ObjectiveTo explore etiopathogenesis of slow transit constipation(STC). MethodsThe model of rat with “cathartic colon” was established, and the changes of colonic electromyography of the rat was examined. ResultsThe frequency and amplitude of slow wave in vivo of rats with cathartic colon was decreased markedly. Postmeal spike potential and duration was decreased, showing that gastrocolonic reflex of rats colon was decreased.ConclusionLong term abuse of stimulant laxuatives could damage enteric nervous system and accelerate the pathological changes of STC.
1概述便秘是很常见的症状，在美国便秘的发生率为2%，英国为10%，日本为4%，我国天津为4.4%［1］，女性发病概率是男性的3倍。多数便秘患者可经药物治疗治愈或改善症状，少数为难治性。少数便秘患者经手术治疗效果较好。便秘不是一种病，而是多种疾病的一个症状，不同的患者有不同的含义，包括： ①大便量少、硬，排出困难； ②排便困难合并一些特殊的症候群，如长期用力排便、直肠胀感、排便不完全或依靠手法帮助排便； ③7天内排便次数少于2～3次。临床上常诊断为慢性顽固性便秘或特发性便秘，但其确切含义很难描述。“慢性”意指病史至少2年，或年幼时就发病； “特发性”说明我们对便秘的原因及流行病学了解不全面； “顽固性”意指经一般药物及非手术治疗很难奏效，常需手术治疗［2］。
Objective To study the neuropathological changes of gastrin and substance P(SP) in the intermuscular and submucous nerve plexus of the colonic walls in patients with delayed motor constipation(DMC).MethodsGastrin and rabbit SP polyclonal antibiotics were used to make an immunohistochemical staining of the samples of different segments obtained from 10 patients with DMC and 8 normal subjects(control group) for a comparative observation as well as a relative semi-quantitative analysis.Results The immune positive nerve cells of gastrin and SP in the intermuscular nerve plexus of colon with DMC were markedly reduced; no differences in the immune response of gastrin and SP in the mucous nerve plexus were found between the two groups(P＜0.01). With routine HE staining, focal inflammation occurred in the mucous membrane of DMC colon and that the neuronal vacuolus of the intermuscular nerve plexus degenerated, reduced and even disappeared. Conclusion The abnormal changes of the neural structure in the immune reponse of gastrin and SP in the intermuscular nerve plexus of colon with DMC might be related to reduction of gastrin and SP peptide neuron or dysfunctional.
Objective To assess the efficacy and safety of Chinese herbal medicines for chronic functional constipation. Methods We searched CNKI (1989 to November, 2009), CBM (1989 to November, 2009), VIP (1989 to November, 2009), Cochrane Library (Issue 4, 2009), PubMed (1966 to November, 2009) and EMbase (1986 to November, 2009). All randomized and quasi-randomized clinical trials of treating chronic functional constipation with Chinese herbal medicines versus untreated, placebo or western drug groups were included. Data were extracted independently by two reviewers. The methodological quality of trials was evaluated with Cochrane Handbook 5.0.2 criteria. Meta-analyses were conducted by the RevMan 5.0 software. Results Twenty-one trials involving 2 602 patients were included. The Meta-analysis results showed that: Chinese herbal medicines improved both syndromes and colonic transit function of recipients; moreover, it is superior to both gastrointestinal prokinetic agent in effective rate (RR=1.18, 95%CI 1.12 to 1.25), healing rate (RR=1.59, 95%CI 1.35 to 1.88), and cathartic in effective rate (RR=1.18, 95%CI 1.10 to 1.27), healing rate (RR=1.16, 95%CI 1.29 to 2.10). Integration of Chinese herbal medicines and gastrointestinal prokinetic agent is superior to gastrointestinal prokinetic agent in effective rate (RR=1.21 95%CI 1.09 to 1.34) and healing rate (RR=1.41, 95%CI 1.11 to 1.79). Conclusion Some Chinese herbal medicines may be effective and safe in treating chronic functional constipation, which can not be bly proved at present for lack of studies with high quality.
目的 评价中药灌肠治疗各型便秘的疗效。 方法 计算机检索CBM、VIP、CNKI及Cochrane图书馆临床对照试验数据库等，查找符合纳入标准的随机对照试验，文献检索时间均从建库截至2012年5月。并按Cochrane系统评价手册的文献质量评价办法评价纳入研究的方法学质量，而后提取相关数据用Rev Man 5.1软件进行Meta分析。 结果 最终纳入15篇随机对照试验，共1 137名受试者。结果显示：中药灌肠治疗各型便秘的效果优于口服药、肥皂水灌肠、开塞露等其他治疗，OR值及相应95%CI分别为6.6（2.61，16.69）、5.46（2.57，11.60）、6.54（2.41，17.70）。 结论 中药灌肠治疗便秘有一定疗效且相对安全。由于纳入分析的研究质量差异较大，因此有必要进行大样本、多中心、随机、双盲的对照试验，以进一步证实其临床疗效。
目的 对比研究口服硫酸镁与聚乙二醇4000对老年冠心病新发便秘患者的通便效果及安全性。 方法 2010年10月－2012年4月将158例冠心病新发便秘老年患者按入院单双号时间随机分为两组，试验组88例患者口服硫酸镁，对照组70例服用聚乙二醇4000 散剂，观察两组患者服药后排便时间、排便效果及服药后不良反应。 结果 两组排便时间比较，试验组67例（76.14%）患者在服药6 h内开始排便，对照组则仅有35例（50.00%）在该时间段排便，试验组人均排便量及总有效率优于对照组。 结论 硫酸镁治疗老年冠心病新发便秘疗效确切，不良反应低，不失为一种临床解除新发便秘安全、有效的药物。