Bauman William A, Sabiev Anton, Shallwani Shahzad, Spungen Ann M, Cirnigliaro Christopher M, Korsten Mark A
Veterans Affairs Rehabilitation Research and Development Service's National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY 10468, USA.
Medical Service, James J. Peters Veterans Affairs Medical Center, Bronx, NY 10468, USA.
J Clin Med. 2021 Mar 8;10(5):1135. doi: 10.3390/jcm10051135.
Persons with spinal cord injury (SCI) have neurogenic bowel disorders characterized by difficulty with evacuation (DWE), fecal incontinence, and discoordination of defecation. Six medically stable in-patients with SCI with a mean age of 57 ± 10 years (range: 39-66 years) and time since injury of 18 ± 17 years (range: 3-47 years) were investigated. Standard of care (SOC) for bowel care was followed by two weeks of SOC plus neostigmine (0.07 mg/kg) and glycopyrrolate (0.014 mg/kg) administered transcutaneously by iontophoresis thrice weekly for two weeks while patients continued to receive SOC. The primary endpoint was time to bowel evacuation. Body weights and abdominal radiographs were obtained. Ten questions related to bowel function and the Treatment Satisfaction Questionnaire for Medication were acquired after each arm. Bowel evacuation time decreased after the dual drug intervention arm (106.9 ± 68.4 vs. 40.8 ± 19.6 min; < 0.0001). Body weight decreased (2.78 ± 0.98 kg; < 0.0001), a finding confirmed on abdominal radiograph. Both questionnaires demonstrated improvement after the dual drug intervention arm. No major adverse events occurred. The addition of neostigmine and glycopyrrolate by transcutaneous administration to SOC for bowel care in persons with SCI and DWE resulted in the safe, effective, and predictable bowel evacuation with subjective improvement in bowel care.
脊髓损伤（SCI）患者存在神经源性肠道疾病，其特征为排便困难（DWE）、大便失禁和排便失调。对6名病情医学稳定的SCI住院患者进行了调查，他们的平均年龄为57±10岁（范围：39 - 66岁），受伤时间为18±17年（范围：3 - 47年）。肠道护理的标准治疗（SOC）方案实施两周后，在患者继续接受SOC的同时，采用新斯的明（0.07 mg/kg）和格隆溴铵（0.014 mg/kg）经皮离子导入法每周三次给药两周。主要终点是排便时间。记录体重并拍摄腹部X光片。在每个治疗阶段结束后，获取与肠道功能相关的10个问题以及药物治疗满意度问卷。双药干预组的排便时间缩短（106.9±68.4 vs. 40.8±19.6分钟；<0.0001）。体重下降（2.78±0.98千克；<0.0001），腹部X光片证实了这一结果。两份问卷均显示双药干预组有改善。未发生重大不良事件。对于患有SCI和DWE的患者，在SOC基础上经皮给予新斯的明和格隆溴铵进行肠道护理，可实现安全、有效且可预测的排便，同时在肠道护理方面有主观改善。
