Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Discipline of Surgery, Faculty of Health and Medical Sciences, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
ANZ J Surg. 2022 Jan;92(1-2):69-76. doi: 10.1111/ans.17418. Epub 2021 Dec 19.
Postoperative ileus is a common complication in the days following colorectal surgery occurring in up to 50% of patients. When prolonged, this complication results in significant morbidity and mortality, doubling the total costs of hospital stay. Postoperative ileus (POI) results from the prolonged inflammatory phase that is mediated in part by the cholinergic anti-inflammatory pathway. Acetylcholinesterase inhibitors, such as neostigmine and pyridostigmine, delay the degradation of acetylcholine at the synaptic cleft. This increase in acetylcholine has been shown to increase gut motility. They have been effective in the treatment of acute colonic pseudo-obstruction, but there is limited evidence for the use of these medications for reducing the incidence of POI. This review was conducted to summarise the evidence of acetylcholinesterase inhibitors' effect on gut motility and discuss their potential use as part of an enhanced recovery protocols to prevent or treat POI.
术后肠梗阻是结直肠手术后几天内常见的并发症，高达 50%的患者会发生这种并发症。如果这种并发症持续时间延长，会导致显著的发病率和死亡率，使住院总费用增加一倍。术后肠梗阻（POI）是由炎症反应期延长引起的，部分是由胆碱能抗炎途径介导的。乙酰胆碱酯酶抑制剂，如新斯的明和吡啶斯的明，可延缓突触间隙乙酰胆碱的降解。这种乙酰胆碱的增加已被证明可增加肠道蠕动。它们在治疗急性结肠假性梗阻方面是有效的，但关于这些药物用于降低 POI 发生率的证据有限。本综述旨在总结乙酰胆碱酯酶抑制剂对肠道蠕动影响的证据，并讨论它们作为增强恢复方案的一部分用于预防或治疗 POI 的潜在用途。
