Alhashimi Dunia, Al-Hashimi Hakima, Fedorowicz Zbys
Paediatrics, Salmaniya Medical Complex, Box 12, Manama, Bahrain.
Cochrane Database Syst Rev. 2009 Apr 15(2):CD005506. doi: 10.1002/14651858.CD005506.pub4.
Vomiting caused by acute gastroenteritis is very common in children and adolescents. Treatment of vomiting in children can be problematic and the use of antiemetics remains a controversial issue. There have been concerns expressed about apparently unacceptable levels of side effects such as sedation and extrapyramidal reactions, which are associated with some of the earlier generation of antiemetics.
To assess the effectiveness of antiemetics on gastroenteritis induced vomiting in children and adolescents.
We searched the Cochrane Central register of Controlled Trials (CENTRAL), which includes the Cochrane Upper Gastrointestinal and Pancreatic Diseases Group Trials Register (searched 28 July 2005), MEDLINE (1966 to July 2005) and EMBASE (1980 to July 2005). Published abstracts from conference proceedings from the United European Gastroenterology Week and Digestive Disease Week were handsearched. Cochrane UGPD Group members were contacted for details of any ongoing or relevant unpublished clinical trials. The search was re-run on 12th July 2006 and 24th June 2008 and two further trials were found.
Randomised controlled trials comparing antiemetics and/or placebo in children and adolescents, under the age of 18, with vomiting due to gastroenteritis.
Two reviewers independently assessed trial quality and extracted data. Study investigators were contacted for additional information.
Four trials involving 501 participants were included. No data was available for the precise time to cessation of vomiting: one trial reported a higher proportion of patients without vomiting over 24 hours in the ondansetron and metoclopramide groups than placebo. Oral ondansetron in one trial ensured cessation of emesis for 8/12 (67%) patients within the first 4 hours and 7/12 (58%) patients in the first 24 hr period. In one trial 14% of patients who received oral ondansetron vomited during oral rehydration compared to 35% to the placebo group. In a further trial intravenous rehydration was required in 21.6% (ondansetron group) versus 54.5% (placebo group) P< 0.001.
AUTHORS' CONCLUSIONS: The small number of included trials provided some limited evidence favouring the use of ondansetron and metoclopramide over placebo to reduce the number of episodes of vomiting due to gastroenteritis in children. The increased incidence of diarrhea with both ondansetron and metoclopramide was considered to be as a result of retention of fluids and toxins that would otherwise have been eliminated through the process of vomiting.
急性肠胃炎引起的呕吐在儿童和青少年中非常常见。儿童呕吐的治疗可能存在问题，使用止吐药仍然是一个有争议的问题。人们对某些早期一代止吐药明显不可接受的副作用水平表示担忧，如镇静作用和锥体外系反应。
评估止吐药对儿童和青少年肠胃炎所致呕吐的疗效。
我们检索了Cochrane对照试验中心注册库（CENTRAL），其中包括Cochrane上消化道和胰腺疾病组试验注册库（2005年7月28日检索）、MEDLINE（1966年至2005年7月）和EMBASE（1980年至2005年7月）。对欧洲胃肠病学联合周和消化系统疾病周会议论文集发表的摘要进行了手工检索。联系了Cochrane UGPD组成员以获取任何正在进行或相关未发表临床试验的详细信息。2006年7月12日和2008年6月24日重新进行了检索，又发现了两项试验。
比较止吐药和/或安慰剂在18岁以下因肠胃炎呕吐的儿童和青少年中的随机对照试验。
两位评价者独立评估试验质量并提取数据。联系研究调查人员以获取更多信息。
纳入了四项涉及501名参与者的试验。没有关于呕吐停止的确切时间的数据：一项试验报告说，与安慰剂相比，昂丹司琼和甲氧氯普胺组在24小时内无呕吐的患者比例更高。一项试验中，口服昂丹司琼使8/12（67%）的患者在最初4小时内停止呕吐，7/12（58%）的患者在最初24小时内停止呕吐。在一项试验中，接受口服昂丹司琼的患者中有14%在口服补液期间呕吐，而安慰剂组为35%。在另一项试验中，21.6%（昂丹司琼组）的患者需要静脉补液，而安慰剂组为54.5%，P<0.001。
纳入试验数量较少，提供了一些有限的证据，表明与安慰剂相比，使用昂丹司琼和甲氧氯普胺可减少儿童肠胃炎所致呕吐发作的次数。昂丹司琼和甲氧氯普胺腹泻发生率增加被认为是由于液体和毒素的潴留，否则这些物质会通过呕吐过程排出。
