Takahashi Mikoto, Ubukata Satoshi, Sato Eizaburo, Shoji Makoto, Morikawa Naoto, Watanabe Hiroshi, Takahashi Hiroshi
Department of Respiratory Medicine, Saka General Hospital.
Nihon Kokyuki Gakkai Zasshi. 2011 Dec;49(12):877-84.
Distigmine bromide is a cholinesterase inhibitor widely used for the treatment of hypotonic neurogenic bladder. However, this drug is also known to cause cholinergic crisis, a rare but serious adverse reaction. Cholinergic crisis is an excessive amount of acetylcholine due to the systemic inhibition of cholinesterase activity, characterized by parasympathetic symptoms such as sweating, salivation, miosis, bradycardia, diarrhea and circulatory and respiratory failure. The incidence of cholinergic crisis has been estimated at approximately 0.2%, and the majority of the patients are elderly with underlying conditions such as cerebrovascular disease. Since 2004, we have encountered 5 cases of acute respiratory failure associated with cholinergic crisis induced by the administration of a normal oral dose of distigmine. We present these cases here and review an additional 23 cases from the literature in Japan. In these 28 cases, mechanical ventilation was required for 57%, with a mean duration of 5.1 days and a mortality rate of 11%. Pneumonia was observed in half of the cases in the acute phase, and relapse due to the readministration of distigmine was reported in 20% of cases. It is important to remember that cholinergic crisis in the elderly is often misdiagnosed and is occasionally treated as simple aspiration pneumonia.
溴化双斯的明是一种胆碱酯酶抑制剂，广泛用于治疗低张性神经源性膀胱。然而，这种药物也已知会引起胆碱能危象，这是一种罕见但严重的不良反应。胆碱能危象是由于胆碱酯酶活性受到全身抑制导致乙酰胆碱过量，其特征为出现诸如出汗、流涎、瞳孔缩小、心动过缓、腹泻以及循环和呼吸衰竭等副交感神经症状。胆碱能危象的发生率估计约为0.2%，大多数患者为患有脑血管疾病等基础疾病的老年人。自2004年以来，我们遇到了5例因口服正常剂量的溴化双斯的明诱发胆碱能危象而导致急性呼吸衰竭的病例。我们在此展示这些病例，并回顾日本文献中的另外23例病例。在这28例病例中，57%的患者需要机械通气，平均持续时间为5.1天，死亡率为11%。急性期有一半的病例观察到肺炎，20%的病例报告因再次使用溴化双斯的明而复发。重要的是要记住，老年人的胆碱能危象常常被误诊，偶尔会被当作单纯的吸入性肺炎进行治疗。
