Wheeler J S, Robinson C J, Culkin D J, Nemchausky B A
J Urol. 1987 Jun;137(6):1202-5. doi: 10.1016/s0022-5347(17)44449-1.
Naloxone has been reported to facilitate detrusor activity by blocking the inhibitory action of the enkephalins. We tested the urodynamic effects of intravenous naloxone (0.4 to 0.8 mg.) in 15 patients with spinal cord injury via rapid fill carbon dioxide cystometry and perineal electromyography. Fourteen patients had suprasacral lesions (3 complete), while 1 had an incomplete lower cord lesion. The average interval from injury was 4.2 months. Most of the patients were managed with intermittent catheterization and most had chronic bacteriuria. Initially, 10 patients had detrusor areflexia and 5 had detrusor hyperreflexia (2 with dyssynergia). Of the 15 patients 14 had no neuropathic condition as noted on baseline electromyography. After naloxone injection no significant cystometrographic changes occurred but 11 patients (73 per cent) had decreased electromyographic activity. The vesicourethral pattern of the 2 patients with dyssynergia did not change after naloxone, even though the electromyographic response decreased in both. The patients showed no other effects of the naloxone administration. Contrary to other studies, naloxone seemed to diminish pelvic floor (electromyographic) activity but it did not change bladder (cystometrographic) function during bladder rehabilitation of spinal cord injury patients.
据报道，纳洛酮可通过阻断脑啡肽的抑制作用来促进逼尿肌活动。我们通过快速充盈二氧化碳膀胱测压法和会阴肌电图，测试了静脉注射纳洛酮（0.4至0.8毫克）对15例脊髓损伤患者的尿动力学影响。14例患者有骶上病变（3例完全性），1例有不完全性脊髓下部病变。受伤后的平均间隔时间为4.2个月。大多数患者采用间歇性导尿法治疗，且多数患有慢性菌尿症。最初，10例患者有逼尿肌无反射，5例有逼尿肌反射亢进（2例伴有协同失调）。15例患者中，14例在基线肌电图检查中未发现神经病变。注射纳洛酮后，膀胱测压图无显著变化，但11例患者（73%）的肌电图活动降低。2例协同失调患者的膀胱尿道模式在注射纳洛酮后未改变，尽管两者的肌电图反应均降低。患者未表现出纳洛酮给药的其他影响。与其他研究相反，在脊髓损伤患者的膀胱康复过程中，纳洛酮似乎会降低盆底（肌电图）活动，但不会改变膀胱（膀胱测压图）功能。
