Thomas Jay
San Diego Hospice & Palliative Care, San Diego, California 92103, USA.
J Pain Symptom Manage. 2008 Jan;35(1):103-13. doi: 10.1016/j.jpainsymman.2007.01.017. Epub 2007 Nov 5.
Opioid-induced bowel dysfunction is a distressing condition that may persist indefinitely in the clinical setting. As we understand more about normal gastrointestinal (GI) physiology, we are also beginning to understand more fully how opioids cause bowel dysfunction. Current therapeutic interventions for opioid-induced bowel dysfunction can be burdensome and sometimes lack efficacy. Systemic opioid antagonists administered orally can induce laxation, but can unpredictably induce systemic or local GI tract withdrawal symptoms. Two new investigational agents, alvimopan and methylnaltrexone, are peripherally acting opioid antagonists that do not cross the blood-brain barrier. Studies to date show promise that these agents may relieve opioid-induced bowel dysfunction in a well-tolerated manner without reversing central analgesia.
阿片类药物引起的肠道功能障碍是一种令人痛苦的病症，在临床环境中可能会无限期持续。随着我们对正常胃肠（GI）生理学的了解越来越多，我们也开始更全面地理解阿片类药物如何导致肠道功能障碍。目前针对阿片类药物引起的肠道功能障碍的治疗干预措施可能很繁琐，有时还缺乏疗效。口服全身性阿片类拮抗剂可引起腹泻，但可能不可预测地诱发全身性或局部胃肠道戒断症状。两种新的研究药物，阿洛司琼和甲基纳曲酮，是外周作用的阿片类拮抗剂，不会穿过血脑屏障。迄今为止的研究表明，这些药物有望以耐受性良好的方式缓解阿片类药物引起的肠道功能障碍，而不会逆转中枢镇痛作用。
