Marinella Mark A
Department of Internal Medicine, Wright State University School of Medicine, Dayton, Ohio, USA.
J Support Oncol. 2009 Jul-Aug;7(4):122-7, 130.
Benign, self-limited hiccups are more of a nuisance, but persistent and intractable hiccups lasting more than 48 hours and 1 month, respectively, are a source of significant morbidity in the patient with advanced malignancy.The hiccup reflex is complex, but stimulation of vagal afferents followed by activation of efferent phrenic and intercostal nerve pathways results in contraction of the diaphragm and intercostal muscles, respectively.The etiology of hiccups in the cancer and palliative care population may include chemotherapy, electrolyte derangements, esophagitis, and neoplastic involvement of the central nervous system (CNS), thorax, and abdominal cavity. Prolonged hiccups can result in depression, fatigue, impaired sleep, dehydration, weight loss, malnutrition, and aspiration syndromes. Evaluation should be symptom-directed, focusing mainly upon the CNS and thoracoabdominal cavities as well as assessment of medications and serum chemistries. Most patients with ongoing hiccups require pharmacotherapy, with chlorpromazine being the only US Food and Drug Administration-approved agent. However, numerous other medications have been reported to be efficacious for treating intractable hiccups. Gabapentin has recently been shown to terminate hiccups effecitvely in cancer patients and may emerge as a therapy of choice in the palliative setting due to favorable tolerability, pain-modulating effects, minimal adverse events, and lack of drug interactions.
良性、自限性呃逆更多只是一种困扰，但持续且难治的呃逆，分别持续超过48小时和1个月，对于晚期恶性肿瘤患者而言是严重发病的一个根源。呃逆反射很复杂，但刺激迷走神经传入纤维，随后激活传出的膈神经和肋间神经通路，会分别导致膈肌和肋间肌收缩。癌症及姑息治疗人群中呃逆的病因可能包括化疗、电解质紊乱、食管炎以及中枢神经系统（CNS）、胸部和腹腔的肿瘤累及。持续性呃逆可导致抑郁、疲劳、睡眠障碍、脱水、体重减轻、营养不良和误吸综合征。评估应以症状为导向，主要关注中枢神经系统以及胸腹腔，同时评估药物和血清化学指标。大多数持续呃逆的患者需要药物治疗，氯丙嗪是唯一经美国食品药品监督管理局批准的药物。然而，据报道许多其他药物对治疗难治性呃逆也有效。加巴喷丁最近已被证明能有效终止癌症患者的呃逆，并且由于耐受性良好、有疼痛调节作用、不良事件极少且无药物相互作用，可能会成为姑息治疗环境中的一种首选疗法。
