de Groot Jan Willem B, Peters Frans T M, Reyners Anna K L
Universitair Medisch Centrum Groningen.
Ned Tijdschr Geneeskd. 2010;154:A2224.
Constipation is a common problem with a considerable negative impact on quality of life in patients who receive palliative care. Over 35% of patients with heart failure, chronic obstructive pulmonary disease or cancer have constipation. In the palliative phase constipation often has multiple causes. Treatment of constipation consists of both medical treatment with laxatives and non-medical treatment. A specific recommendation for the use of laxatives cannot be made because of the lack of comparative trials. The choice of what laxative to use can only be made on the basis of clinical experience, mechanism of action, personal preference of the patient and costs. Prophylactic use of laxatives is indicated to prevent constipation when initiating constipation inducing medication such as opioids. In treatment-resistant constipation prucalopride, colchicine or misoprostol may be effective. Opioid-antagonists such as naloxone and methylnaltrexone are effective in patients with persistent opioid-induced constipation despite the use of laxatives.
便秘是一个常见问题，对接受姑息治疗的患者的生活质量有相当大的负面影响。超过35%的心力衰竭、慢性阻塞性肺疾病或癌症患者患有便秘。在姑息治疗阶段，便秘往往有多种原因。便秘的治疗包括使用泻药的药物治疗和非药物治疗。由于缺乏对比试验，无法给出使用泻药的具体建议。只能根据临床经验、作用机制、患者个人偏好和成本来选择使用哪种泻药。当开始使用如阿片类药物等可导致便秘的药物时，建议预防性使用泻药以预防便秘。对于难治性便秘，普芦卡必利、秋水仙碱或米索前列醇可能有效。尽管使用了泻药，但阿片类拮抗剂如纳洛酮和甲基纳曲酮对持续存在阿片类药物引起的便秘的患者有效。
