阿片类药物引起的便秘病理机制及治疗进展  

Progress in pathological mechanism and therapy of opioid-induced constipation

作　　者：王玥(综述)[1] 蒋葵(审校)[1] Yue Wang;Kui Jiang(Department of Oncology,The Second Affiliated Hospital of Dalian Medical University,Dalian 116000,China)

机构地区：[1]大连医科大学附属第二医院妇瘤及泌尿生殖肿瘤内科,辽宁省大连市116000

出　　处：《中国肿瘤临床》2021年第16期852-857,共6页Chinese Journal of Clinical Oncology

摘　　要：阿片类药物是一种常用的镇痛药,通常用于癌症疼痛患者的治疗。阿片类药物引起的肠功能障碍(opioid-induced bowel dysfunction,OIBD)是其长期治疗的常见并发症。阿片类药物引起的便秘(opioid-induced constipation,OIC)是癌症患者中最常见的症状,其影响了60%~90%的使用阿片类药物止痛的癌症患者。阿片类药物能结合胃肠道中的μ受体,抑制胃肠道的转运和蠕动,减少胃肠液的分泌,增加液体的吸收,导致包括便秘、胃食管反流病、恶心、呕吐、腹胀和腹痛在内的肠功能障碍症状。阿片类药物引起的便秘与生存质量下降、医疗费用增加有关。可用于治疗阿片类引起的便秘的药物包括泻药、促分泌剂、促动力药和阿片受体拮抗剂。然而,泻药的疗效往往有限,以及有较强的胃肠道不良反应(如恶心、呕吐、腹泻、腹痛),阿片受体拮抗剂被推荐用于治疗阿片类引起的便秘。其能阻断阿片类药物在外周的作用且不影响阿片类药物的中枢镇痛作用。本文旨在对阿片类药物引起的便秘的定义、病理机制和治疗进展做一综述,以期更好地鉴别、治疗阿片类药物引起的便秘,节约医疗资源。Opioids are commonly used analgesic drugs for treating cancer pain.Opioid-induced bowel dysfunction(OIBD)is a common complication of long-term opioid treatment.Opioid-induced constipation(OIC)is the most common symptom,affecting 60%-90%of patients who use opioids to treat cancer pain.Opioids drugs can bind toμreceptors in the gastrointestinal tract,inhibit gastrointestinal transit and peristalsis,reduce gastrointestinal fluid secretion,increase fluid absorption,resulting in intestinal dysfunction,including constipation,gastroesophageal reflux disease,nausea,vomiting,abdominal distension,and abdominal pain.Constipation caused by opioid drugs is associated with a decrease in the quality of life and an increase in medical expenditure.Drugs that can be used to treat OIC include laxatives,secretagogues,prokinetic agents and opioid receptor antagonists.However,the effectiveness of laxatives is often limited,and laxative use is associated with gastrointestinal side effects such as nausea,vomiting,diarrhea,and abdominal pain.Opioid receptor antagonists are recommended for the treatment of OIC.They can block the action of opioids on the peripheral nervous system and their use does not affect the analgesic effect of opioids on the central nervous system.This study aimed to provide an up-to-date review of the definition,pathophysiology and management of OIC to better identify and treat OIC and save medical resources.

关 键 词：阿片类 便秘 肠功能障碍 阿片受体拮抗剂 

分 类 号：R574.62[医药卫生—消化系统] R730.53[医药卫生—内科学]