功能性便秘患儿干预策略的选择及疗效分析

Intervention strategies and treatment effectiveness in children with functional constipation

摘要

目的 了解西安市功能性便秘(FC)患儿干预现状,比较不同干预策略的疗效,并分析各干预方式的优势与不足,为优化FC患儿管理提供依据。方法 2022年11月—2023年2月,基于罗马Ⅳ诊断标准设计问卷,通过网络平台对西安市1~14岁FC患儿主要照护人开展调查,并按年龄分为＜4岁组和≥4岁组。采用χ²检验或Fisher确切概率法比较不同干预措施的疗效及相关因素。结果 共回收问卷1 988份,剔除无效问卷后有效问卷1 911份(有效回收率96.1%);其中728例(38.10%)未接受任何干预,1 183例(61.90%)接受过医院治疗、药物治疗、饮食调整及物理治疗中的一种或多种干预。两亚组内性别、居住地及是否独生子女与干预效果无关(P＞0.05)。在接受干预的患儿中,饮食调整的采用率及有效率均较高,且干预有效患儿的初次干预时间短于干预无效患儿(P＜0.05)。分策略分析显示:医院治疗疗效与家属配合程度相关(P＜0.05);在≥4岁组中,乳果糖、益生菌、开塞露或通便栓及中药/中成药治疗与较高有效率相关(P＜0.001)。饮食调整中最常用方式为增加蔬菜和水果摄入(＜4岁组92.97%,≥4岁组91.13%)。结论 西安市FC患儿干预策略差异较大,整体疗效不理想。建议强化早期识别与规范化、个体化综合干预,并加强患儿及照护人健康教育以改善预后。

Abstract

Objective To characterize current intervention patterns for functional constipation (FC) in children in Xi′an, and to compare the effectiveness of different intervention strategies, so as to identify their strengths and limitations to inform clinical management. Methods From November 2022 to February 2023, a Rome Ⅳ-based questionnaire was administered via an online platform to primary caregivers of children aged 1 - 14 years with FC in Xi′an.Participants were stratified into <4 years and ≥4 years subgroups.The chi-square test or Fisher′s exact test was used to compare effectiveness across interventions and related factors. Results A total of 1 988 questionnaires were collected, of which 1 911(96.1%) were valid.Of these, 728 children (38.10%) received no intervention, whereas 1 183 (61.90%) received one or more interventions, including hospital-based treatment, pharmacotherapy, dietary adjustment, and physical therapy.Within each age subgroup, sex, residence, and only-child status were not associated with intervention effectiveness (P>0.05).Dietary adjustment was the most frequently adopted strategy and had the highest effectiveness in both subgroups; children with effective outcomeshad shorter initialintervention durationthan those with ineffective outcomes (both P<0.05).Hospital-based treatment effectiveness was associated with family cooperation (P<0.05).In the ≥4-year subgroup, lactulose, probiotics, enema/suppository, and traditional Chinese medicine/Chinese patent medicine were associated with higher effectiveness (P<0.001).Increasing vegetable and fruit intake was the most common dietary approach (92.97% vs.91.13% in the <4-year and ≥4-year subgroups, respectively). Conclusions Intervention strategies for pediatric FC vary substantially in Xi′an, and overall effectiveness remains suboptimal.Early identification and guideline-concordant, individualized multimodal interventions, together with caregiver education, may improve outcomes.

关键词

功能性便秘 / 干预策略 / 依从性 / 预后

Key words

functional constipation / treatment strategies / compliance / prognosis

[1] Fedele F, Fioretti MT, Scarpato E, et al.The ten "hard" questions in pediatric functional constipation[J].Ital J Pediatr, 2024, 50(1):64-72.
[2] Kilgore A, Khlevner J.Functional constipation: Pathophysiology, evaluation, and management[J].Aliment Pharmacol Ther, 2024, 60(Suppl 1):20-29.
[3] Tabbers MM, DiLorenzo C, Berger MY, et al.Evaluation and treatment of functional constipation in infants and children: Evidence-based recommendations from ESPGHAN and NASPGHAN[J].J Pediatr Gastroenterol Nutr,2014, 58(2):258-274.
[4] 中华医学会消化病学分会胃肠动力学组,功能性胃肠病协作组.中国慢性功能性便秘专家共识意见(2019,广州)[J].中华消化杂志, 2019, 39(9):577-598.
Neurogastroenterology and Motility Comittee, Chinese Society of Gastroenterolog.Chinese expert consensus on chronic functional constipation (2019, Guangzhou)[J].Chin J Dig, 2019, 39(9): 577-598.(in Chinese)
[5] Mulhem E, Khondoker F, Kandiah S.Constipation in children and adolescents: Evaluation and treatment[J].Am Fam Physician, 2022, 105(5):469-478.
[6] Bekkali NL, van den Berg MM, Dijkgraaf MG,et al.Rectal fecal impaction treatment in childhood constipation: Enemas versus high doses oral PEG[J].Pediatrics, 2009, 124(6):e1108-e1115.
[7] Russo M, Strisciuglio C, Scarpato E, et al.Functional chronic constipation: Rome III criteria versus Rome IV criteria[J].J Neurogastroenterol Motil, 2019, 25(1):123-128.
[8] Wegh CAM, Baaleman DF, Tabbers MM, et al.Nonpharmacologic treatment for children with functional constipation: A systematic review and meta-analysis[J].J Pediatr, 2022, 240:136-149.
[9] 郑秀丽.小儿推拿联合排便习惯训练治疗小儿功能性便秘的临床观察[D].广州:.广州中医药大学, 2018:15-18.
Zheng XL.Observation of clinical on children′s functional constipation treated by pediatric massage combined with defecation training[D].Guangzhou:Guangzhou University of Chinese Medicine, 2018: 15-18.(in Chinese)
[10] 张伟,郭宏伟,王宝西.肠道菌群与儿童功能性便秘研究进展[J].中华实用儿科临床杂志, 2020, 35(16):1277-1280.
Zhang W, Guo HW, Wang BX.Study progress of gut microbiota and functional constipation in children[J].Chin J Appl Clin Pediatr, 2020, 35(16): 1277-1280.(in Chinese)
[11] Vriesman MH, Koppen IJN, Camilleri M, et al.Management of functional constipation in children and adults[J].Nat Rev Gastroenterol Hepatol, 2020, 17(1):21-39.
[12] 刘元华,洪明星,廖品东.成都城市小儿功能性便秘流行病学调查[J].现代医药卫生, 2007, 23(005):777-778.
[13] 何丹,樊烁烁,杜方叶.北京市儿童就医行为影响因素研究 ——以北京儿童医院和首都儿研所为例[J].北京联合大学学报, 2022, 36(3):44-52.
He D, Fan SS, Du FY.Research on the influencing factors of health seeking behavior for children in Beijing: Taking Beijing Children′s Hospital and Capital Pediatric Research Institute as examples[J].Journal of Beijing Union University, 2022, 36(3): 44-52.(in Chinese)
[14] 陈永田,谷兴琳.儿童功能性便秘的诊断及治疗现状[J].中国实用儿科杂志, 2001, 16(10):622-624.
[15] de Geus A, Koppen IJN, Flint RB, et al.An update of pharmacological management in children with functional constipation[J].Paediatr Drugs, 2023, 25(3):343-358.
[16] 苏元元,王新军.儿童功能性便秘治疗的研究进展[J].新疆中医药, 2019, 37(5):73-75.
[17] Sullivan PB, Alder N, Shrestha B, et al.Effectiveness of using a behavioural intervention to improve dietary fibre intakes in children with constipation[J].J Hum Nutr Diet, 2012, 25(1):33-42.

基金资助

陕西省科学技术厅社发重点项目(2022SF-082)