Department of Emergency Medicine, Lehigh Valley Hospital and Health Network, CC & I-78, Allentown, PA 18103, USA.
Am J Emerg Med. 2012 Mar;30(3):514.e5-7. doi: 10.1016/j.ajem.2011.01.012. Epub 2011 Mar 29.
Hiccups, or singultus, are the result of spontaneous and repetitive contractions of the diaphragm. In most cases, episodes of singultus are benign and self-limited. However, prolonged attacks can result in significant discomfort, morbidity, and even death. Although the etiology of hiccups is theoretical at best, a wide array of treatments has been proposed with varying efficacy. Both pharmacologic and nonpharmacologic treatments target different components of the hiccup reflex, which includes the vagus and phrenic nerves, the respiratory center in the upper medulla, and the motor neurons in the diaphragm, glottis, and external intercostal muscles. In this case report, we describe the successful cessation of hiccups in a 9-year-old boy with a treatment called suboccipital release. With this approach, gentle traction and pressure is applied to the posterior neck, stretching the suboccipital muscles and fascia. The manual decompression of the vagus, and possibly phrenic, nerves interrupts the hiccup reflex and allows for normal autonomic function to be reestablished. We propose that the suboccipital release, noninvasive, simple, and with virtually no side effects, is an ideal initial treatment of singultus.
打嗝，又称呃逆，是由膈肌自发性、反复性收缩引起的。在大多数情况下，呃逆是良性的、自限性的。然而，长时间的打嗝会导致严重的不适、发病率甚至死亡。尽管打嗝的病因理论上最好，但已经提出了多种治疗方法，疗效不一。药物和非药物治疗针对呃逆反射的不同组成部分，包括迷走神经和膈神经、延髓上部的呼吸中枢以及膈肌、声门和肋间外肌的运动神经元。在本病例报告中，我们描述了一种名为枕下松解术的治疗方法成功停止了一名 9 岁男孩的打嗝。这种方法通过轻柔地牵拉和按压后颈部，拉伸枕下肌肉和筋膜，从而中断呃逆反射，恢复正常的自主神经功能。我们提出，枕下松解术无创、简单，几乎没有副作用，是治疗呃逆的理想初始方法。
