Kev nce qib hauv kev kuaj mob thiab kev kho mob ntawm tus mob plab hnyuv siab rau theem pib Ⅱ

Cov tsos mob ntawm cem quav tsis tu ncua feem ntau tsis yog tshwj xeeb, xws li cov quav tawv, qhov quav tsis tiav, qhov quav hauv plab, thiab lwm yam. Raws li cov txheej txheem kuaj mob zaum kawg ntawm Rome IV, kev kuaj mob cem quav ntev yuav tsum ua raws li 5 kauj ruam hauv qab no:

① keeb kwm kho mob;

② Kev kuaj lub cev;

③ ob peb qhov kev kuaj mob raws li qhov ua tau;

④ colonoscopy lossis lwm yam kev kuaj mob; pathophysiological mechanism.

Clinicians should first rule out organic diseases that can cause constipation, such as colorectal cancer, which are usually accompanied by some specific alarm signs, including blood in the stool, unexplained weight loss (>10% hauv 3 lub hlis), ua npaws, Tsev neeg keeb kwm ntawm mob qog noj ntshav lossis cov tsos mob tshiab tom qab hnub nyoog 50, thiab lwm yam.

Nyem rau ntawm Cistanche rau cem quav

(1) Kev kuaj mob keeb kwm thiab kuaj lub cev

Kev cem quav tuaj yeem ua rau muaj ntau yam kab mob lossis tshuaj, yog li kev txheeb xyuas qhov ua rau cem quav yog qhov tseem ceeb. Cov keeb kwm kho mob ntxaws ntxaws yuav tsum suav nrog lub sijhawm ntawm cov tsos mob, zaus ntawm lub plab zom mov, cov tsos mob cuam tshuam xws li mob plab, tsam plab, thiab nyem tom qab tso zis. Tsis tas li ntawd, nws yuav tsum muaj xws li tus nqi, cov duab, thickness, thiab kev siv zog ntawm qhov quav. Keeb kwm tshuaj, keeb kwm kev phais, keeb kwm kab mob, keeb kwm kev haus luam yeeb, thiab keeb kwm kev siv yeeb tshuaj kuj tseem cuam tshuam nrog qhov tshwm sim ntawm cem quav thiab yuav tsum tau suav nrog hauv keeb kwm kho mob.

Kev ntsuam xyuas lub qhov quav yog qhov tseem ceeb hauv kev ntsuam xyuas cov neeg mob cem quav, txiav tawm lub qhov quav loj lossis lwm yam ua rau muaj kev cuam tshuam (piv txwv li, qhov quav stenosis, qhov quav prolapse, intussusception), saib lub perineum thaum so thiab thaum lub sijhawm defecation, ntsuas qhov quav. muaj nuj nqi kuj tuaj yeem siv rau hauv kev kuaj mob ntawm pelvic pem teb tsis ua haujlwm. Cov kev tshawb fawb tau pom tias qhov rhiab heev ntawm kev kuaj lub qhov quav rau kev kuaj mob hauv plab hauv plab yog 75.9%, thiab qhov tshwj xeeb yog 87.0% [11].

(2) Laboratory kuaj

Ua ntej kuaj pom tus kab mob cem quav, nws yog ib qho tsim nyog yuav tsum ua cov thyroid ua haujlwm lossis kuaj ntshav calcium raws li keeb kwm kho mob thiab kuaj lub cev kom tsis suav nrog cov cem quav thib ob los ntawm lwm yam kab mob. Kev tshuaj ntsuam colonoscopy yuav tsum tau ua rau txhua tus neeg mob uas muaj lub tswb ceeb toom lossis hnub nyoog> 50 xyoo Tshawb xyuas kom tsis txhob muaj cov kab mob colonic obstructive lesions lossis inflammatory lesions. Cov kev tshawb fawb pom xws li barium rectal thiab magnetic resonance defecography kuj tseem pab tau rau kev kuaj mob anorectal dysfunction (kev sib koom tes defecation disorder) thiab anatomical abnormalities.

(3) Anorectal function test

Muaj ntau qhov sib tshooj hauv cov tsos mob qhia ntawm ntau yam subtypes ntawm cem quav. Hauv kev kho mob, kev txiav txim siab qhov chaw kho mob phenotype tsis yog qhov tseem ceeb, tab sis cov neeg mob uas tsis teb rau qhov tsim nyog empiric txoj kev kho (xws li, fiber supplementation, osmotic laxatives) yuav tsum tau mus rau kev ntsuam xyuas los txheeb xyuas cov subtypes ntawm cem quav. Kev txheeb xyuas cov subtypes tuaj yeem ua rau txoj hauv kev rau kev kho mob thiab kev kwv yees, tshwj xeeb tshaj yog nyob rau hauv cov xwm txheej uas kev kho thawj kab tsis ua tiav.

1. Kev sim ntsuas lub zais pa: Kev ntsuas lub zais pa tshem tawm yog qhov yooj yim thiab txhim khu kev qha, thiab tuaj yeem siv rau kev kuaj mob ntawm qhov quav khoob qhov quav [12]. Nyob rau tib lub sijhawm, txoj kev no muaj qee qhov kev txwv, xws li tsis tuaj yeem paub qhov txawv ntawm kev ua haujlwm thiab lub cev ua rau lub plab khoob, thiab cov txiaj ntsig txawv txav yuav tsum tau kuaj ntxiv; cov txiaj ntsig ib txwm tsis suav nrog tag nrho pelvic pem teb cov leeg nqaij contraction kev sib koom ua haujlwm tsis zoo tuaj yeem ua tau.

2. Colonic/anorectal manometry: Pa anorectal manometry thiab high-resolution anorectal manometry yog physiological txoj kev los ntsuam xyuas so thiab cog lus qhov quav sphincter tone, recto-anal reflex, rectal sensation, thiab siab hloov thaum lub sij hawm defecation. Kev ntsuam xyuas los pab txheeb xyuas qhov quav thiab lub plab hauv plab pelvic los yog qhov txawv txav ntawm qhov quav. Lub siab anorectal gradient tuaj yeem siv los ua qhov qhia tau zoo rau kev kuaj mob defecation dyssynergia, tab sis muaj qhov sib tshooj loj hauv txhua qhov kev ntsuas anorectal ntawm cov neeg mob cem quav thiab cov neeg ua haujlwm noj qab haus huv, yog li qhov kev kuaj mob tag nrho ntawm cov txheej txheem nws tus kheej raug txwv [13], thiab yuav tsum tau ua ke nrog cov ntsuas ntsuas (keeb kwm kho mob, kuaj lub cev). Colonic manometry tuaj yeem ntsuas kev hloov pauv hauv lub siab hauv plab hauv lub xeev so thiab tom qab stimulation los ntawm zaub mov thiab tshuaj. Cov neeg mob uas muaj kev cuam tshuam qeeb qeeb uas tsis teb zoo rau kev kho tshuaj yuav raug txiav txim siab rau colonic manometry. Txawm li cas los xij, vim qhov nyuaj ntawm kev siv cov qauv no thiab qhov sib txawv ntawm cov plab hnyuv siab raum, tam sim no tsis muaj tus qauv tseeb, thiab nws tsuas yog siv los ua cov cuab yeej tshawb fawb es tsis yog cov khoom kuaj mob.

3. Colonic transit test: colonic transit test tuaj yeem kuaj tau ntau txoj hauv kev, thiab txoj kev siv ntau tshaj plaws hauv kev kho mob yog kev kuaj pom cov cim radiopaque. Qhov kev ntsuas ntsuas tag nrho lub sijhawm hla txoj hnyuv, tsis yog lub sijhawm hla colonic, txawm hais tias tom kawg suav rau qhov loj tshaj plaws ntawm tag nrho cov hnyuv hauv lub sijhawm. Txoj kev yooj yim tshaj plaws thiab siv dav tshaj plaws hauv kev kho mob yog txoj kev Hinton: tus neeg mob siv 1 capsule uas muaj 20-24 radiopaque markers nyob rau tib hnub, thiab tom qab ntawd siv 1 lub plab x-ray hnub 5. Yog tias ntau tshaj 20% ntawm cov cim tseem nyob, nws tuaj yeem kuaj tau tias kev thauj mus los qeeb qeeb; Yog hais tias qhov seem seem yog concentrated nyob rau hauv lub qhov quav, nws yuav kuaj tau raws li qhov hluav taws xob obstruction cem quav. Cov txheeb ze yooj yim, tus nqi qis, thiab kev muaj dav dav yog cov yam ntxwv zoo tshaj plaws ntawm kev kuaj pom radiopaque, tseem ua rau muaj hluav taws xob ntau dua thiab mus ntsib tsev kho mob ntxiv.

Scintigraphy kuj tseem siv tau los ntsuas lub sijhawm caij tsheb thauj mus los. Txoj kev no yuav tsum muaj kev tswj hwm qhov ncauj ntawm cov xov tooj cua isotopes nrog ntev ib nrab-lub neej xws li 111In lossis 99Tc, thiab nuclide imaging yog ua raws li lub sijhawm, txhawm rau xam lub sijhawm dhau los ntawm qee qhov hnyuv. Txawm hais tias txoj kev no tuaj yeem kuaj xyuas lub sijhawm hla ntawm txhua ntu ntawm txoj hnyuv, nws yog qhov kim thiab nyuaj rau kev nrov ntawm theem no.

Lwm txoj hauv kev txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau txhawm rau tshem tawm nws, nws yog ib qho tsim nyog yuav tsum kuaj xyuas cov kab mob hauv lub plab zom mov, uas tuaj yeem ntsuas pH, qhov siab, thiab qhov kub thiab txias ntawm tag nrho cov plab hnyuv siab raum los ntawm cov tshuaj ntsiav wireless los ntsuas qhov kev ua haujlwm ntawm txoj hnyuv. Cov tshuaj ntsiav kuj tseem tuaj yeem kuaj xyuas qhov loj ntawm qhov kev cog lus raws GI ib puag ncig, tab sis tsis yog qhov kev taw qhia ntawm nws qhov kev nthuav tawm. Tam sim no, txoj kev no tau pom zoo los ntawm Asmeskas thiab European lub plab zom mov thiab lub paj hlwb rau kev tshawb pom ntawm cov kab mob colonic transit [14].

Ntuj Herbal Tshuaj Rau Relieving cem quav-Cistanche

Cistanche yog ib tug genus ntawm parasitic nroj tsuag uas belongs rau tsev neeg Orobanchaceae. Cov nroj tsuag no paub txog lawv cov khoom siv tshuaj thiab tau siv hauv Cov Tshuaj Suav Tshuaj (TCM) rau ntau pua xyoo. Cov hom Cistanche feem ntau pom muaj nyob hauv thaj av qhuav thiab suab puam ntawm Tuam Tshoj, Mongolia, thiab lwm qhov chaw ntawm Central Asia. Cistanche nroj tsuag yog tus cwj pwm los ntawm lawv cov nqaij tawv, yellowish stems thiab muaj nuj nqis heev rau lawv cov txiaj ntsig kev noj qab haus huv. Hauv TCM, Cistanche ntseeg tau tias muaj cov khoom siv tonic thiab feem ntau yog siv los kho lub raum, txhim kho qhov tseem ceeb, thiab txhawb kev ua haujlwm ntawm kev sib deev. Nws kuj yog siv los daws cov teeb meem ntsig txog kev laus, qaug zog, thiab kev noj qab haus huv tag nrho. Thaum Cistanche muaj keeb kwm ntev ntawm kev siv tshuaj ib txwm siv, kev tshawb fawb tshawb fawb txog nws txoj kev ua tau zoo thiab kev nyab xeeb yog tsis tu ncua thiab txwv. Txawm li cas los xij, nws paub tias muaj ntau yam bioactive tebchaw xws li phenylethanoid glycosides, iridoids, lignans, thiab polysaccharides, uas tuaj yeem ua rau nws cov teebmeem tshuaj.

Wecistanche covcistanchehmoov, cistanchentsiav tshuaj, cistanchetshuaj ntsiav, thiab lwm yam khoom tsim los sivsuab puamcistancheraws li cov khoom siv raw, txhua yam muaj txiaj ntsig zoo rau kev tshem tawm cem quav. Cov txheej txheem tshwj xeeb yog raws li hauv qab no: Cistanche ntseeg tau tias muaj cov txiaj ntsig zoo rau kev tshem tawm cem quav raws li nws cov kev siv ib txwm siv thiab qee cov tshuaj uas nws muaj. Txawm hais tias kev tshawb fawb tshawb fawb tshwj xeeb ntawm Cistanche qhov cuam tshuam rau cem quav yog txwv, nws tau xav tias muaj ntau lub tswv yim uas yuav ua rau nws muaj peev xwm txo tau cem quav. Laxative nyhuv:Cistanchetau ntev tau siv nyob rau hauv tsoos suav tshuaj raws li ib tug tshuaj rau cem quav. Nws ntseeg tau tias muaj cov nyhuv laxative me me, uas tuaj yeem pab txhawb kev zom zaub mov thiab ua rau cem quav. Cov nyhuv no tuaj yeem raug ntaus nqi rau ntau lub tebchaw nyob hauv Cistanche, xws li phenylethanoid glycosides thiab polysaccharides. Moistening cov hnyuv: Raws li kev siv ib txwm siv, Cistanche suav hais tias muaj cov khoom siv moisturizing, tshwj xeeb yog tsom rau cov hnyuv. Los ntawm kev txhawb hydration thiab lubrication ntawm cov hnyuv, nws yuav pab tau soften cov cuab yeej thiab pab kom yooj yim dua, li no relieving cem quav. Anti-inflammatory Effect: cem quav tej zaum yuav txuam nrog o nyob rau hauv lub plab zom mov. Cistanche muaj qee qhov sib txuas, suav nrog phenylethanoid glycosides thiab lignans, uas ntseeg tau tias muaj cov tshuaj tiv thaiv kab mob. Los ntawm kev txo cov kab mob hauv cov hnyuv, nws tuaj yeem pab txhim kho kev zom zaub mov tsis tu ncua thiab txo qhov cem quav.