Park Chang Hwan, Joo Young Eun, Kim Hyun Soo, Choi Sung Kyu, Rew Jong Sun, Kim Sei Jong
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
J Korean Med Sci. 2005 Feb;20(1):150-2. doi: 10.3346/jkms.2005.20.1.150.
We treated a 49-yr-old man with neostigmine, who had liver cirrhosis, acute hepatic encephalopathy, and acute intestinal pseudoobstruction. He was admitted in a state of hepatic confusion. On physical examination, the abdomen was distended; and bowel sound was absent. Plain abdomen film revealed multiple air-fluid levels and distention of bowel loops. Initially, we gave him lactulose enemas every 6 hr for one day without improvement in his mental state. Furthermore, he became to a state of coma. Therefore, we gave him 0.5 mg of neostigmine subcutaneously to improve his peristaltic movement, and 2 L of polyethylene glycol electrolyte solution through a nasogastric tube for 4 hr to reduce the production and absorption of gut-derived toxins of nitrogenous compounds. After these treatments, the venous ammonia level decreased to the normal range within 12 hr, and the coma disappeared after 2 days. We suggest that neostigmine may be one of the most effective treatments to initiate peristaltic movement and bowel cleansing in cirrhotic patients with acute hepatic encephalopathy and acute intestinal pseudoobstruction.
我们对一名49岁患有肝硬化、急性肝性脑病和急性肠假性梗阻的男性患者使用了新斯的明进行治疗。他入院时处于肝性意识模糊状态。体格检查发现腹部膨隆，肠鸣音消失。腹部平片显示多个气液平面和肠袢扩张。起初，我们每6小时给他进行一次乳果糖灌肠，持续一天，但他的精神状态没有改善。此外，他陷入了昏迷状态。因此，我们给他皮下注射0.5毫克新斯的明以改善其蠕动，通过鼻胃管给予2升聚乙二醇电解质溶液持续4小时，以减少肠道含氮化合物衍生毒素的产生和吸收。经过这些治疗后，静脉血氨水平在12小时内降至正常范围，2天后昏迷消失。我们认为新斯的明可能是启动肝硬化合并急性肝性脑病和急性肠假性梗阻患者蠕动和肠道清洁的最有效治疗方法之一。
