Rosman Alan S, Chaparala Geeta, Monga Amit, Spungen Ann M, Bauman William A, Korsten Mark A
Gastroenterology Practice and the Spinal Cord Center of Excellence, James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY 10468, USA.
Dig Dis Sci. 2008 Oct;53(10):2710-3. doi: 10.1007/s10620-008-0216-z. Epub 2008 Mar 13.
Difficulty with evacuation after spinal cord injury (SCI) may be due to a lack of parasympathetic stimulation of the colon. Prior studies in persons with spinal cord injury have suggested that intravenous administration of neostigmine stimulates colonic motility while glycopyrrolate attenuates some of the cholinergic side effects of neostigmine. We thus performed a double-blind, cross-over study to evaluate the effect of neostigmine/glycopyrrolate injections in patients with SCI and defecatory difficulties. Seven subjects received active treatment (neostigmine 2 mg and glycopyrrolate 0.4 mg intramuscularly) during three consecutive bowel evacuation sessions and were crossed-over to placebo injections for three consecutive sessions. Compared with placebo, neostigmine/glycopyrrolate reduced the total bowel evacuation time from 98.1 +/- 7.2 to 74.8 min +/- 5.8 (p < 0.05). The lowest heart rate or blood pressure was not significantly different between the treatment and placebo groups. In conclusion, neostigmine/glycopyrrolate may improve bowel evacuation in patients with SCI-related defecatory disorders.
脊髓损伤（SCI）后排便困难可能是由于结肠缺乏副交感神经刺激。先前对脊髓损伤患者的研究表明，静脉注射新斯的明可刺激结肠蠕动，而格隆溴铵可减轻新斯的明的一些胆碱能副作用。因此，我们进行了一项双盲交叉研究，以评估新斯的明/格隆溴铵注射对脊髓损伤且有排便困难患者的影响。七名受试者在连续三次排便过程中接受了积极治疗（肌肉注射新斯的明2mg和格隆溴铵0.4mg），并在连续三个疗程中交叉接受安慰剂注射。与安慰剂相比，新斯的明/格隆溴铵使总排便时间从98.1±7.2分钟减少到74.8分钟±5.8分钟（p<0.05）。治疗组和安慰剂组的最低心率或血压没有显著差异。总之，新斯的明/格隆溴铵可能改善脊髓损伤相关排便障碍患者的排便情况。
