Effect of biofeedback treatment on the clinical efficacy in patients with different subtypes of functional defecation disorders
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摘要: 目的 探讨生物反馈治疗对不同亚型功能性排便障碍患者临床疗效的影响。方法 收集120例功能性排便障碍患者，其中不协调性排便(F3a)和排便推进不足(F3b)2个亚型各60例。每个亚型再随机将患者分为常规组和生物反馈组，各30例。常规组采用聚乙二醇4000散剂治疗4周，生物反馈组采用短期生物反馈强化治疗方案治疗4周，比较各组患者临床症状、焦虑自评量表(SAS)、抑郁自评量表(SDS)、中文版患者便秘状况评估问卷(PAC-QOL)评分、肛门直肠动力、感觉变化。结果 治疗后，F3a型生物反馈组和F3a型常规组，F3b型生物反馈组和F3b型常规组比较，临床症状积分、SAS分值、SDS分值、PAC-QOL评分、直肠最低敏感量、最大耐受量、直肠顺应性、肛门括约肌压力均较低(均P< 0.05)，直肠静息压的差异无统计学意义(均P>0.05)，而F3a型生物反馈组与F3b型生物反馈组比较，各项指标的差异均无统计学意义(均P>0.05)。此外，F3a型和F3b型生物反馈组治疗后分别与治疗前比较，常规组治疗后分别与治疗前比较，临床症状积分、SAS分值、SDS分值、PAC-QOL评分、直肠最低敏感量、最大耐受量、直肠顺应性和肛门括约肌压力均显著降低(均P< 0.01)，直肠静息压的差异无统计学意义(均P>0.05)。结论 生物反馈治疗能改善F3a型和F3b型功能性排便障碍患者临床症状、心理状况、生活质量及肛门直肠生理功能，且均优于常规治疗，对2个亚型疗效影响相差不大。Abstract: Objective To investigate the effect of biofeedback treatment on the clinical efficacy in patients with different subtypes of functional defecation disorders.Methods A total of 120 patients with functional defecation disorders were collected, including 60 non coordinated defecation(F3a) subtype and 60 the lack of promoting defecation(F3b) subtype. For each subtype, the patients were randomly divided into conventional treatment group and biofeedback group, 30 cases in each group. The conventional group was treated with Macrogol 4000 powder for oral solution for 4 weeks. And the biofeedback group used a short-term biofeedback intensive treatment plan for 4 weeks. The changes of the clinical symptoms, self-rating anxiety scale(SAS), self-rating depression scale(SDS), Chinese version of the patient assessment of constipation quality of life questionnaire(PAC-QOL), anorectal motility and anorectal sensation were compared.Results After treatment, F3a subtype biofeedback group compared with F3a subtype routine group, F3b subtype biofeedback group compared with F3b subtype routine group, the clinical symptom score, SAS score, SDS score, PAC-QOL score, minimum rectal sensitivity, maximum rectal tolerance, rectal compliance and anal sphincter pressure were significantly decreased(allP< 0.05), the difference in rectal resting pressure was not statistically significant(allP>0.05), whereas F3a subtype biofeedback group compared with F3b subtype biofeedback group, the differences in the above indicators were not statistically significant(allP>0.05). In addition, compared with F3a subtype biofeedback group before treatment, the clinical symptom score, SAS score, SDS score, PAC-QOL score, minimum rectal sensitivity, maximum rectal tolerance, rectal compliance and anal sphincter pressure were noticeably reduced in F3a type biofeedback group after treatment(allP< 0.01), whereas rectal resting pressure did not reach statistical significance before and after Infliximab treatment(allP>0.05). The same conclusion was drawn from F3a subtype routine group, F3b subtype biofeedback group, F3b subtype routine group.Conclusion Our findings suggested that biofeedback treatment could ameliorate the symptoms, psychological condition, living standard and anorectal physiological functions in patients with F3a subtype and F3b subtype of functional defecation disorders, which was better than conventional treatment, and the effect of the two subtypes was similar.
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Key words:
- biofeedback /
- functional defecation disorder /
- clinical efficacy
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表 1 FDD患者治疗前后的有效率比较
例 组别 例数 治愈 显效 有效 无效 总有效/例(%) P F3a型 0.030 常规组 30 11 6 5 8 22(73.33) 生物反馈组 30 16 9 4 1 29(96.67) F3b型 0.006 常规组 30 10 7 4 9 21(70.00) 生物反馈组 30 14 11 4 1 29(96.67) 注：FDD为功能性排便障碍；F3a为不协调性排便；F3b为排便推进不足。 
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表 2 不同亚型FDD患者治疗前后临床症状积分、SAS分值、SDS分值、PAC-QOL比较
分，X±S 组别 临床症状积分 SAS分值 SDS分值 PAC-QOL评分 F3a型生物反馈组 治疗前 9.57±1.63 52.17±5.02 56.03±4.90 94.77±6.99 治疗后 5.17±2.071)2) 38.93±4.231)2) 43.27±4.651)2) 68.90±5.061)2) F3a常规组 治疗前 9.60±1.71 51.50±4.75 55.60±5.04 95.00±7.19 治疗后 7.07±1.891) 42.93±4.981) 48.23±4.631) 78.30±5.291) F3b型生物反馈组 治疗前 8.90±1.35 53.10±4.56 54.80±5.13 95.13±7.69 治疗后 4.37±1.591)2) 39.87±4.951)2) 42.67±5.161)2) 69.17±5.381)2) F3b型常规组 治疗前 9.47±1.63 52.47±5.07 55.60±4.79 94.67±6.96 治疗后 6.37±1.811) 43.03±4.681) 49.43±4.801) 79.53±5.531) 与同组治疗前比较，1)P < 0.01；与同亚型常规组治疗后比较，2)P < 0.01。
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表 3 不同亚型FDD患者治疗前、后肛门直肠动力、感觉指标比较
X±S 组别 直肠最低敏感量/mL 直肠最大耐受量/mL 直肠顺应性/(mL·mmHg-1) 直肠静息压/kPa 肛门括约肌压力/kPa F3a型生物反馈组 治疗前 195.27±11.51 279.40±19.26 39.30±2.74 1.39±0.08 5.90±0.38 治疗后 170.33±17.281)2) 235.17±21.721)2) 32.23±2.031)2) 1.39±0.06 5.15±0.301)2) F3a常规组 治疗前 193.20±10.28 278.13±22.15 38.60±2.24 1.39±0.06 5.91±0.39 治疗后 181.57±13.201) 253.33±20.611) 35.03±2.911) 1.39±0.08 5.43±0.391) F3b型生物反馈组 治疗前 193.57±10.63 278.03±21.15 38.73±2.20 1.38±0.06 5.88±0.38 治疗后 169.47±16.051)2) 236.77±25.841)2) 31.37±2.251)2) 1.37±0.06 5.14±0.291)2) F3b型常规组 治疗前 196.40±9.71 276.53±29.11 39.50±2.52 1.39±0.07 5.85±0.37 治疗后 179.90±11.311) 250.17±21.111) 36.07±1.981) 1.39±0.07 5.45±0.411) 注：1 mmHg=0.133 kPa。与同组治疗前比较，1)P < 0.01；与同亚型常规组治疗后比较，2)P < 0.01。
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