Carlstedt A, Nordgren S, Fasth S, Appelgren L, Hultén L
Department of Surgery, Sahlgrenska sjukhuset, Göteborg, Sweden.
Int J Colorectal Dis. 1989 Aug;4(3):144-9. doi: 10.1007/BF01649690.
The effects of epidural anaesthesia (EDA, mepivacaine) and EDA in combination with atropine and neostigmine on postoperative intestinal motility were studied in 17 patients undergoing operation for cancer of the rectum or sigmoid colon. Motility was recorded by a volumetric technique. Epidural anaesthesia (EDA) increased motor activity in the small bowel as well as in the left colon and rectum. Phasic motility dominated in the small intestine whereas tonic and segmental contractions were recorded from the large bowel. EDA induced a powerful tonic contraction with a concomitant shortening of the rectum. This effect was inhibited by atropine. The influence of atropine/neostigmine on left colonic motor activity was studied in six patients before and during EDA in a cross-over fashion. When administered alone, atropine/neostigmine did not cause any motility increase. Atropine/neostigmine administered during EDA, however, elicited a significant increase of motility. The increase of intestinal motor activity induced by EDA may expose a newly constructed colorectal anastomosis to undue strain in the immediate postoperative period. When EDA is used in combination with general anaesthesia, particular attention should be directed towards the use of neostigmine for reversing the effect of nondepolarizing muscle relaxants. Atropine appears under such circumstances not to protect from the excitatory effects of this drug on colorectal motility.
对17例接受直肠癌或乙状结肠癌手术的患者，研究了硬膜外麻醉（EDA，甲哌卡因）以及EDA联合阿托品和新斯的明对术后肠道蠕动的影响。通过容积技术记录蠕动情况。硬膜外麻醉（EDA）增加了小肠以及左半结肠和直肠的运动活性。小肠中以阶段性蠕动为主，而大肠则记录到强直性和节段性收缩。EDA诱发了直肠的强力强直性收缩并伴有直肠缩短。这种效应被阿托品抑制。采用交叉法对6例患者在EDA前和EDA期间研究了阿托品/新斯的明对左半结肠运动活性的影响。单独给药时，阿托品/新斯的明未引起任何蠕动增加。然而，在EDA期间给予阿托品/新斯的明可引起蠕动显著增加。EDA引起的肠道运动活性增加可能会使新构建的结直肠吻合口在术后早期承受过度的张力。当EDA与全身麻醉联合使用时，应特别注意使用新斯的明来逆转非去极化肌松药的作用。在这种情况下，阿托品似乎无法防止该药物对结直肠蠕动的兴奋作用。
