METHODS: We included randomized controlled studies, quasi-randomized trials, case reports, clinical trials, systematic reviews, and meta-analyses assessing the use of atropine in patients with sialorrhea or drooling. The endpoints were reduction in salivary flow rate, amount of saliva secreted, reduction in clinical symptoms of sialorrhea, death rattle intensity, or reduction in drooling intensity as measured by an objective scale such as the drooling intensity scale.
RESULTS: A total of 56 studies with 2,378 patients were included in the systematic review. The underlying disease states included brain injury, amyotrophic lateral sclerosis, cerebral palsy, clozapine- and perphenazine-induced sialorrhea, Parkinson\'s disease, and terminal illness. The routes of atropine administration included sublingual, intravenous, subcutaneous, oral tablet or solution, and direct injection of atropine into parotid glands or at the base of the tongue. The generalized estimated equation regression models showed that sublingual administration is superior to oral and subcutaneous routes.
CONCLUSIONS: Atropine is efficacious in managing sialorrhea in most disease states. Sublingual administration of atropine is superior to other routes of administration in reducing salivary flow in patients with sialorrhea.
方法:我们纳入了随机对照研究,准随机试验,病例报告,临床试验,系统评价,和荟萃分析评估阿托品在流涎或流口水患者中的使用。终点是唾液流速降低,分泌的唾液量,减少流涎的临床症状,死亡拨浪鼓强度,或如通过客观尺度(诸如流口水强度尺度)测量的流口水强度的降低。
结果:共有56项研究纳入了2,378例患者的系统评价。潜在的疾病状态包括脑损伤,肌萎缩侧索硬化,脑瘫,氯氮平和奋乃静引起的流涎,帕金森病,和绝症。阿托品的给药途径包括舌下,静脉注射,皮下,口服片剂或溶液,和阿托品直接注射到腮腺或舌根。广义估计方程回归模型表明,舌下给药优于口服和皮下途径。
结论:阿托品在大多数疾病状态下可有效控制流涎。阿托品舌下给药在减少流涎患者的唾液流量方面优于其他给药途径。