Kev kho mob cem quav hauv cov neeg laus

Thawj kauj ruam hauv kev kho mob cem quav ntev yog los kho koj txoj kev ua neej thiab kev noj haus.

Volume laxatives raug pom zoo rau cov neeg mob uas tsis teb rau txoj kev ua neej thiab kev hloov pauv kev noj haus. Cov neeg mob uas tsis teb rau qhov ntim tshuaj laxative yuav tsum xav txog kev sim osmotic laxative. Hauv cov neeg mob uas tau ua tsis tiav kev sim ntawm osmotic laxatives, yuav tsum tau txiav txim siab rau lub plab zais cia (lubiprostone).

Stimulant laxatives yog cov tshuaj siv tau zoo tab sis yuav tsum tsis txhob siv mus ntev vim tias lawv txoj kev nyab xeeb rau kev siv mus ntev hauv cov neeg laus tsis paub.

Nyem rau cov tshuaj hauv tsev rau cem quav

Cov quav mos thiab cov tshuaj suppositories (glycerin los yog bisacodyl) muaj kev siv tshuaj kho mob tsawg.

Enema yuav tsum tau siv tsuas yog rau cov neeg mob uas cem quav rau ob peb hnub los tiv thaiv fecal impaction.

Opioid antagonists yuav muaj lub luag haujlwm hauv kev kho mob ntawm narcotic-induced cem quav thiab tuag tes tuag taw ileus. Rau cov neeg uas defecation dyssynergia (DD), biofeedback kho tej zaum yuav pab tau.

1. Kho koj lub neej

Kev ntsuas dav dav (xws li kev haus dej ntau ntxiv thiab kev tawm dag zog) raug pom zoo los kho cem quav, tab sis muaj pov thawj tsawg los txhawb txoj hauv kev no. Ib qho kev tshawb fawb me me ntawm cov neeg ua haujlwm pab dawb tau pom tias kev haus dej ntxiv tsis cuam tshuam nrog cov quav tso zis ntau ntxiv.

Nws yog ib qho tsim nyog los txhawb cov neeg mob kom tsim kom muaj lub plab zom mov tsis tu ncua. Feem ntau cov neeg mob uas ua rau lub plab zom mov feem ntau muaj lub plab zom mov nyob ib ncig ntawm tib lub sijhawm txhua hnub.

Qhov tseeb no qhia tau hais tias qhov pib ntawm qhov defecation yog ib feem ntawm kev kho mob reflex. Colon motility muaj zog dua thaum sawv ntxov thiab tom qab noj mov. Yog li ntawd, lub sij hawm zoo tshaj plaws rau kev tso quav yog feem ntau tsis pub dhau 2 teev tom qab sawv thiab noj tshais.

Lwm qhov kev ntsuas dav dav suav nrog kev npaj tso quav tso quav, uas suav nrog kev qhia tus neeg mob kom sim tso quav tsawg kawg ob zaug hauv ib hnub, feem ntau 30 feeb tom qab noj mov thiab kom tsis txhob tso quav rau ntau tshaj 5 feeb.

Kev ua pa ntawm plab thiab lub cev lub cev kuj tuaj yeem cuam tshuam rau kev txhawb nqa thiab kev yooj yim ntawm kev zom zaub mov.

Cov kev ntsuas muaj xws li zaum ncaj, tig mus rau pem hauv ntej, thiab tsa taw 8 mus rau 12 ntiv tes tawm hauv pem teb.

2. Kev noj haus thiab fiber ntau

Fiber ntxiv ntau rau cov quav, uas tuaj yeem ua rau cov hnyuv loj thiab pab cov quav propulsion. Nws feem ntau pom zoo kom haus 20-25g / d ntawm fiber ntau.

Nws yuav siv sij hawm ob peb lub lis piam rau qhov ua rau lub plab zom mov ntawm fiber ntau los ua haujlwm.

Bloating thiab flatulence yog cov teeb meem tshwm sim nrog kev noj fiber ntau.

3. Laxatives

Kev siv cov tshuaj laxatives hauv cov neeg laus yuav tsum tau hais txog ntawm tus kheej, ua tib zoo mloog tus neeg mob keeb kwm kev kho mob (mob plawv thiab lub raum kab mob), kev sib cuam tshuam tshuaj, nqi tshuaj, thiab kev phiv.

ntim laxative

Volume laxatives muaj xws li psyllium husk (piv txwv li, Metamucil), methylcellulose (xws li, Citrucel), calcium polycarbophil (xws li, FiberCon), thiab nplej dextrin (xws li, Benefiber).

Lawv yog ntuj lossis hluavtaws polysaccharides lossis cellulose derivatives uas ua rau lawv cov tshuaj laxative feem ntau los ntawm kev nqus dej thiab ua rau cov quav ntau ntxiv. Cov laxatives no muaj txiaj ntsig zoo hauv kev ua kom lub plab zom mov thiab ua kom cov quav mos, nrog cov kev mob tshwm sim tsawg. Lawv tuaj yeem siv ib leeg lossis ua ke nrog kev noj zaub mov muaj fiber ntau.

Txawm hais tias cov ntaub ntawv kho mob loj heev qhia tau hais tias cov tshuaj laxative volumetric muaj txiaj ntsig, cov pov thawj lub hom phiaj hais txog lawv cov txiaj ntsig tsis sib xws. Kev tshuaj xyuas zoo tau pom tias psyllium nce plab hnyuv ntau zaus hauv cov neeg uas muaj cem quav, tab sis tsis muaj pov thawj txaus rau lwm hom fiber ntau, suav nrog calcium polycarbophil, methylcellulose, thiab nplej bran.

Lwm qhov kev tshuaj xyuas pom tau pom cov pov thawj txhawb kev ua tau zoo thiab kev nyab xeeb ntawm calcium polycarbophil, tab sis tsawg cov pov thawj txhawb kev siv psyllium thiab methylcellulose. Lwm txoj kev tshawb fawb pom tau hais tias plums qhuav (prunes) tau zoo dua li psyllium raws li kev kho thawj kab rau kev cem quav me me mus rau nruab nrab.

Ib txoj kev tshawb fawb qhia tau hais tias cov txiv hmab txiv ntoo-raws li soluble fiber ntau (piv txwv li, Suprafiber) muaj txiaj ntsig zoo li psyllium tab sis qab qab zoo dua thiab ua rau tsam plab.

Osmotic laxatives

Cov neeg mob uas tsis teb rau qhov ntim tshuaj laxative yuav tsum xav txog kev sim osmotic laxative.

Tsawg-dose polyethylene glycol (PEG) (17 g / d) yog siv tau zoo thiab zam rau cov neeg laus. Txawm li cas los xij, koob tshuaj loj ntawm PEG (34 g / d) tuaj yeem ua rau tsam plab, cramping, thiab flatulence, thiab cov neeg laus tuaj yeem ua rau muaj kev phom sij ntau dua.

Piv nrog rau cov placebo, lactulose nce lub plab zom mov ntau zaus, txo cov tsos mob cem quav, thiab txo qis kev xav tau rau lwm cov tshuaj laxatives hauv cov neeg laus. Tab sis ib txoj kev tshawb nrhiav pom tias lactulose tsis zoo dua li cov koob tshuaj qis PEG thiab muaj qhov tshwm sim ntau dua ntawm qhov quav.

Ib txoj kev tshawb fawb plaub-lub lim tiam nrog rau cov neeg laus uas muaj cem quav tau pom tias sorbitol muaj txiaj ntsig zoo li lactulose, tsis tshua muaj nqi, thiab tau txais txiaj ntsig zoo dua.

Ntsev laxatives xws li magnesium hydroxide tsis tau kawm nyob rau hauv cov neeg laus thiab yuav tsum tau siv nrog ceev faj vim muaj kev pheej hmoo ntawm hypermagnesemia.

Stimulant laxatives

Stimulant laxatives tuaj yeem cuam tshuam rau kev thauj mus los ntawm electrolyte hla lub plab hnyuv mucosa thiab txhim kho txoj hnyuv thiab kev txav mus los.

Ib txoj kev tshawb fawb tau pom tias kev sib txuas ntawm senna (ib qho tshuaj stimulant laxative) nrog fiber ntau txhim kho cov quav sib xws thiab zaus thiab ua rau cov quav tso quav yooj yim dua piv rau lactulose hauv cov neeg laus hauv tsev laus. , thiab ob qho kev kho mob tshwm sim tau zoo sib npaug.

Bisacodyl tau raug soj ntsuam nyob rau hauv ib qho kev randomized, ob-dig muag, placebo-tswj, sib npaug-pab pawg kawm. Txoj kev tshawb no tau muab cov neeg mob mus rau bisacodyl (10 mg) lossis placebo rau 4 lub lis piam. Piv nrog rau cov placebo pab pawg, qhov nruab nrab tus naj npawb ntawm kev ua tiav lub plab zom mov (CSBM) ib lub lis piam, tus naj npawb ntawm cov plab hnyuv siab raum (SBM), cov tsos mob ntawm cem quav, thiab kev ua neej zoo ntawm cov neeg mob hauv pawg bisacodyl tau txhim kho zoo, thiab cov kev kho mob bisacodyl tau zam tau. zoo. Txawm li cas los xij, kev nyab xeeb mus sij hawm ntev ntawm stimulant laxatives tsis meej.

4. Cov quav softeners, suppositories thiab enemas

Txawm hais tias siv dav, cov quav softeners (docusate), suppositories (glycerin lossis bisacodyl), thiab enemas muaj qhov ua tau zoo ntawm kev kho mob. Rau cov neeg laus nrog DD uas nyob hauv tsev laus, glycerin lossis bisacodyl suppositories tuaj yeem siv los pab ua kom lub qhov quav.

Enemas (kais dej, dej xab npum) yuav tsum tau siv tsuas yog thaum tsim nyog (piv txwv li, tom qab ob peb hnub ntawm cem quav) rau cov neeg laus uas cem quav los tiv thaiv fecal impaction. Cov teebmeem tsis zoo muaj xws li kev puas tsuaj rau lub qhov quav mucosa los ntawm soapy enema.

Nws raug nquahu kom tsis txhob siv sodium phosphate enemas los kho cem quav hauv cov neeg laus. Hauv cov ntaub ntawv rov qab, cov teeb meem cuam tshuam nrog kev siv cov tshuaj sodium phosphate enemas hauv cov neeg laus (txhais tau tias muaj hnub nyoog 80 xyoo, tsuas yog ib kis qis dua 70 xyoo) suav nrog hypotension thiab hypovolemia, hyperphosphatemia, thiab hypokalemia. Hyperkalemia lossis hyperkalemia, metabolic acidosis, mob hnyav hypocalcemia, lub raum tsis ua haujlwm, thiab kev hloov pauv ntawm electrocardiogram (QT ncua ntev).

Thaum Lub Ib Hlis Ntuj xyoo 2014, US FDA tau tshaj tawm cov lus qhia txog kev nyab xeeb hais tias kev siv ib koob tshuaj sodium phosphate hauv khw muag khoom ntau dua li cov tshuaj pom zoo lossis kev siv ntau dua 1 koob tshuaj ntawm cov tshuaj no hauv 24 teev tuaj yeem ua rau electrolyte. txawv txav thiab lub cev qhuav dej hnyav. FDA tau hais tias cov neeg mob uas muaj kev pheej hmoo siab rau qhov tshwm sim tsis zoo thaum noj ntau dua cov tshuaj pom zoo suav nrog: cov neeg muaj hnub nyoog 55 xyoos, cov neeg uas muaj lub cev qhuav dej, plab hnyuv, lossis mob, thiab cov neeg mob raum lossis noj cov tshuaj uas. tuaj yeem cuam tshuam rau lub raum ua haujlwm. Cov neeg mob yeeb tshuaj.

5. Lwm yam kev kho mob rau cem quav

Ob peb cov tshuaj tau kawm los yog tab tom kawm ntxiv rau lawv cov txiaj ntsig hauv kev kho mob cem quav. Cov tshuaj no suav nrog colonic secretagogues, opioid antagonists, thiab 5HT4 receptor agonists.

(1) Colon secretagogue

Lubiprostone yog ib qho kev hais lus bicyclic fatty acid uas activates hom 2 chloride channel nyob rau hauv cov hnyuv epithelial hlwb, yog li secreting chlorine thiab dej rau hauv txoj hnyuv lumen.

Hauv ob qhov kev tshawb fawb 4-lub lim tiam III, lubiprostone 24 ug ob zaug ib hnub ua rau muaj qhov ua rau lub plab zom mov ntau ntxiv thiab txo qis lwm cov tsos mob cem quav piv nrog cov placebo. Ib pab pawg neeg soj ntsuam kuj tau lees paub tias lubiprostone tau txais txiaj ntsig zoo rau cov neeg mob laus. Cov tshuaj no zoo tshaj plaws tsuas yog siv rau cov neeg mob cem quav hnyav uas ua tsis tau lwm yam kev kho mob.

Linaclotide thiab plucanatide yog guanylate cyclase C (GCC) receptor agonists uas ua rau lub plab hnyuv tso tawm thiab thauj.

Hauv ob qhov kev sim loj III hauv cov neeg mob nrog cem quav ntev, cov neeg mob tau txais linaclotide (145 ug thiab 290 ug) muaj CSBM Ntau dua lossis sib npaug li 3 zaug hauv ib lub lis piam piv nrog cov placebo tsawg kawg 9 ntawm 12 lub lis piam. Qhov xwm txheej tau nce ntxiv, thiab qhov tshwm sim ntawm CSBM nce ntau dua lossis sib npaug li 1 zaug los ntawm lub hauv paus kuj tseem nce ntxiv (145 ug pawg: 21% thiab 16%; 290 ug pawg: 19% thiab 21%; pawg placebo : 3% thiab 6%).

Qhov tshwm sim tsis zoo ntawm koob tshuaj feem ntau yog raws plab, uas ua rau 4% ntawm cov neeg mob hauv ob pawg neeg kho mob linaclotide txiav kev kho mob ntxiv. Hauv kev sim randomized txuas ntxiv nrog rau cov neeg mob laus, qhov txo qis ntawm linaclotide (72 ug / d) kuj tseem siv tau los txhim kho cem quav.

(2) Opioid antagonists

Peripherally acting μ-opioid receptor antagonists, uas yog avimopan, methylnaltrexone, naloxol ether, los yog nadmidine, yuav muaj qee yam cuam tshuam rau kev kho mob ntawm opioid-vim cem quav. Paralytic ileus tuaj yeem ua lub luag haujlwm. Vim hais tias cov opioid antagonists ua peripheral thiab tsis tuaj yeem hla cov ntshav-hlwb barrier, lawv tsis txo qis cov teebmeem analgesic ntawm opioids.

(3) 5HT (4) receptor agonist

Serotonin (5HT) yog ib qho tseem ceeb regulator ntawm plab hnyuv motility. Prucalopride yog ib tug high-affinity xaiv 5HT4 receptor agonist. Thaum siv ntawm koob tshuaj 1 mg / hnub thiab 4 mg / hnub ib zaug ib hnub, 4- thiab 12- lub lim tiam kev sim tau pom tias prucalopride zoo dua rau cov placebo thiab muaj kev nyab xeeb thiab zam tau rau cov neeg mob ntau dua lossis sib npaug rau 65 xyoo muaj hnub nyoog. zoo. Hauv kev sim tshuaj, 2 mg ntawm prucalopride tau zoo li 4 mg, yog li 2 mg yog koob tshuaj siv dav hauv kev kho mob. Cov koob tshuaj prucalopride tuaj yeem maj mam nce ntxiv raws li kev soj ntsuam teb.

6. Biofeedback

Biofeedback therapy yog ib txoj kev tsis mob, uas tsis yog-invasive ntawm kev txawj ntse retraining lub pelvic pem teb thiab plab phab ntsa musculature los txhawb kev khoob.

Siv electromyography los ntawm nto electrodes ntawm lub plab phab ntsa thiab nto electrodes ntawm lub qhov quav, tus neeg mob raug coj los txhim kho kev tswj ntawm cov leeg nqaij saum toj no.

Kev kho biofeedback yuav tsum raug txiav txim siab hauv cov neeg mob uas muaj lub plab hauv plab tsis ua haujlwm, tshwj xeeb yog DD, qhov quav tsis pom kev, lossis qhov quav mucosal intussusception.

Randomized tswj kev sim tau soj ntsuam qhov ua tau zoo ntawm biofeedback kev kho mob hauv kev kho mob DD thiab xaus lus tias biofeedback tsis tu ncua zoo tshaj rau cov tshuaj laxatives, kev saib xyuas tus qauv, kev kho sham, placebo, thiab diazepam. Kev kho mob hauv tsev biofeedback tsuas yog siv tau zoo li hauv chaw ua haujlwm biofeedback kho.

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 covcistanche hmoov, cistanche ntsiav tshuaj, cistanche capsules, 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. Txhawb nqa dej thiab lubrication ntawm txoj hnyuv, nws yuav pab tau cov cuab yeej soften thiab yooj yim dua, yog 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.