ACPO又称Ogilvie综合征这类临床表现由WilliamHeneageOgilvie.DOCVIP

中枢系统疾病相关奥格尔维综合征2例并文献分析 文力 韩兴 宋莉莉 陈燕启 卫生部北京医院 急诊科 Central nervous system diseases related Ogilvie’s syndrome：2 cases report and literature analysis Wen Li，Han Xing，Song Li-li，CHEN Yan-qi Division of Emergency Medicine, Beijing Hospital, Beijing 100730, China 【摘要】 急性假性肠梗阻（Acute colonic pseudo-obstruction）又称奥格尔维综合征（Ogilvie’s syndrome），是一种结肠非机械性梗阻，临床较为少见。通常因内环境紊乱、药物、创伤等疾病导致肠自主神经功能紊乱引起，发生于急性胃肠功能损伤的严重阶段。鉴于其特殊的发病机制，纠正内环境紊乱、胃肠管减压、胃肠动力药等常规治疗效果不理想。而新斯的明、溴吡斯的明、脊髓麻醉等治疗手段常可获得理想疗效。必要时肠镜减压、造瘘、手术切除病变肠段可作为治疗选择之一。本文介绍两例较为罕见的由中枢系统疾病直接影响患者自主神经功能，引起奥格尔维综合征病例并对相关文献资料进行分析总结。 【关键词】　肠梗阻；奥格尔维综合征；中枢神经系统疾病；新斯的明；脊髓麻醉 【Abstract】Acute colonic pseudo-obstruction, known by the eponym Ogilvie’s syndrome, is a rare but serious non mechanical obstruction of colon. It usually caused by internal environment disorders or colon autonomic nerve dysfunction lead by nervous system diseases. Central nervous system diseases such as cerebrovascular disease and neuromyelities may affect the autonomic nerve function directly, which may appear Ogilvie syndrome when intestinal affected. Unlike other causes of pseudo obstruction, correct internal environment disturbances, gastric tube decompression, erythromycin treatment effect is un-ideal, but ，neostigmine and spinal anesthesia treatment often obtain good effect. When necessary，colonoscopy decompression and surgery can be a choice. 【Key Word】Intestinal obstruction; Ogilvie syndrome; Central nervous system disease; Neostigmine; Spinal anesthesia 急性假性肠梗阻(Acute colonic pseudo-obstruction，ACPO)因奥格尔维首先报道而得名，故又称奥格尔维综合征（Ogilvie’s syndrome）【1】。其发病机制是由各种原因导致的肠自主神经功能紊乱，表现为临床少见的结肠非机械性梗阻。病情隐匿凶险，诊断需根据病史、临床表现及特异性影像学表现综合判断，极易漏诊或误诊。本文报道2例较为罕见的由中枢系统疾病导致的奥格尔维综合征并对相关文献资料进行分析总结。 1 病例报道 1.1 病例一 患者女性，53岁，主因“腹胀、腹痛一周”入院。患者一周来腹胀、腹部隐痛。无排便，有少量排气。无明显发热、呕吐、呃逆。既往史：三年前因视物不清发现视神经脊髓炎；两年前出现双下肢瘫痪并确诊多发性硬化；一年前反复出现神经源性膀胱炎或尿路感染。瘫痪后大便1一次，性状偏干。入院后查体见腹部膨隆，脐周轻压痛，移动浊音阴性，肠鸣音活跃。查立位腹平片见广泛肠积气