Management of cancer.
Management of cancer.
复制标题
癌症的管理。
DOI：
10.1136/bmj.1.5741.173-b
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发表时间：
1971
影响因子：
--
通讯作者：
A. Green
中科院分区：
文献类型：
--
作者：
A. Green
先生，-你的领导人“控制胃酸”（11月28日，第510页）指出“抗胆碱能药物通过减少迷走神经活动起作用。它们只有在引起不良副作用如嗜睡、口干、视力模糊和膀胱排空困难的剂量下才完全有效。“当这些药物以单剂量给药时，所有这些都是真实的。但是，当他们每天给药四次，在最大剂量，使没有副作用，由逐步升级确定，结果是不同的。例如，Mitchell et al.比较了阿托品或波尔丁在不产生副作用的剂量下对胃内容物酸度的降低。这项研究是双盲的，平均治疗时间为7天，每种药物每天给药4次。普通食物后胃内容物的酸度平均降低60%，阿托品和约80%或更多的波尔丁。Seidelin 2研究了无副作用剂量的波尔定对胃酸分泌的影响。使用增强组胺试验，他发现患者在接受治疗约三周后胃酸分泌减少了50%。他指出，这种减少接近于迷走神经切断术和胃肠吻合术后增加组胺试验所达到的减少。Hunt和Douthwaite [3]每天给Poldine四次，剂量没有副作用;对试验餐的胃分泌减少了一半。这些作者还指出，连续服用波尔丁需要长达三周的时间才能发挥全部效果。Poldine在临床上是否有效见仁见智。“然而，似乎可以确定的是，根据患者调整剂量，胃酸分泌减少50%-几乎等于外科迷走神经切断术产生的胃酸分泌减少-通常没有副作用。此外，根据我们的经验，将剂量增加到产生副作用的剂量不会进一步减少胃分泌。有大量的临床意见支持抗胆碱能药物，如波尔定，如果这些药物使用得当。虽然关于科学证据的争论仍在继续，但假设有经验的临床医生必然会将安慰剂效应误认为药理学活性是不合理的，特别是因为有很好的理论理由期待抗胆碱能药物使这些患者受益。我们是，等等，J. N.亨特
SIR,-Your leader "Controlling Gastric Acid" (28 November, p. 510) states "Anticholinergic drugs act by reducing vagal activity. They are fully effective only when given in doses which cause undesirable side effects such as drowsiness, dryness of the mouth, blurring of vision, and difficulty with emptying the bladder." All this is true when these drugs are given in single doses. But when they are given four times a day, in the maximal dose that gives no side effects as determined by gradual escalation, the result is different. For example, Mitchell et al.' compared the reduction of acidity of the gastric contents obtained with atropine or poldine at doses that produced no side effects. The study was double blind, and the mean duration of the treatment was seven days with each drug given four times daily. The mean reduction in acidity of the gastric contents after ordinary food was 60% with atropine and about 80% or more with poldine. Seidelin2 studied gastric secretion of acid with doses of poldine that produced no side effects. Using the augmented histamine test he found a reduction of gastric secretion of acid by 50% after the patients had been treated for about three weeks. He pointed out that the reduction was close to that achieved with the augmented histamine test after vagotomy and gastroenterostomy. Hunt and Douthwaite3 gave poldine four times a day at doses which gave no side effects; gastric secretion in response to test meals was reduced by half. These authors also noted that the full effect of poldine took up to three weeks to develop on continuous dosage. Whether or not poldine is clinically effective is a matter of opinion.' However, it does seem to be established that at doses adjusted to the patient a reduction of gastric secretion of acid by 50%-nearly equal to that produced by surgical vagotomy-is commonly obtained without side effects. Moreover, increasing the dose to that which gives side effects does not in our experience reduce gastric secretion further. There is a substantial body of clinical opinion in favour of anticholinergic drugs such as poldine, if these are used properly. While argument continues about the scientific evidence it is unreasonable to assume that experienced clinicians are necessarily mistaking the placebo effect for pharmacological active, particularly as there are good theoretical reasons for expecting anticholinergic drugs to benefit these patients.-We are, etc., J. N. HUNT