国外患者在术后普遍使用肌肉松弛的药物,这种药物对新生反射弧的建立显然不利:刚刚逼尿肌要收缩,你来一个肌松药。。。我想,这可能是原因之一。
肌松药的问题,至少Beaumont医院早就知道了,患者术前就开始减肌松药:
http://xysblogs.org/xysergroup/archives/7146They were asked to cut it by 1/3 a week prior to surgery, they will cut again in 3 months and completely stop at 6
反过来说,停用这种药物很可能对大便有利。据NYU的Christopher E Kelly说:
"We postulate two possible reasons for the improved bowel function," observed Dr. Kelly. "It may be secondary to discontinuation of anticholinergic medication or reinnervation of the large bowel parasympathetic ganglion."
你关于“现在的情况”的说法不完整:
而现在的情况是:反射弧建立了,临床上有改善;尔后反射弧又消失,临床效果仍在持续好转。
前半句,见《“肖氏手术”的效果与“反射弧”无关》
http://www.xys.org/xys/ebooks/others/science/dajia11/xiaochuanguo133.txt再加上患者自我评估:
http://xysblogs.org/wp-content/blogs/107/uploads/tab12a.gif后半句,“临床效果仍在持续好转”应该改成:两个最差的患者“失访”(
http://www.xys.org/forum/db/9/64/144.html)后,绝大多数患者习惯了腹压排尿valsalva to void,尿得比以前多了。
这方面的确持续好转:“4 (5) of 7 off catheterization”。估计改用尿布了:“Incontinence still problem in most ... 6/7 leak urine”。
再加上边教授的评价:“从趋势来看,有效率在下降。这次又有一个病人变无效了。”