Lidums I, Checklin H, Mittal R K, Holloway R H
Department of Gastrointestinal Medicine, Royal Adelaide Hospital, Australia.
Gut. 1998 Jul;43(1):12-6. doi: 10.1136/gut.43.1.12.
Atropine reduces the rate of reflux episodes in normal subjects by inhibition of transient lower oesophageal sphincter (LOS) relaxations. The aim of this study was to investigate the effect of atropine on the rate and mechanisms of reflux in patients with reflux disease.
Oesophageal motility and pH were recorded for one hour after a meal in 15 patients with reflux disease. On separate days, atropine (15 micrograms/kg bolus intravenously, 4 micrograms/kg/h infusion) or saline were given and maintained for the recording period.
Atropine significantly reduced basal LOS pressure from 7.1 (2.2) to 2.9 (1.3) mm Hg (mean (SEM)). Atropine also reduced the rate of reflux episodes from 5.0 (2.0-8.75) to 1.0 (0-6.25) per hour (median (interquartile range)) largely because of a decrease in the rate of transient LOS relaxations from 2.0 (0-4.75) to 0 (0-0) per hour and abolition of reflux during swallow induced LOS relaxation. There was no change in the rate of reflux episodes because of absent basal LOS pressure.
Atropine inhibits reflux in patients with reflux disease largely by inhibition of transient LOS relaxations and swallow induced LOS relaxation. These findings suggest that pharmacological control of reflux through control of transient LOS relaxations is possible in patients with reflux disease.
阿托品通过抑制食管下括约肌(LOS)的短暂松弛来降低正常受试者的反流发作率。本研究的目的是探讨阿托品对反流性疾病患者反流率及反流机制的影响。
对15例反流性疾病患者餐后1小时的食管动力和pH值进行记录。在不同日期,分别给予阿托品(静脉推注15微克/千克,输注速度为4微克/千克/小时)或生理盐水,并在记录期间持续给药。
阿托品使基础LOS压力从7.1(2.2)显著降至2.9(1.3)毫米汞柱(均值(标准误))。阿托品还使反流发作率从每小时5.0(2.0 - 8.75)次降至1.0(0 - 6.25)次(中位数(四分位间距)),这主要是因为短暂LOS松弛率从每小时2.0(0 - 4.75)次降至0(0 - 0)次,并且在吞咽诱发的LOS松弛期间反流消失。由于基础LOS压力缺失,反流发作率没有变化。
阿托品在反流性疾病患者中抑制反流主要是通过抑制短暂LOS松弛和吞咽诱发的LOS松弛。这些发现表明,通过控制短暂LOS松弛对反流性疾病患者进行药物控制反流是可行的。