孕期恶心呕吐的女性管理。加拿大共识。
Managing women with nausea and vomiting of pregnancy. Canadian consensus.
出版信息
Can Fam Physician. 2000 Feb;46:299-301.
QUESTION
I have a 30-year-old pregnant patient who is asthmatic and is taking prednisone. Whenever she decreases her prednisone dose, her nausea increases tremendously even though she is taking two tablets of doxylamine and pyridoxine combination (Diclectin) daily. She is already at 26 weeks' gestation, and I really do not want her to continue the prednisone beyond what is needed for her asthma, but two attempts to taper prednisone off failed because of unbearable nausea.
ANSWER
Several controlled trials show the efficacy of prednisone for nausea and vomiting of pregnancy (NVP), but your case is fascinating in proving the point by challenge-rechallenge. You should try to decrease the prednisone while increasing doxylamine and pyridoxine to its recommended dose of two tablets before sleep, one in the morning, and on in the afternoon.
问题
我有一位30岁的哮喘孕妇，正在服用泼尼松。每当她减少泼尼松剂量时，她的恶心感就会大幅增加，尽管她每天服用两片多西拉敏和吡哆醇组合药物（迪克莱汀）。她现在已经怀孕26周了，我真的不想让她在哮喘所需剂量之外继续服用泼尼松，但由于无法忍受的恶心，两次尝试逐渐减少泼尼松剂量都失败了。
答案
多项对照试验表明泼尼松对妊娠恶心和呕吐（NVP）有效，但你的病例通过反复试验来证明这一点很有意思。你应该尝试在减少泼尼松剂量的同时，将多西拉敏和吡哆醇增加到推荐剂量，即在睡前服用两片，早上一片，下午一片。
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