便秘診治的相關(guān)概念及藥物選擇

便秘診治的相關(guān)概念及藥物選擇[1](Therelatedconceptsand

drugselectionofconstipationdiagnosisandtreatment[11)

PrimaryhealthcareinChina

2006

Augustth

Volume20

The8issue(general)

247issue)

Therelatedconceptsanddrugselectionofconstipation

diagnosisandtreatment

RcindyEresman

1.

Somemisconceptionsabouttheconceptanddiagnosisand

treatmentofconstipationwerediscussed

Combinedwithclinicalandrelatedliterature

Giveadescriptionofthenewestconceptofconstipation

Andyes

Diagnosis,treatmentanddrugselectionarediscussed

Inordertoimprovetheprofessionallevelofmedicaltreatment

andconstipationpatientsconsciousnessofhealthcare.

Keywordsconstipation;conception;medication;

[CLCnumber

]

R574.4

[documentidentificationcode

]B

[articlenumber

1001-568X(2006)08-0088-03

CorrelativeKnowledgein

Diagnosisand

Treatment

OfConstipation

And

RemedySelection/AI

Wei-min//Chinese

Primary

Healthcare,

2006,

20(8):88-90

Abstract

In

Order

To

Correct

Misunderstanding

In

Knowledge

Of

The

Definition,

The

Diagnosis

And

The

Treatment

Of

Constipation,

Some

Clinical

Data

Were

Analyzed,

And

Correlative

Literature

Were

Reviewed.

And

The

Advancement

In

The

Diagnosis

And

Treatment,

Include

Principlesof

Remedy

Selection,

Of

Constipation

In

Recent

Year

Swereexploredto

Improvetechnique

Of

Professional

Staff

Andto

Enlighten

The

Patient

On

Healthcare

Knowledge.

Key

Words

Constipation,

Definition,

Remedyselection

Author'saddress

The

ShaoxingSecondHospital

OfZhejangProvince,

Zhejiang,

Shaoxing,

312000,

China

ConstipationisacommonsymptominDepartmentofanus&

intestinesurgeryandevenintheoutpatientdepartmentof

gastroenterology.1definitionofconstipation

Withthedevelopmentofeconomy,thedeteriorationof

ecologicalenvironmentandthequickeningpaceofpeople'slife

Constipation,asweusuallycallit,isasymptomterm

Ratherthandiagnosticscientificnames

Inthebowelclinic,about

5%to10%peoplearetreatedwithconstipation.Stateside

Word.Inthis

In1999,theNationalSymposiumonnewprogressinconstipation

treatmentwasformulated

Annuallyaccountingfor

1.2%ofthepopulationisconstipatedbecauseofthedoctor

Thisproportionisintheprovisionalstandardforthe

diagnosisandtreatmentofnonwhiteconstipation,andZhang

Dongming

Bothin[Il,spelvicfloorandanaldiseases

Theincidencerateofhumanpopulationisrelativelyhigher

Ofthetotalpopulation

3%to4%.Itscharacteristicsaredescribed

Webelievethattheconceptofconstipationisdefinedmore

preciselybyProfessorZhangDongming

Itincreaseswithage

Thereweremorewomenpatientsthanmen

Poor,cold,andsimpleandeasytoremember.

Muchofthetrappedareasandremoteruralareas.

1.1constipation

Constipationisagroupofsymptomsassociatedwithfecal

dischargedisorders

Theimplicationsinclude

Shaoxingsecondhospital,Zhejiang,Zhejiang,Shaoxing

Province,China

312000(1)naturalreduction

Fecalexcretionisdifficult

(2)thetwohaveandsufferdiscomfort

Equaleffect.TCMtheoryholdsthatMailuoninghastheeffect

ofactivatingbloodcirculationtoremovebloodstasis

Anti-inflammatoryanddetoxifying

Supplementqiandbloodandsoon.Accordingtomodernmedicine,

Mailuoningcanimproveblood

Theliquidviscosityandhighcoagulationstate

Itcanincreasethefibrinolyticactivityinvivo

Reducecellaggregation

Set.Italsorelievesvasospasm

Dilatebloodvessel

Improvecirculation

Increaselocalblood

flow

Italsohasanticoagulantandthrombolyticeffects.

Xuesaitongisaneffectiveactiveingredientextractedfromthe

raremedicinalherb37

-three

Sevenpreparationoftotalsaponinpowder

Ithasthefunctionofenhancingthebody

Increasecerebralbloodflow

,expansion

Vascular

Reducearterialpressure

Reducemyocardialoxygenconsumption

Plateletaggregationresistance

Lowerplasmafibrinconcentration

Andenhancecellsurfacecharge

Reducebloodviscosityand

Bloodlipidsandothereffects.Relevantinformationindicates

that

37totalsaponinscandilatethecerebralvesselsdirectly

Changebloodrheology

Topreventthrombosisandpromotetheactionoffiber.

TostudytheeffectofMailuoningandXuesaitonginthe

treatmentofacutecerebralinfarction

Andwith

Thecontrolgroup,treatedwithMailuoningalone,received

clinicalefficacybeforeandaftertreatment

set

Compare

Efficacyofthe2groups.Resultsshow

The2groupsweretreatedwithtotalacutecerebralinfarction

Therewasnosignificantdifferenceinefficiency

However,MailuoningandXuesaitongcombinedtherapygroupwere

treated

Thebasiccurerateandefficiencyofacutecerebralinfarction

weresignificantlyhigherthanthoseofMailuoningalone

Group.Thusitcanbeseen

,Mailuoningandbloodplugwithcommunicationscan

significantlyimprovethenervefunctiondeficiency

damage

,improvebloodviscosityandhypercoagulablestate

Itcanincreasethefibrinolyticactivityinvivo

Reducecellaggregation

Relievevasospasm

Dilatebloodcamp

Improvemicrocirculation

Increase.

Localbloodflow

Anticoagulantandthrombolytic

Inhibitionofplateletaggregation

GaiShanhong

Celldeformability

Effectivelychangethebloodhyperviscositystatus

Loweringthecompensatoryelevation

protein

Cactivity

Cerebralmicrocirculationperfusionwasincreased

Itisthetreatmentofcerebralinfarctiontoimprovesurvival

Adrugofrelativelyhighquality.Itscurativeeffectis

obviouslysuperiortotraditionaltreatment

Ignorance

Significantadversereaction

Itisworthpopularizinginclinic.

Reference

1NationalFourthAcademicConferenceoncerebrovascular

diseases

Clinicalneurologicaldeficitsinpatientswithstroke

Gradingstandard

[J]

ChineseJournalofNeurology

1996,

29(6):381.

2HanJinan

Hu,rat

Thestudyoftheprotectiveeffectoftotalsaponinsof37on

ischemicbraininjury

exhibition

[J]

ChineseJournalofintegratedtraditionalandWesternMedicine

1996,

16(8):506.

3JinWu,TanFei,ZhangDeying

,etc.

37totalsaponinsoncerebralinfarction,brain,humanplasma,

egg

white

TheeffectofCactivity

[J].Journalofstrokeandneurologicaldiseases

1998,

15(2):121.

4YangXinghuai

MengGuangqin

ChenHaixia

,etc.

DefibraseandMailuoninginthetreatmentofacutecerebral

infarction

Comparison

[J]

ChineseJournalofnewdrugsandclinicalmedicine

1998,

17(5):299.

5HanJinan

Hu,rat

Theprotectiveeffectoftotalsaponinsof37onischemicbrain

injurywasstudied

exhibition

[J]

ChineseJournalofintegratedtraditionalandWesternMedicine

1996,

16(8):506.

6callsforXiaoFeng

Mailuoning!Addlightionforthetreatmentofcerebral

infarction

Clinicalanalysisof26cases

[J]

MiddleofZhejiang

JournalofWesternMedicine

2000,

10(2):82.

[Epub

2006-06-06]

(edit

(JinYan)

CHINESE

PRIMARYHEALTHCARE

Vol.20,

No.8

Aug,

Twothousandandsix

Eighty-eight

Therelatedconceptsanddrugselectionofconstipation

diagnosisandtreatment

-AiWeimin

Suchasabdominaldistension,nausea,anorexia,bilge,

defecationinsufficiency,moodirritabilityembolism.

1.2symptomsofconstipation

(1)constipation;

-lackofpleasureorease

-reducethenumberofnaturaldefecation

less

)；

(2)difficultdefecation

-butthedroppingsareexcreted

Thereispleasure,evenpleasure

Difficulties.

1.3definitionofnormalbowe1movement

[1]

Smoothdefecation

Thereisnopain

Shapingsoftstools

Noneedforlaxatives

Thinkso

Normaldefecation.

1.3.1naturaldefecationfrequency

6.03+2.41times

Aweek

(+S)thenormalvalueis

Two

second

Day3times

Week.

1.3.2defecationtime

:aftergettinguporafterbreakfastdefecationaccountedfor

42.1%,defecatenot

Timeroccupation

48.3%.

1.3.3

Fecalwetweightwasexcretedin24hours

(+S):malesare

Twohundredandninety-eightpointnine

G+132

G;

Femaleas

266.4+112.9

G.

1.3.4singledefecationtime

(+S):malesare

6.9+5.

4minutes

Forwomen

5.8+3.9minutes.

1.3.5thetimeofthefirstfecaldischarge

(+S):malesare

31+41seconds;female

For

43+58seconds.

1.3.6fecalblockdiameter

2.2+0.6

Cm.

Theabovefiguresarethenormaldefecationparametersof

Chinesepopulation

Diagnosisforclinicians

Andprovideguidelinesforpatientguidance.

2etiology

Therearemanyreasonsforconstipation

Andoftenthereisanoverlapofsymptoms

Imagetakingplace

Therefore

Atpresent,allkindsoftextbooksandmagazinesarethereasons

forconstipation

enterintoaspecifiedrelationship

Bisexual

Therearethreemajorcategories

2.1primaryandsecondary

2.1.1primarycause

(1)functional.Irritablebowelsyndromeandpelvicfloor

muscles

Maladjustment

Analspasm

Slowtransmissionlesions.(2)neurogenic.Congenitalanus

Pathologicalchangesofportalsphincter,congenitalmegacolon,

highgangliaandspinalcordinjuries.

(3)obstructive.Analstenosis,segmentalenteritis,tumor

compression,stenosis.(4)

Gynecologicalaspects.Rectocele,pelvicfloorrelaxation.

Secondarycausesof2.1.2

(1)connectivetissuedisease

Amyloidosis,systemic

Sclerosis.

(2)lifestyle.Dehydration,lackofdietaryfiber,andchronic

habituation

Sittingandartificiallysuppressingconstipation.

(3)drugform.Anticholinergic,anticonvulsant

Drugs,antidepressants,antihistamines,antipsychotics,and

drugsforthetreatmentofparalysis

Antacids,calciumchannelblockers,calciumsupplements,

diuretics,ironsupplements,andlaxative

agent

Longtermmisuse

)nonnestedanti-inflammatoryagentsandopiates.

(4)metabolism,

Endocrineaspects.Diabetes,heavymetalpoisoning,

hypercalcemia,hypokalemia,

Hypothyroidism,porphyria,uremia.

(5)nervousaspects.SelfGod

Disorders,multiplesclerosis,Parkinson'sdisease.

(6)psychologicalaspect,depressed

Symptoms,eatingdisorders,andmentalstress.

2.2,threecategories

2.2.1intestinalitselflesions

Theorganicorfunctionalnatureofthecolon,anus,orrectum

Disease

Tumors,inflammation,stenosis,congenitalmegacolon,atonyof

thecolon,etc.

2.2.2extraintestinallesions

Neurological,mental,endocrine,andmetabolicdiseases

Patient.

2.2.3dietandbadhabits

Coarsefiberinfood

Lesswater

Lackofforging

Refining,environmentalchanges

Neglectone'smind,mind,etc.

Intheabovedivision

Itwasemphasizedthatbeforethegastrointestinalexamination

wascarriedout

Identificationand

Essentialforthetreatmentofdisordersofthetissuesystem,

however

Constipationiscausedbyavarietyofreasons

Caused

Thereasonthatcausesconstipationinourclinicismostly

irritablebowelsyndrome

Thesyndrome

(IBS)forthefirstplace

Accountedfor.

59%,pelvicfloordysfunctionalone

25%;

Separateslowtransitconstipation

5%,pelvicfloordysfunctionandslowtransitconstipation

Mixedtypeaccountingfor

2%,mixedconstipationinpatientswithcolonicconstipation

99%

Above

[2].Havedata

[3]isright

Irritablebowelsyndrome,190case

(IBS)andothersnot;

Inastudyofpatientswithseriouscauses

There.

59%peopledefecateturbulent

chaos

27%sufferfromchronicconstipation

(STC),

6%ofthepeopleinfrontof

2diseasesconcurrently

Yes,otherwise

8%wereunabletodeterminethecauseofthedisease,this

8%ofthepeopleinourdevelopment

Statisticsofsecretclinicstatistics

Femaleandmentalfactorsaccountforthemajority.

3diagnosticproblems

Etiologicaldiagnosisisdirectlyrelatedtothetherapeutic

effect

Therefore

IntheprocessofAdmissions

Inadditiontoroutinemedicalhistoryandthenecessarymeans

ofexamination

Payattentiontothefollowingdetails

3.1pairsofpatientswhohavenosecondarycause

Colonoscopymustbegiven

Barium.

Enemaandflexiblesigmoidoscopy.Ifyouhavethefollowing

obvioussigns

Theweightloss,becauseofillness,thenightwokeupwitha

familysufferingfromcolonandhematochezia

Cancerpatient

Itindicatesorganiclesion.

3.2givingtreatmenttopatients

(therecanbelaxativesymptoms

Highfiberdiet

(ordietarysupplements)

Ifthereisnoeffect,orthepatienthasrecurrentconstipation

Thediseaseshouldbegiven

Peopledoextensiveexaminations.Forexample,gynecological

examinationoffemalepatients

Vasculardisease

Ischemic

).

DSAcheck,etc..

3/3ageandrelatedsymptoms

[4]:wherehastheacuteattacksymptom?

Age

Apatientwithconstipationoraggravatedsymptomsover50

yearsofage

Thisindicatestheoriginofthedisease

Becauseitisorganic.Inchildren,thereisaseizure

Indicatingthatitmaybecongenital

Amentalormentaldisorder.Ifyouhaverectalpainorurinary

stress,incontinencesymptoms

Itcouldbeadisorderofexcretion.

After3.4mealshavetheacheconvulsion,thebloating,the

abdominalpain,whenthebowelmovement,thestomachflatulence

slowsdown,

Mucusexcretionandconstipation,constipationanddiarrhea

occuralternately

Bothare

IBS

Performance

Asaresultof

IBSaccountsforconstipation

Morethan59%

Therefore,itisright

Judgmentisnecessary

Countthenumberofoccurrencesofthefollowingsymptoms

Canbeusedtojudge

Light,medium,heavy,varyingdegrees

IBS:(1)abdominalpaineasedafterdefecation

(2)frequency

Complicateddefecationaccompaniedbyabdominalpain

(3)abdominalpaincausedbysparsedefecation

(4)amucousline

(5)thereisasenseofnotbeingabletodoso

(6)therewasobviousabdominaldistension.

Thesymptomsarelessthandaily

2kindsofappearance

It'simpossibletosufferfromit

IBS;abovesymptoms

Everyday

2~3kindsofappearance

Moderateriskofsufferingfrom

IBS;everysymptomabove

Day

4or

Morethan4appear

Likelytosufferfrom

IBS.

Someunderstandingsof4diagnostictests

4.1acompletewholebloodcellexaminationandserum

electrolyte,bloodureanitrogen,promote

Thedeterminationofthyroidhormoneishelpfulforthe

judgementofthesecondarycauseofconstipation.

4.2,ifthereisnoabdominalpain,abdominaldistension

symptoms

Abdomen

Xrayphotographsareavailableindiagnosis

Useless.

4,3,whenevaluatingconstipation

Thereisnowaytoprovethatcolonoscopyisbetterthanbarium

enema

Goodeffect.

5treatmentoptionsanddrugs

5.1,theprincipleofconstipationmedication

Thevarietiesof5.1.1shouldbefewandrefined

Trytoavoidusingalaxative

Anthraquinones

Lessmedication.

5.1.2inpatientswithchronicconstipation

Medicationtimeshouldbelongandslow

Andwiththesymptoms

Theimprovementgraduallyreducesthedrugdose.

5.1.3canbeusedtoregulateintestinalfloraandrepair

intestinalmucosalcellfunction

Drugs

SuchasBeiFeida,GlutamineGranulesandsoon.

5.1.4afterstoppingalargeamountoflaxativeintake

Thepatientwants

4~6weeksafterrecovery

Normaldefecationfunction

Thepatientmustbeinformedduringthediagnosisand

treatment.

CHINESE

PRIMARYHEALTHCARE

Vol.20,

No.8

Aug,

Twothousandandsix

Therelatedconceptsanddrugselectionofconstipation

diagnosisandtreatment

-AiWeimin

5.1.5doesnothaveanyinstancestodemonstratethechoiceof

fiberlaxativeinconstipationtreatmentoverotherlaxative

5.4.2

[5]:seetheform

1.

Strongefficacy

Butbecauseitisgoodforthehealthofthebody

1choiceofconstipationtreatment

Andthesecurityused

Dosetypeforchronicconstipationpatients

Prooflevel

Itisreasonabletostartusingalaxative.

5.1.6lubricant,laxativeandmineraloilshallbeavoided

Use

Becausethesesubstancescancause1ipidinhalation

Pneumonia.SuchasDocusatesodiumthislubricatinglaxative.

Itsefficacyisquestionable

Andintherangeofconstipationcontrol

Alsosmaller,therefore

Itisrecommendedthatthereisnolaxativeinthefiber

When.

Usenormalsalinelaxativeandosmoticpass

Agent

Itisalsocalledvolumelaxative

).

5.2enemalaxativeuse

Enemalaxativecanstimulatecoloncontraction

Softening

Faeces

Common

:water,physiologicalsaline,soap

Liquid,highphosphate,mineraloil,etc..Butnotewhenyou

useit

Whattimewouldyou1ikeit?

5.2.1waterenema,laxativepronetowaterpoisoning

Thissituationismorecommoninchildren,childrenandelderly

groups.

Patientstreatedwith5.2.2phosphateenemaarepronetooccur

Hypercholesterolemia

Hypocalcemia

Shouldbecarefullyreused

Drugs,childrenunder3yearsolddisablethistreatment.

5.2.3patientswithfecalimpaction

Inadditiontovegetableoil

Extraintestinal

Doanabdominalarea

Xsheetstocheckif

Obstructivecondition.Ifthereisnoobstruction

CantakepolyB

glycol

8Lor

8Lmorethanpolyethyleneglycolcanpromote

Completeexcretion

Therefore

Relevantexpertssuggest

3times

/day

Takethemedicineorally

Tilldefecationbegins.

5.2.4laxativeisusedtonormalbowelhabits

Youcanstoptakingitforafewweeks.

5.3treatmentopportunity

Following

2itemsor

Howmanysymptomsdoyouhaveinmorethan2items?

Weeklong

Thatis,fortreatment

Lumpdung:

block

Difficultdefecation

Defecation

Analsensation

Senseofobstruction

Thefrequencyofdefecationwaslessthanoneweek

3times.

5.4clinicalcommonlyusedlaxativeandconstipationtreatment

options

Optional

Lifestyle

Addfluidfoodtoyourdiet

Increasefiberindiet

Moderateamountofphysicalexercise

Don'ttakelaxative

Fiberlaxative

wheatbran

Plantain

Methylcellulose

Calciumpolycarbophil

Physiologicallaxative

Magnesiumcitrate

magnesiumhydroxide

Permeablelaxative

polyethyleneglycol

Lactulose

sorbitol

Irritantlaxative

Castoroil

ThanShaKeding

Senna

Aloe

Enema

Waterflooding

Normalsaline

phosphate

mineraloil

suppository

Glycerine

Bisacodyl

Behaviortherapy

Biofeedback

Regulardefecationaftermeals

surgicaloperation

Avarietyofintractableconstipation

Mineralwater

Ediblefiber

Vague

Matamucil

Citrucel

Fibercon

Citroma

Milk

OfMagnesia

Miralax

Chronulac

Generic

Emulsoil

Dulcolax

Senokot

Generic

Generic

Fleets

Generic

Generic

Generic

Pelvicfloormuscletraining

breakfast

In15~20minutes.

Classifiedcolectomy

21/d

A

Twenty-five

G/dA

Vague

D

-D

Twenty

G/d

A

Seven

G/d

A

From4to6

G/d

A

From4to6

G/d

A

Twohundred

Ml/d

A

Twopointfour

G/d

A

Seventeen

G/d

A

Thirty

Ml/d

A

Twenty

G/d

A

15~16

Ml/d

A

Thirty

G/d

A

17~34

Mg/d

A

50~200

Ml/d

A

Fivehundred

Ml/d

D

Thirty

Mg/d

D

Onehundredandtwenty-sevenpointfiveseven

G/d

D

100^250

Ml/d

D

Ten

Mg/d

D

Three

G/dD

A

D

A

5.4.1commonlyusedlaxative

:(1)SiShahBilly

(5mg

Note:

FromA:

1casesor

Morethan1randomizedcontro