：生物反饋治療功能性便秘的遠期療效隨訪與分析，由筆耕文化傳播整理發(fā)布。