The influencing factors of constipation after stroke: a meta-analysis_West China Medical Journal

Authors：

LIAO Xiaoqin ¹ , LIN Hongyuan ² ,  PENG Shanling ³

1. School of Nursing, Fujian University of Traditional Chinese Medicine, Fuzhou, Fujian 350001, P. R. China;
2. School of Nursing, Fujian Medical University, Fuzhou, Fujian 350108, P. R. China;
3. Department of Nursing, the 900th Hospital of the Joint Logistics Support Force of the Chinese People’s Liberation Army, Fuzhou, Fujian 350001, P. R. China;

Corresponding?author：

PENG Shanling, Email: psl30@163.com

Keywords：

Stroke; constipation; influencing fctors; meta-analysis

DOI：

10.7507/1002-0179.202103230

Video：

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Objective To systematically evaluate the related factors of constipation in patients with stroke. Methods Cochrane Library, PubMed, Web of Science, Embase, CNKI, VIP, Wanfang and China Biomedical Literature Database were searched by computer, and the retrieval time was set to May 2022. Case-control studies, cohort studies and cross-sectional studies on stroke and constipation were selected. Meta-analysis was performed using RevMan 5.3 software. Results A total of 13 studies involving 2 834 patients were included. Meta-analysis showed that age [odds ratio (OR) =2.54, 95% confidence interval (CI) (1.36, 3.73), P<0.001], lesion location [OR=1.98, 95%CI (1.27, 3.11), P=0.003], National Institutes of HealthStroke Scale score [OR=0.40, 95%CI (0.10, 0.70), P=0.010], hemiplegia [OR=4.31, 95%CI (2.59, 7.17), P<0.001], dysphagia [OR=2.32, 95%CI (1.27, 4.25), P=0.006], antidepressants [OR=2.33, 95%CI (1.62, 3.34), P<0.001], BI score [OR=?17.08, 95%CI (?33.07, ?1.08), P=0.04], eating pattern [OR=4.18, 95%CI (1.16, 15.09), P=0.030], drinking water volume ≥800 mL [OR=0.30, 95%CI (0.19, 0.46), P<0.001] might be the influencing factors of constipation in patients after stroke. The results of sensitivity analysis showed that age, education level, diabetes, smoking, stroke type, lesion location, diuretic and BI score might be the influencing factors of constipation after stroke (P<0.05). The results of bias analysis suggest that publication bias is less likely. Conclusions There are many risk factors for constipation in patients with stroke. Current evidence shows that age, diabetes, smoking and other 11 factors may be risk factors for stroke constipation, while high education level and drinking water ≥800 mL may be protective factors, and the other influencing factors have not been determined and need further study.

Citation： LIAO Xiaoqin, LIN Hongyuan, PENG Shanling. The influencing factors of constipation after stroke: a meta-analysis. West China Medical Journal, 2022, 37(6): 902-908. doi: 10.7507/1002-0179.202103230 Copy

1.	Algra A, Wermer MJ. Stroke in 2016: stroke is treatable, but prevention is the key. Nat Rev Neurol, 2017, 13(2): 78-79.
2.	Li J, Yuan M, Liu Y, et al. Incidence of constipation in stroke patients: a systematic review and meta-analysis. Medicine (Baltimore), 2017, 96(25): e7225.
3.	Sumida K, Molnar MZ, Potukuchi PK, et al. Constipation and risk of death and cardiovascular events. Atherosclerosis, 2019, 281: 114-120.
4.	高雁鴻, 李建梅, 粟茂, 等. 疏肝調氣配穴針刺治療卒中后慢傳輸型便秘及對患者胃腸激素水平的影響. 中國針灸, 2017, 37(2): 125-129.
5.	Zhai J, Mu W, Si J, et al. Acupuncture for constipation in patients with stroke: protocol of a systematic review and meta-analysis. BMJ Open, 2018, 8(3): e020400.
6.	Cheng J, Li L, Xu F, et al. Poststroke constipation is associated with impaired rectal sensation. Am J Gastroenterol, 2020, 115(1): 105-114.
7.	Bharucha AE, Pemberton JH, Locke GR 3rd. American gastroenterological association technical review on constipation. Gastroenterology, 2013, 144(1): 218-238.
8.	Wald A, Bharucha AE, Cosman BC, et al. ACG clinical guideline: management of benign anorectal disorders. Am J Gastroenterol, 2014, 109(8): 1141-1157.
9.	Wells G, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. (2010)[2021-03-01]. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
10.	曾憲濤, 劉慧, 陳曦, 等. Meta 分析系列之四: 觀察性研究的質量評價工具. 中國循證心血管醫學雜志, 2012, 4(4): 297-299.
11.	張艷華, 李曉玲, 李增寧. 國內惡性腫瘤患者營養不良影響因素 Meta 分析. 中國臨床保健雜志, 2020, 23(5): 649-655.
12.	Bracci F, Badiali D, Pezzotti P, et al. Chronic constipation in hemiplegic patients. World J Gastroenterol, 2007, 13(29): 3967-3972.
13.	Lim SF, Ong SY, Tan YL, et al. Incidence and predictors of new-onset constipation during acute hospitalisation after stroke. Int J Clin Pract, 2015, 69(4): 422-428.
14.	Lin CJ, Hung JW, Cho CY, et al. Poststroke constipation in the rehabilitation ward: incidence, clinical course and associated factors. Singapore Med J, 2013, 54(11): 624-629.
15.	Yi JH, Chun MH, Kim BR, et al. Bowel function in acute stroke patients. Ann Rehabil Med, 2011, 35(3): 337-343.
16.	卞靜, 楊怡堯, 易蘭, 等. 輕型卒中后排便障礙危險因素分析. 實用醫學雜志, 2017, 33(22): 3729-3733.
17.	張鑫. 腦卒中后發生便秘的原因、影響因素及護理對策. 解放軍護理雜志, 2011, 28(20): 33-35.
18.	戚勝, 董立煥, 成杰, 等. 腦卒中后急性應激障礙患者發生便秘的影響因素. 中國健康心理學雜志, 2017, 25(9): 1335-1339.
19.	楊宇, 鐘代曲, 沈盈盈, 等. 急性腦卒中病人排便情況的影響因素分析. 護理研究, 2018, 32(24): 3870-3874.
20.	王麗. 腦卒中后便秘與認知功能的相關性及其干預研究. 廣州: 南方醫科大學, 2013.
21.	蘇永靜, 張小燕, 曾進勝, 等. 生存分析模型在卒中患者便秘預測中的應用. 護理學雜志, 2009, 24(7): 1-4.
22.	鄧國華. 腦卒中便秘的相關因素分析和預測. 現代醫藥衛生, 2008, 24(15): 2266-2267.
23.	靳京. 某康復醫院神經內科患腦卒中后遺癥患者便秘現況調查與分析. 長春: 吉林大學, 2018.
24.	Mounsey A, Raleigh M, Wilson A. Management of constipation in older adults. Am Fam Physician, 2015, 92(6): 500-504.
25.	季德江. “醒神通調腸胃”針刺法治療缺血性腦卒中后便秘的臨床療效評價研究. 銀川: 寧夏醫科大學, 2020.
26.	Pasanen ME. Evaluation and treatment of colonic symptoms. Med Clin North Am, 2014, 98(3): 529-547.
27.	馬婷, 鄧莉瑩, 唐朝. 邵陽市社區缺血性腦卒中患者服藥與功能鍛煉依從性調查. 中國預防醫學雜志, 2020, 21(12): 1269-1273.
28.	Savin Z, Kivity S, Yonath H, et al. Smoking and the intestinal microbiome. Arch Microbiol, 2018, 200(5): 677-684.
29.	Bauer PV, Duca FA. Targeting the gastrointestinal tract to treat type 2 diabetes. J Endocrinol, 2016, 230(3): R95-R113.
30.	Yamada E, Namiki Y, Takano Y, et al. Clinical factors associated with the symptoms of constipation in patients with diabetes mellitus: a multicenter study. J Gastroenterol Hepatol, 2018, 33(4): 863-868.
31.	Rosen DR, Inaba K, Oh PJ, et al. Outpatient laparoscopic appendectomy: feasible in a public county hospital?. J Am Coll Surg, 2017, 224(5): 862-867.
32.	Birimoglu Okuyan C, Bilgili N. Effect of abdominal massage on constipation and quality of life in older adults: a randomized controlled trial. Complement Ther Med, 2019, 47: 102219.
33.	Li LJ, Yao XM, Guan BY, et al. Persistent depression is a predictor of quality of life in stroke survivors: results from a 5-year follow-up study of a Chinese cohort. Chin Med J (Engl), 2019, 132(18): 2206-2212.
34.	McRae MP. Effectiveness of fiber supplementation for constipation, weight loss, and supporting gastrointestinal function: a narrative review of meta-analyses. J Chiropr Med, 2020, 19(1): 58-64.
35.	Christodoulides S, Dimidi E, Fragkos KC, et al. Systematic review with meta-analysis: effect of fibre supplementation on chronic idiopathic constipation in adults. Aliment Pharmacol Ther, 2016, 44(2): 103-116.
36.	中華醫學會消化病學分會胃腸動力學組, 功能性胃腸病協作組. 中國慢性便秘專家共識意見 (2019, 廣州). 中華消化雜志, 2019, 39(9): 577-598.
37.	袁景, 林樺, 沈宏華, 等. 腦卒中后便秘治療進展. 中國實用神經疾病雜志, 2016, 19(11): 96-98.
38.	邱濤, 熊瑛, 吳紅梅. 老年 2 型糖尿病患者發生便秘的因素及抬臀干預的影響. 中國老年學雜志, 2020, 40(23): 4940-4944.
39.	Solismaa A, Kampman O, Lyytik?inen LP, et al. Genetic polymorphisms associated with constipation and anticholinergic symptoms in patients receiving clozapine. J Clin Psychopharmacol, 2018, 38(3): 193-199.

1. Algra A, Wermer MJ. Stroke in 2016: stroke is treatable, but prevention is the key. Nat Rev Neurol, 2017, 13(2): 78-79.
2. Li J, Yuan M, Liu Y, et al. Incidence of constipation in stroke patients: a systematic review and meta-analysis. Medicine (Baltimore), 2017, 96(25): e7225.
3. Sumida K, Molnar MZ, Potukuchi PK, et al. Constipation and risk of death and cardiovascular events. Atherosclerosis, 2019, 281: 114-120.
4. 高雁鴻, 李建梅, 粟茂, 等. 疏肝調氣配穴針刺治療卒中后慢傳輸型便秘及對患者胃腸激素水平的影響. 中國針灸, 2017, 37(2): 125-129.
5. Zhai J, Mu W, Si J, et al. Acupuncture for constipation in patients with stroke: protocol of a systematic review and meta-analysis. BMJ Open, 2018, 8(3): e020400.
6. Cheng J, Li L, Xu F, et al. Poststroke constipation is associated with impaired rectal sensation. Am J Gastroenterol, 2020, 115(1): 105-114.
7. Bharucha AE, Pemberton JH, Locke GR 3rd. American gastroenterological association technical review on constipation. Gastroenterology, 2013, 144(1): 218-238.
8. Wald A, Bharucha AE, Cosman BC, et al. ACG clinical guideline: management of benign anorectal disorders. Am J Gastroenterol, 2014, 109(8): 1141-1157.
9. Wells G, Shea B, O'Connell D, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. (2010)[2021-03-01]. http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp.
10. 曾憲濤, 劉慧, 陳曦, 等. Meta 分析系列之四: 觀察性研究的質量評價工具. 中國循證心血管醫學雜志, 2012, 4(4): 297-299.
11. 張艷華, 李曉玲, 李增寧. 國內惡性腫瘤患者營養不良影響因素 Meta 分析. 中國臨床保健雜志, 2020, 23(5): 649-655.
12. Bracci F, Badiali D, Pezzotti P, et al. Chronic constipation in hemiplegic patients. World J Gastroenterol, 2007, 13(29): 3967-3972.
13. Lim SF, Ong SY, Tan YL, et al. Incidence and predictors of new-onset constipation during acute hospitalisation after stroke. Int J Clin Pract, 2015, 69(4): 422-428.
14. Lin CJ, Hung JW, Cho CY, et al. Poststroke constipation in the rehabilitation ward: incidence, clinical course and associated factors. Singapore Med J, 2013, 54(11): 624-629.
15. Yi JH, Chun MH, Kim BR, et al. Bowel function in acute stroke patients. Ann Rehabil Med, 2011, 35(3): 337-343.
16. 卞靜, 楊怡堯, 易蘭, 等. 輕型卒中后排便障礙危險因素分析. 實用醫學雜志, 2017, 33(22): 3729-3733.
17. 張鑫. 腦卒中后發生便秘的原因、影響因素及護理對策. 解放軍護理雜志, 2011, 28(20): 33-35.
18. 戚勝, 董立煥, 成杰, 等. 腦卒中后急性應激障礙患者發生便秘的影響因素. 中國健康心理學雜志, 2017, 25(9): 1335-1339.
19. 楊宇, 鐘代曲, 沈盈盈, 等. 急性腦卒中病人排便情況的影響因素分析. 護理研究, 2018, 32(24): 3870-3874.
20. 王麗. 腦卒中后便秘與認知功能的相關性及其干預研究. 廣州: 南方醫科大學, 2013.
21. 蘇永靜, 張小燕, 曾進勝, 等. 生存分析模型在卒中患者便秘預測中的應用. 護理學雜志, 2009, 24(7): 1-4.
22. 鄧國華. 腦卒中便秘的相關因素分析和預測. 現代醫藥衛生, 2008, 24(15): 2266-2267.
23. 靳京. 某康復醫院神經內科患腦卒中后遺癥患者便秘現況調查與分析. 長春: 吉林大學, 2018.
24. Mounsey A, Raleigh M, Wilson A. Management of constipation in older adults. Am Fam Physician, 2015, 92(6): 500-504.
25. 季德江. “醒神通調腸胃”針刺法治療缺血性腦卒中后便秘的臨床療效評價研究. 銀川: 寧夏醫科大學, 2020.
26. Pasanen ME. Evaluation and treatment of colonic symptoms. Med Clin North Am, 2014, 98(3): 529-547.
27. 馬婷, 鄧莉瑩, 唐朝. 邵陽市社區缺血性腦卒中患者服藥與功能鍛煉依從性調查. 中國預防醫學雜志, 2020, 21(12): 1269-1273.
28. Savin Z, Kivity S, Yonath H, et al. Smoking and the intestinal microbiome. Arch Microbiol, 2018, 200(5): 677-684.
29. Bauer PV, Duca FA. Targeting the gastrointestinal tract to treat type 2 diabetes. J Endocrinol, 2016, 230(3): R95-R113.
30. Yamada E, Namiki Y, Takano Y, et al. Clinical factors associated with the symptoms of constipation in patients with diabetes mellitus: a multicenter study. J Gastroenterol Hepatol, 2018, 33(4): 863-868.
31. Rosen DR, Inaba K, Oh PJ, et al. Outpatient laparoscopic appendectomy: feasible in a public county hospital?. J Am Coll Surg, 2017, 224(5): 862-867.
32. Birimoglu Okuyan C, Bilgili N. Effect of abdominal massage on constipation and quality of life in older adults: a randomized controlled trial. Complement Ther Med, 2019, 47: 102219.
33. Li LJ, Yao XM, Guan BY, et al. Persistent depression is a predictor of quality of life in stroke survivors: results from a 5-year follow-up study of a Chinese cohort. Chin Med J (Engl), 2019, 132(18): 2206-2212.
34. McRae MP. Effectiveness of fiber supplementation for constipation, weight loss, and supporting gastrointestinal function: a narrative review of meta-analyses. J Chiropr Med, 2020, 19(1): 58-64.
35. Christodoulides S, Dimidi E, Fragkos KC, et al. Systematic review with meta-analysis: effect of fibre supplementation on chronic idiopathic constipation in adults. Aliment Pharmacol Ther, 2016, 44(2): 103-116.
36. 中華醫學會消化病學分會胃腸動力學組, 功能性胃腸病協作組. 中國慢性便秘專家共識意見 (2019, 廣州). 中華消化雜志, 2019, 39(9): 577-598.
37. 袁景, 林樺, 沈宏華, 等. 腦卒中后便秘治療進展. 中國實用神經疾病雜志, 2016, 19(11): 96-98.
38. 邱濤, 熊瑛, 吳紅梅. 老年 2 型糖尿病患者發生便秘的因素及抬臀干預的影響. 中國老年學雜志, 2020, 40(23): 4940-4944.
39. Solismaa A, Kampman O, Lyytik?inen LP, et al. Genetic polymorphisms associated with constipation and anticholinergic symptoms in patients receiving clozapine. J Clin Psychopharmacol, 2018, 38(3): 193-199.

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