Sherman S, Gottlieb K, Uzer M F, Smith M T, Khusro Q E, Earle D T, Brunelle R L, Hawes R H, Lehman G A
Department of Medicine, Indiana University School of Medicine, Indianapolis 46202-5000, USA.
Gastrointest Endosc. 1996 Sep;44(3):239-42. doi: 10.1016/s0016-5107(96)70158-x.
Opioids are traditionally avoided during sphincter of Oddi manometry because of indirect evidence suggesting that these agents cause sphincter of Oddi spasm. This study was undertaken to determine the direct effects of meperidine on the biliary and pancreatic sphincter.
Forty-seven patients were prospectively evaluated by sphincter of Oddi manometry in the conventional retrograde fashion. Manometry was initially performed with intravenous diazepam sedation alone. The manometry was repeated 3 to 5 minutes after meperidine was administered.
The basal sphincter pressure of the biliary sphincter, pancreatic sphincter, and the combined sphincter group were not significantly altered by meperidine. Concordance (normal versus abnormal) between the basal sphincter pressure before and after meperidine was seen in 44 of 47 patients (94%). Meperidine produced a significant increase in the pancreatic, biliary, and combined sphincter phasic frequency and a significant decrease in the phasic duration. The pancreatic and combined sphincter phasic pressures were significantly reduced following meperidine administration. Seventeen manometry tracings (36%) were believed to be qualitatively better after meperidine, while only four (8.5%; p < .001) were qualitatively better with diazepam alone.
Meperidine can be used for additional analgesia during sphincter of Oddi manometry if the basal sphincter pressure is the parameter used to determine therapy.
由于间接证据表明阿片类药物会导致Oddi括约肌痉挛，因此在Oddi括约肌测压期间传统上避免使用此类药物。本研究旨在确定哌替啶对胆管和胰管括约肌的直接影响。
对47例患者采用传统逆行方式进行Oddi括约肌测压的前瞻性评估。最初仅通过静脉注射地西泮镇静进行测压。在给予哌替啶后3至5分钟重复进行测压。
哌替啶对胆管括约肌、胰管括约肌及联合括约肌组的基础括约肌压力无显著影响。47例患者中有44例（94%）在哌替啶前后基础括约肌压力的一致性（正常与异常）情况良好。哌替啶使胰管、胆管及联合括约肌的相性频率显著增加，相性持续时间显著缩短。给予哌替啶后，胰管和联合括约肌的相性压力显著降低。17份测压记录（36%）在使用哌替啶后质量上被认为更好，而仅4份（8.5%；p <.001）仅使用地西泮时质量更好。
如果以基础括约肌压力作为确定治疗的参数，哌替啶可用于Oddi括约肌测压期间的辅助镇痛。
