Glare Paul A, Dunwoodie David, Clark Katherine, Ward Alicia, Yates Patsy, Ryan Sharon, Hardy Janet R
Pain and Palliative Care Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York 10021, USA.
Drugs. 2008;68(18):2575-90. doi: 10.2165/0003495-200868180-00004.
Nausea and vomiting is a common and distressing symptom complex in patients with far-advanced cancer, affecting up to 60% of individuals at some stage of their illness. The current approach to the palliative care of patients with nausea and vomiting is based on identifying the cause, understanding its pathophysiology and knowing the pharmacology of the drugs available for its amelioration. The following six main syndromes are identified: gastric stasis, biochemical, raised intracranial pressure, vestibular, mechanical bowel obstruction and ileus. A careful history, focused physical examination and appropriate investigations are needed to elucidate the syndrome and its cause, so that therapy is rational. Drugs are the mainstay of treatment in terminal cancer, and the main classes of antiemetic agents are prokinetics, dopamine antagonists, antihistamines, anticholinergics and serotonin antagonists. Dexamethasone and octreotide are also used, especially in bowel obstruction. Non-drug measures are important in relieving the associated distress. Patients should be able to die comfortably, without tubes. Despite decades of practice affirming this approach, the evidence base is weak and well designed studies are urgently needed.
恶心和呕吐是晚期癌症患者常见且令人痛苦的症状组合，在疾病的某些阶段影响多达60%的患者。目前针对恶心和呕吐患者的姑息治疗方法是基于确定病因、了解其病理生理学以及掌握可用于缓解症状的药物药理学。确定了以下六种主要综合征：胃潴留、生化性、颅内压升高、前庭性、机械性肠梗阻和麻痹性肠梗阻。需要仔细询问病史、进行针对性体格检查并开展适当的检查，以阐明综合征及其病因，从而使治疗合理。药物是晚期癌症治疗的主要手段，主要的止吐药物类别包括促动力药、多巴胺拮抗剂、抗组胺药、抗胆碱能药和5-羟色胺拮抗剂。地塞米松和奥曲肽也有使用，尤其是在肠梗阻时。非药物措施对于缓解相关痛苦很重要。患者应能够舒适地离世，无需插管。尽管数十年来一直采用这种方法，但证据基础薄弱，迫切需要设计完善的研究。
