Department of Emergency Medicine, University of New Mexico, Albuquerque, New Mexico 87131, USA.
Prehosp Emerg Care. 2012 Oct-Dec;16(4):463-8. doi: 10.3109/10903127.2012.695430. Epub 2012 Jun 28.
Antiemetics have been shown to be effective in multiple hospital settings, but few studies have been done in the prehospital environment.
Our hypotheses were 1) that the amount of normal saline administered during an emergency medical services (EMS) transport was not related to a change in nausea and vomiting and 2) that the addition of the ondansetron orally disintegrating tablet (ODT) would decrease the degree of nausea.
This was a pre-post study of two cohorts of consecutive patients with nausea in the prehospital setting. During phase 1 of the study, our local EMS agency adopted a protocol form to complete whenever a patient with nausea and/or vomiting was assessed and transported to one of the area hospitals. Patients were asked to rate their nausea on a visual analog scale (VAS) and a Likert scale, and saline administration and active vomiting were documented. During phase 2, our EMS system adopted the use of ondansetron ODT for nausea and continued to complete the same forms. The nausea forms completed by EMS during phase 1 (saline only) and phase 2 (ondansetron ODT) were evaluated and compared. For both phases, the primary outcome measures were the change in VAS nausea rating (0 = no nausea, 100 = most nausea imaginable) from beginning to end of the transport and the results on the Likert scale completed at the end of the transport. Relationships were considered significant if p < 0.01.
Data were collected from 274 transports in phase 1 and 372 transports in phase 2. The average patient age was 50 ± 12 years. In phase 1 of the study, 178 of 274 patients (65%) received normal saline (mean volume ± standard deviation = 265 ± 192 mL). There was no significant correlation between the VAS change and the amount of fluid administration in either phase of the study. Conversely, during phase 2, patients receiving ondansetron ODT showed significant improvement in both measures of nausea. The difference in nausea improvement between phase 1 and phase 2 was significant (difference in VAS change: 24.6; 95% confidence interval 20.9, 28.3).
There was no improvement in patient nausea related to quantity of saline alone during an EMS transport. The addition of ondansetron ODT resulted in a significant improvement in degree of nausea.
止吐药已被证明在多种医院环境中有效，但在院前环境中进行的研究较少。
我们的假设是 1）在紧急医疗服务（EMS）转运过程中给予的生理盐水量与恶心和呕吐的变化无关，2）口服昂丹司琼分散片（ODT）的添加会降低恶心程度。
这是一项针对院前环境中恶心的两批连续患者的前后研究。在研究的第一阶段，我们当地的 EMS 机构采用了一种方案表，每当评估并将恶心和/或呕吐的患者转运到该地区的一家医院时，都要填写该表。患者被要求在视觉模拟量表（VAS）和李克特量表上对其恶心程度进行评分，并记录生理盐水的给予情况和主动呕吐情况。在第二阶段，我们的 EMS 系统采用昂丹司琼 ODT 治疗恶心，并继续填写相同的表格。对第一阶段（仅生理盐水）和第二阶段（昂丹司琼 ODT）期间由 EMS 完成的恶心表格进行评估和比较。在两个阶段中，主要的结局指标是从转运开始到结束时 VAS 恶心评分的变化（0 =无恶心，100 =可想象的最恶心），以及转运结束时完成的李克特量表的结果。如果 p < 0.01，则认为关系具有统计学意义。
第一阶段共收集了 274 次转运的数据，第二阶段共收集了 372 次转运的数据。患者的平均年龄为 50 ± 12 岁。在研究的第一阶段，274 名患者中有 178 名（65%）接受了生理盐水（平均体积 ± 标准差= 265 ± 192 mL）。在两个研究阶段中，生理盐水的给予量与 VAS 变化均无显著相关性。相反，在第二阶段，接受昂丹司琼 ODT 的患者在恶心的两种测量方法上均有显著改善。第一阶段和第二阶段之间恶心改善的差异具有统计学意义（VAS 变化差异：24.6；95%置信区间 20.9，28.3）。
在 EMS 转运过程中，仅给予生理盐水不能改善患者的恶心症状。添加昂丹司琼 ODT 可显著改善恶心程度。
