Thomas G P, Duelund-Jakobsen J, Dudding T C, Bradshaw E, Nicholls R J, Alam A, Emmanuel A, Thin N, Knowles C H, Laurberg S, Vaizey C J
The Sir Alan Parks Department of Physiology, St Mark's Hospital and Academic Institute, Harrow, UK.
Department of Surgical Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
Colorectal Dis. 2015 Nov;17(11):990-5. doi: 10.1111/codi.12982.
Sacral nerve stimulation (SNS) may be offered to patients with constipation who have failed to improve with conservative treatment. The response to SNS is variable, with a significant loss of efficacy in some patients. An increased frequency of stimulation may improve the efficacy of SNS for faecal incontinence. This study aimed to see if alteration of the pulse width or frequency improved the outcome for those with constipation.
Eleven patients with constipation currently being treated by SNS were recruited from three centres. They were randomized to five different protocols of stimulation each applied for 5 weeks. Group 1 used standard settings (pulse width 210 μs, frequency 14 Hz); in the other four groups (Groups 2-5) the pulse width and/or frequency were halved or doubled. Patients and investigators were blinded to the group allocation.
The Cleveland Clinic constipation score varied significantly between the five groups. Group 1 achieved the lowest score mean (± SD) 13.4 (± 4.4) (P = 0.03). The number of digitations per defaecation was the lowest in Group 4, 90 μs and 14 Hz (P < 0.01). No other variable changed significantly. Standard settings were the most preferred by the recruited patients.
Alteration of pulse width or frequency of stimulation had no significant effect on the outcome of SNS for constipation.
对于经保守治疗后病情仍未改善的便秘患者，可考虑给予骶神经刺激（SNS）治疗。SNS的反应因人而异，部分患者会出现明显的疗效丧失。增加刺激频率可能会提高SNS治疗大便失禁的疗效。本研究旨在探讨改变脉冲宽度或频率是否能改善便秘患者的治疗效果。
从三个中心招募了11名正在接受SNS治疗的便秘患者。他们被随机分为五种不同的刺激方案，每种方案应用5周。第1组采用标准设置（脉冲宽度210μs，频率14Hz）；在其他四组（第2 - 5组）中，脉冲宽度和/或频率减半或加倍。患者和研究人员对分组情况不知情。
五组之间克利夫兰诊所便秘评分差异显著。第1组的平均评分最低（±标准差）为13.4（±4.4）（P = 0.03）。排便时手指辅助排便次数在第4组（90μs和14Hz）中最低（P < 0.01）。其他变量均无显著变化。招募的患者最喜欢标准设置。
改变刺激的脉冲宽度或频率对SNS治疗便秘的效果没有显著影响。
