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首页> 外文期刊>DMW: Deutsche Medizinische Wochenschrift >Opiate induced constipation - Mechanisms, relevance and treatment [Opiatinduzierte Obstipation - Mechanismen, Relevanz und Behandlung]
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Opiate induced constipation - Mechanisms, relevance and treatment [Opiatinduzierte Obstipation - Mechanismen, Relevanz und Behandlung]

机译：阿片类药物引起的便秘-机制，相关性和治疗[阿片类药物引起的便秘-机制，相关性和治疗]

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摘要

Opiates inhibit propulsive gastrointestinal motility and intestinal secretion in both the small and large intestine. The clinical result may be opiate induced constipation (OIC) presenting as one or more of the following symptoms: sense of abdominal fullness, bloated abdomen, infrequent stools, hard stools, difficult defecation, and sense of incomplete emptying of the bowel. The reported frequency of constipation on opioid treatment covers a wide range up to two thirds of patients. In fact, about one half of the patients seem to be affected. This applies also to transdermal systems. Only few trials have been conducted with laxatives in OIC. They work, but not satisfactorily in all patients. An alternative approach preventing or treating OIC is by co-administering an opiate antagonist. Methylnaltrexone is a systemically active antagonist poorly penetrating the brain and acting in the periphery only. It is available for subcutaneous administration only. A fixed combination of oxycodone with naloxone in a ratio of 2:1 can be administered orally and has also been proved to counteract or prevent constipation in patients without antagonizing pain relief. By its high first-pass metabolism in the liver naloxone does not reach systemically active serum levels and antagonizes the opiate only locally from the luminal side of the gut. A high awareness for OIC is mandatory for optimal pain management by either asking the patient for a treatment need or by prophylactically co-administering an opiate antagonist.
机译：阿片抑制小肠和大肠的推进性肠胃蠕动和肠分泌。临床结果可能是鸦片引起的便秘（OIC），表现为以下一种或多种症状：腹部饱胀感，腹部胀气，大便稀少，大便硬，排便困难和肠排空不完全。据报道，阿片类药物治疗后便秘的频率范围广泛，多达三分之二的患者。实际上，大约一半的患者似乎受到了影响。这也适用于透皮系统。在OIC中，只有很少的试验用泻药进行。它们起作用，但并非对所有患者都令人满意。预防或治疗OIC的另一种方法是共同服用鸦片拮抗剂。甲基纳曲酮是一种全身性的拮抗剂，穿透性差，仅在大脑外围起作用。它仅可用于皮下给药。羟考酮与纳洛酮的比例为2：1的固定组合可以口服，也已被证明可以抵消或预防患者的便秘，而不会拮抗疼痛。由于其在肝脏中的高首过代谢，纳洛酮不能达到全身活性的血清水平，并且只能从肠道腔侧局部拮抗阿片。对OIC的高度了解对于最佳疼痛管理是必不可少的，方法是通过询问患者治疗需求或预防性地共同使用阿片拮抗剂。

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