Mehta Rajiv, John Anil, Nair Prem, Raj V V, Mustafa C P, Suvarna Deepak, Balakrishnan V
Department of Gastroenterology, Amrita Institute of Medical Sciences, Cochin, Kerala, India.
J Gastroenterol Hepatol. 2006 Feb;21(2):459-61. doi: 10.1111/j.1440-1746.2005.03994.x.
To evaluate predictors of neostigmine response in patients with acute colonic pseudo-obstruction.
Twenty-seven patients with acute colonic pseudo-obstruction were enrolled in the study. All patients had received initial conservative management such as nil orally, nasogastric suction, rectal tube placement and correction of electrolyte imbalance for the first 24 h. Those who did not resolve with conservative management received 2 mg neostigmine intravenously. The same dose was repeated after 24 h in patients who did not response to the first dose (initial non-responders), or in those patients who relapsed after an initial response (initial responders). All non-responders to neostigmine underwent colonoscopic decompression followed by 2 mg neostigmine infusion for 30 min. A sustained response was defined as the resolution of symptoms and colonic dilatation on a plain radiograph.
The study enrolled 27 patients; 18 were male (67%), and the median age was 60 years (range 18-78 years). Eight (30%) patients had spontaneous resolution. Initial response with neostigmine was observed in 16 (84%) patients, of which 10 (63%) had a sustained response. Nine patients (three initial non-responders and six initial responders) had received a second dose of neostigmine. A sustained response was seen only in five initial responders. Four patients who did not respond to neostigmine underwent colonoscopic decompression followed by neostigmine infusion and had a sustained response. Neostigmine responders were more likely to be postoperative patients (11 of 15 (73%) vs one of four (25%), P = 0.07), less likely to have electrolyte imbalance and to be on antimotility agents (three of 15 (20%) vs four of four (100%), P = 0.009 and two of 15 (13%) vs four of four (100%), P = 0.003).
Electrolyte imbalance and usage of anti-motility agents are factors associated with a poor response, while postoperative patients showing good response to neostigmine therapy.
评估急性结肠假性梗阻患者新斯的明反应的预测因素。
27例急性结肠假性梗阻患者纳入本研究。所有患者在最初24小时均接受了初始保守治疗，如禁食、鼻胃管抽吸、直肠管置入及纠正电解质失衡。经保守治疗未缓解的患者静脉注射2毫克新斯的明。对首剂无反应的患者（初始无反应者）或初始有反应后复发的患者（初始有反应者），24小时后重复相同剂量。所有对新斯的明无反应的患者均接受结肠镜减压，随后输注2毫克新斯的明30分钟。持续反应定义为症状缓解且腹部平片显示结肠扩张消失。
本研究纳入27例患者；18例为男性（67%），中位年龄为60岁（范围18 - 78岁）。8例（30%）患者自行缓解。16例（84%）患者对新斯的明有初始反应，其中10例（63%）有持续反应。9例患者（3例初始无反应者和6例初始有反应者）接受了第二剂新斯的明。仅5例初始有反应者出现持续反应。4例对新斯的明无反应的患者接受结肠镜减压，随后输注新斯的明并出现持续反应。新斯的明有反应者更可能是术后患者（15例中的11例（73%）对4例中的1例（25%），P = 0.07），发生电解质失衡和使用抗动力药物的可能性较小（15例中的3例（20%）对4例中的4例（100%），P = 0.009；15例中的2例（13%）对4例中的4例（100%），P = 0.003）。
电解质失衡和抗动力药物的使用是反应不佳的相关因素，而术后患者对新斯的明治疗反应良好。
Zotero 插件