Joehl R J, Koch K L, Nahrwold D L
Am J Surg. 1984 Jan;147(1):134-8. doi: 10.1016/0002-9610(84)90047-3.
Hepatobiliary scans using Tc-IDA are reliable in making the diagnosis of acute cholecystitis. Commonly, opioid drugs are administered in patients with acute cholecystitis to relieve pain. Opioid drugs cause biliary sphincter spasm. Whether these drugs adversely affect hepatobiliary scans is unknown. We studied 13 healthy volunteer subjects, performing three hepatobiliary scans in each one. Scans were performed without opioid drugs and 30 minutes after intramuscularly administered meperidine, morphine, hydroxyzine, hydroxyzine plus meperidine, butorphanol, and nalbuphine. Opioid drugs markedly delayed clearance of Tc-IDA from the common bile duct, simulating common bile duct obstruction. Hydroxyzine alone caused an insignificant delay. We have concluded that opioid drugs cause bile duct obstruction in healthy persons. If opioid drugs are administered before a diagnostic hepatobiliary scan, delayed clearance of Tc-IDA from the common bile duct might lead to an erroneous diagnosis and indicate a potentially unnecessary common bile duct exploration. Opioid drugs should not be administered for several hours before a diagnostic hepatobiliary scan.
使用锝-亚氨基二乙酸（Tc-IDA）进行的肝胆扫描在诊断急性胆囊炎方面是可靠的。通常，急性胆囊炎患者会使用阿片类药物来缓解疼痛。阿片类药物会引起胆道括约肌痉挛。这些药物是否会对肝胆扫描产生不利影响尚不清楚。我们研究了13名健康志愿者，每人进行三次肝胆扫描。扫描分别在未使用阿片类药物时以及肌肉注射哌替啶、吗啡、羟嗪、羟嗪加哌替啶、布托啡诺和纳布啡30分钟后进行。阿片类药物显著延迟了Tc-IDA从胆总管的清除，模拟了胆总管梗阻。单独使用羟嗪造成的延迟不明显。我们得出结论，阿片类药物会导致健康人出现胆管梗阻。如果在诊断性肝胆扫描前使用阿片类药物，Tc-IDA从胆总管的清除延迟可能会导致错误诊断，并提示可能进行不必要的胆总管探查。在诊断性肝胆扫描前数小时不应使用阿片类药物。
