Saunders M D, Kimmey M B
Division of Gastroenterology, University of Washington, Seattle, 98195, USA.
Aliment Pharmacol Ther. 2005 Nov 15;22(10):917-25. doi: 10.1111/j.1365-2036.2005.02668.x.
Acute colonic pseudo-obstruction is the clinical syndrome of acute large bowel dilatation without mechanical obstruction that is an important cause of morbidity and mortality. Acute colonic pseudo-obstruction occurs in hospitalized or institutionalized patients with serious underlying medical and surgical conditions. The pathogenesis of acute colonic pseudo-obstruction is not completely understood but likely results from an imbalance in the autonomic regulation of colonic motor function. Metabolic or pharmacological factors, as well as spinal or retroperitoneal trauma, may alter the autonomic regulation of colonic function, leading to excessive parasympathetic suppression or sympathetic stimulation. This imbalance results in colonic atony and dilatation. Early recognition and appropriate management are critical to minimizing morbidity and mortality. The mortality rate is estimated at 40% when ischaemia or perforation occurs. The best-studied treatment of acute colonic pseudo-obstruction is intravenous neostigmine, which leads to prompt colon decompression in the majority of patients after a single infusion. In patients failing or having contraindications to neostigmine, colonoscopic decompression is the active intervention of choice. Surgery is reserved for those with peritonitis or perforation.
急性结肠假性梗阻是一种无机械性梗阻的急性大肠扩张临床综合征，是发病和死亡的重要原因。急性结肠假性梗阻发生于患有严重基础内科和外科疾病的住院或机构化患者中。急性结肠假性梗阻的发病机制尚未完全明确，但可能是由于结肠运动功能自主调节失衡所致。代谢或药理因素，以及脊柱或腹膜后创伤，可能会改变结肠功能的自主调节，导致副交感神经抑制过度或交感神经刺激。这种失衡会导致结肠无张力和扩张。早期识别和适当处理对于将发病率和死亡率降至最低至关重要。发生缺血或穿孔时，死亡率估计为40%。研究最多的急性结肠假性梗阻治疗方法是静脉注射新斯的明，大多数患者单次输注后可迅速实现结肠减压。对于新斯的明治疗失败或有禁忌证的患者，结肠镜减压是首选的积极干预措施。手术仅适用于患有腹膜炎或穿孔的患者。
