Berger Zoltán, Arcos Mario, Matamala Fernanda, Rojas Claudia
Clínica Dávila, Santiago, Chile.
Rev Med Chil. 2017 Mar;145(3):406-409. doi: 10.4067/S0034-98872017000300018.
Morphine produces contraction of Oddis sphincter, which can be severe and of longer duration in some pathological conditions. This exaggerated response can manifest as a colicky biliary pain, frequently accompanied by a dramatic increase in hepatic enzymes. We report a 32 years old female who consulted in the emergency room for severe low abdominal pain of gynecologic origin, which was completely controlled by morphine. However, she presented a sudden epigastric colicky pain irradiating in the back, which persisted for several hours in spite of the repeated administration of analgesics. Transaminases elevated from previously normal value to over 1,000 U/L, and returned to the normal level without further treatment after several days. Magnetic resonance cholangiography showed normal fine bile duct, without stones. This transient increase in hepatic enzymes was considered as a consequence of high biliary pressure secondary to morphine-induced spastic contraction of Oddis sphincter and a consecutive hepatocellular necrosis.
吗啡可引起奥狄括约肌收缩，在某些病理情况下，这种收缩可能很剧烈且持续时间更长。这种过度反应可表现为胆绞痛，常伴有肝酶显著升高。我们报告一名32岁女性，因妇科原因导致的严重下腹痛到急诊室就诊，其疼痛通过吗啡得到完全控制。然而，她突然出现上腹部绞痛并向后背部放射，尽管反复给予镇痛药，疼痛仍持续了数小时。转氨酶从之前的正常水平升至超过1000 U/L，几天后未经进一步治疗即恢复至正常水平。磁共振胆胰管造影显示肝内胆管正常，无结石。这种肝酶的短暂升高被认为是由于吗啡诱导的奥狄括约肌痉挛性收缩继发胆道高压以及随后的肝细胞坏死所致。
