使用strain/squeeze指数评估便秘患者的肛门括约肌异常收缩

作     者：Karlbom U. Eeg-Olofsson K.E. Graf W. Phlman L. 廖新华 

作者机构：Department Surgical Sciences University Hospital SE-758 51 Uppsala Sweden.Dr 

出 版 物：《世界核心医学期刊文摘（胃肠病学分册）》 (Core Journals in Gastroenterology)

年 卷 期：2006年第2卷第3期

页      面：30-30页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：便秘患者 strain/squeeze 耻骨直肠肌 检验效能 排空障碍 肌肉活动 

摘      要：PURPOSE: One finding in patients with constipation is the paradoxical puborectalis contraction, i.e., activation of the sphincter muscles during straining instead of relaxation. The aims of this study were to evaluate the importance of needle placement in sphincter-electromyography and to evaluate a strain/squeeze index in constipated patients and control subjects. METHODS: We investigated consecutively 194 constipated patients and 16 control subjects with integrated electromyography during straining and squeezing and calculated a strain/squeeze index. The examination was performed in the puborectalis and in the external anal sphincter muscle through hook-electrodes. RESULTS: There was a strong correlation between indices in the puborectalis muscle and in the external anal sphincter muscle (r =0.70-0.80, P 0.001). Forty-seven patients (24 percent) had a mean index of greater than 50 compared with none in the control group (P = 0.01). Mean overall index in patients was 24 (range, 0-306) vs. 18 (range, 0-45) in controls (P = 0.12). Patients with an index greater than 50 had impaired rectal evacuation (P 0.001), increased threshold for urge (P 0.05), and tended to have fewer stools (P = 0.06). CONCLUSION: Quantification of paradoxical contraction in the puborectalis and external anal sphincter with a strain/squeeze index differentiates patients in whom paradoxical activity may be a cause of constipation. An index above 50 may be of pathologic significance. Correlations between activity in the puborectalis and external anal sphincter muscle were strong which suggests that investigation in one of them is sufficient.