Department of Surgery and Cancer, Imperial College London, Praed Street, London W2 1NY, UK.
Int J Surg. 2012;10(9):453-7. doi: 10.1016/j.ijsu.2012.08.008. Epub 2012 Sep 14.
A best evidence topic was written according to a structured protocol. In [patients with acute colonic pseudo-obstruction] is [neostigmine] superior to [conservative treatment] with respect to [duration of symptoms and complications]. In total 51 papers were found using the reported search, and ten of these represented the best evidence to answer the clinical question. The authors, date, journal, study type, population, main outcome measures and results are tabulated. We conclude that intravenous neostigmine is associated with significantly reduced duration of acute colonic pseudo-obstruction (ACPO) compared to conservative treatment alone. Neostigmine infusion should be administered with continuous cardiac monitoring for possible bradycardia, which may require treatment with atropine. Seven prospective analyses and one retrospective study showed that intravenous neostigmine reduces time to resolution of clinical and radiological features of ACPO. One prospective study showed that neostigmine is only effective in improving duration of ACPO when it is combined with proponalol. One prospective study showed no difference in time to resolution of ACPO between neostigmine and conservative treatment but this study was limited by small sample size, lack of radiological examinations and poor reporting of adverse effects. In four separate studies patients experienced bradycardia with intravenous neostigmine and this required treatment with atropine. No other significant adverse effects were reported. Overall, intravenous neostigmine is associated with a significant reduction in duration of ACPO. In addition to regularly reviewing patients for antic-cholinergic side effects, patients should undergo continuous cardiac monitoring for bradycardia. The wide variety in methodology and measurement of outcomes reinforce the need for higher power studies to improve patient selection and monitoring of outcomes.
一个最佳证据主题是根据一个结构化的方案编写的。在[急性结肠假性梗阻患者]中，[新斯的明]与[保守治疗]相比，在[症状和并发症持续时间]方面更优。共检索到 51 篇文献，其中 10 篇文献为回答临床问题的最佳证据。作者、日期、期刊、研究类型、人群、主要观察指标和结果均列于表中。我们的结论是，与单独保守治疗相比，静脉内新斯的明可显著缩短急性结肠假性梗阻（ACPO）的持续时间。新斯的明输注应在持续心脏监测下进行，以防止可能出现的心动过缓，心动过缓可能需要用阿托品治疗。7 项前瞻性分析和 1 项回顾性研究表明，静脉内新斯的明可缩短 ACPO 的临床和影像学特征缓解时间。1 项前瞻性研究表明，新斯的明仅与普萘洛尔联合使用时才有效改善 ACPO 的持续时间。1 项前瞻性研究表明，新斯的明与保守治疗相比，在 ACPO 缓解时间上无差异，但该研究受到样本量小、缺乏影像学检查和不良反应报告不完善的限制。在 4 项单独的研究中，患者在接受静脉内新斯的明治疗时出现心动过缓，需要用阿托品治疗。未报告其他严重不良反应。总的来说，静脉内新斯的明可显著缩短 ACPO 的持续时间。除了定期检查患者是否出现抗胆碱能副作用外，还应持续监测患者的心脏情况，以防发生心动过缓。由于研究方法和结果测量的多样性，需要进行更多的、有更高功率的研究来改善患者的选择和监测结果。
