Osatakul Seksit, Boonviriya Sopa, Saengnil Sulee, Ovartlarnporn Bancha
J Med Assoc Thai. 2016 Dec;99(12):1291-7.
To date, there have been no studies to evaluate the influence of posture on anorectal manometric measurements in patients with functional constipation. The present study aimed to compare differences in anorectal manometric measurements in constipated patients when performing the test in the lying and sitting positions.
Anorectal manometry with a conventional solid state manometric catheter was performed in 30 constipated patients in both the lying and sitting positions. Anorectal manometric variables at rest and during attempted defecation with empty rectum were assessed in both positions. A colonic transit study using Sitzmarks radiopaque markers and a 50-mL water-filled balloon expulsion test was also performed in all patients. Patients exhibiting an abnormal manometric pattern of defecation in either the sitting or lying position proceeded to a simulated defecation test. The anorectal pressure parameters of resting and during attempted defecation of the both positions were compared.
The resting rectal pressure, maximum rectal straining pressure, and defecation index during attempted defecation were significantly higher in the sitting position than the lying position. A dyssynergic manometric pattern during attempted defecation with empty rectum was seen in 46% of the patients in the lying position, not significantly different from the 56% in the seated position (p = 0.58). Most patients (71%) who exhibited manometric dyssynergia with an empty rectum could relax their anal sphincter during the simulated defecation test. Only six (20%) constipated patients had abnormal dyssynergic anal sphincter contraction confirmed by a simulated defecation test.
Body position affects the results of manometric measurements related to the defecation mechanism.
迄今为止，尚无研究评估姿势对功能性便秘患者肛门直肠测压测量结果的影响。本研究旨在比较便秘患者在仰卧位和坐位进行测试时肛门直肠测压测量结果的差异。
对30例便秘患者在仰卧位和坐位时均使用传统固态测压导管进行肛门直肠测压。评估两个体位下静息时以及直肠排空时模拟排便过程中的肛门直肠测压变量。所有患者还进行了使用 Sitzmarks 不透X线标志物的结肠传输研究和50毫升充水球囊排出试验。在坐位或仰卧位表现出异常排便测压模式的患者进行模拟排便试验。比较两个体位下静息时和模拟排便时的肛门直肠压力参数。
坐位时静息直肠压力、最大直肠用力压力和模拟排便时的排便指数显著高于仰卧位。仰卧位46%的患者在直肠排空时模拟排便过程中出现不协调测压模式，与坐位的56%无显著差异（p = 0.58）。大多数直肠排空时表现出测压不协调的患者（71%）在模拟排便试验中能够放松肛门括约肌。只有6例（20%）便秘患者经模拟排便试验证实存在异常的不协调肛门括约肌收缩。
体位会影响与排便机制相关的测压测量结果。
