Boston V E, Cywes S, Davies M R
Gut. 1977 Dec;18(12):1036-44. doi: 10.1136/gut.18.12.1036.
One-hundred-and-one normal neonates were examined manometrically in the first day of life to assess anorectal function. In order to overcome some of the difficulties in subjective interpretation of results, the stimuli used and the response pattern seen in the anal canal were measured. In the unstimulated state, all subjects demonstrated rhythmical changes in anal canal tone. Mean maximal intraluminal pressure in the anal canal decreased significantly after 10 hours of age and after the first meconium stool. Only five out of the 101 examined on the first day of life had an abnormal manometric response. It is significant that none of these had passed meconium at the time of examination, and that all had a normal response pattern at the age of 28 hours. In 20 of these babies the sensitivity of the rectoanal reflex was measured and found to be significantly increased on the third day of life compared with the first. The quantitative changes in anorectal reflex function in the newborn, are thought to be related to the state of physiological ;constipation' which exists in utero and in the early neonatal period. The results indicate that a normal response pattern can be obtained in healthy babies after the first day of life. Consequently, anorectal manometry will be meaningful as a diagnostic method thereafter in the neonatal period. Further, it is suggested that measurement of the stimulus and the response will add useful information and reduce subjective error in interpretation of results.
101名正常新生儿在出生第一天接受了测压检查，以评估肛门直肠功能。为了克服结果主观解读中的一些困难，对所使用的刺激以及肛管内观察到的反应模式进行了测量。在未受刺激状态下，所有受试者的肛管张力均呈现节律性变化。肛管内平均最大腔内压力在出生10小时后及首次排出胎便后显著下降。在出生第一天接受检查的101名新生儿中，只有5名测压反应异常。值得注意的是，这些异常的新生儿在检查时均未排出胎便，且在28小时龄时均具有正常的反应模式。对其中20名婴儿的直肠肛门反射敏感性进行了测量，发现与出生第一天相比，出生第三天时显著增强。新生儿肛门直肠反射功能的定量变化被认为与子宫内及新生儿早期存在的生理性“便秘”状态有关。结果表明，出生第一天后健康婴儿可获得正常的反应模式。因此，此后在新生儿期，肛门直肠测压作为一种诊断方法将具有意义。此外，建议对刺激和反应进行测量将增加有用信息并减少结果解读中的主观误差。
