Han T R, Kim J H, Kwon B S
Department of Rehabilitation Medicine, Seoul National University College of Medicine, Korea.
Spinal Cord. 1998 Jul;36(7):485-90. doi: 10.1038/sj.sc.3100616.
Amongst complications arising from spinal cord injury (SCI), chronic gastrointestinal (G-I) problems and bowel dysfunction have not received as much research attention as many other medical and rehabilitation problems, even although their incidence is not negligible. We therefore investigated chronic G-I problems and bowel dysfunction in SCI patients where the degree of these was such that activities of daily living (ADL) were significantly affected and/or long-term medical management was required. Detailed semi-structured individual interviews were conducted with 72 traumatic SCI patients. The history of SCI was longer than 6 months, bowel habits had settled, and neurological recovery was completed. The incidence of chronic G-I problems was very high (62.5%), most were associated with defecation difficulties such as severe constipation, difficult with evacuation, pain associated with defecation, or urgency with incontinence. These problems had an extensive impact on ADL, and in particular, restricted diet (80%), restricted outdoor ambulation (64%) and caused unhappiness with bowel care (62%). Bowel care was performed once per 2.85 +/- 1.96 days and occupied an average of 42.1 +/- 28.7 min. To improve bowel habits, 43% of the patients took oral medication, and 36.1% controlled their diet. The usual methods of bowel care were anal massage (34.7%), unaided self-defecation with or without oral medication and abdominal massage (29.2%), finger enema (18.1%), rectal suppository (15.2%) and in two patients a colostomy tube had been inserted because of rectal cancer and traumatic colorectal injury. These chronic G-I symptoms were vague and very subjective, but significant enough to affect the quality of life. Bowel dysfunction was not related to age, duration of, or the neurological level of injury, ASIA score of ADL level, and bowel habits had generally settled within 6 months of SCI. With regard to frequency, time, and method of defection, bowel care habits varied considerably amongst individuals, and in relation to the extent to which practical results matched the level of expectation generated by physicians' recommended care program. Individual satisfaction was also very subjective. We therefore suggest that during the early stage of rehabilitation, an appropriate bowel program should be properly designed and adequate training provided.
在脊髓损伤（SCI）引发的并发症中，慢性胃肠道（G-I）问题和肠道功能障碍并未像许多其他医学及康复问题那样受到同等程度的研究关注，尽管其发病率不容小觑。因此，我们对SCI患者中慢性G-I问题和肠道功能障碍展开了调查，这些患者的此类问题严重影响了日常生活活动（ADL）且/或需要长期医疗管理。我们对72例创伤性SCI患者进行了详细的半结构化个人访谈。SCI病史超过6个月，排便习惯已稳定，神经功能恢复已完成。慢性G-I问题的发生率非常高（62.5%），大多数与排便困难相关，如严重便秘、排便困难、排便疼痛或急迫性尿失禁。这些问题对ADL产生了广泛影响，尤其是限制饮食（80%）、限制户外行走（64%）并导致对肠道护理不满意（62%）。肠道护理每2.85±1.96天进行一次，平均耗时42.1±28.7分钟。为改善排便习惯，43%的患者服用口服药物，36.1%的患者控制饮食。常用的肠道护理方法包括肛门按摩（34.7%）、借助或不借助口服药物及腹部按摩的自主排便（29.2%）、手指灌肠（18.1%）、直肠栓剂（15.2%），有两名患者因直肠癌和创伤性结直肠损伤插入了结肠造口管。这些慢性G-I症状模糊且非常主观，但严重到足以影响生活质量。肠道功能障碍与年龄、损伤持续时间、损伤神经平面、ADL水平的ASIA评分无关，排便习惯通常在SCI后的6个月内稳定下来。在排便频率、时间和方法方面，个体的肠道护理习惯差异很大，且实际效果与医生推荐护理方案所产生的期望水平的匹配程度也存在差异。个体满意度也非常主观。因此，我们建议在康复早期，应妥善设计合适的肠道方案并提供充分的训练。
