Benze G, Alt-Epping B, Geyer A, Nauck F
Abteilung Palliativmedizin, Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland.
Schmerz. 2012 Sep;26(5):500-14. doi: 10.1007/s00482-012-1216-7.
Many recommendations concerning the treatment of nausea and vomiting in palliative care patients exist but what is the evidence for this? Most studies dealing with this topic have focused on cancer patients under chemotherapy and/or radiation therapy or on patients with postoperative nausea. Cancer patients without chemotherapy or radiation therapy, patients without postoperative nausea, and patients having other diseases with palliative care aspects, such as acquired immunodeficiency syndrome (AIDS), chronic obstructive pulmonary disease (COPD), progressive heart failure, amyotrophic lateral sclerosis (ALS) and multiple sclerosis (MS) have been underrepresented in studies on nausea and vomiting so far.
The aim of this review was to determine the level of evidence for the treatment of nausea and vomiting with prokinetics and neuroleptics in palliative care patients suffering from far advanced cancer and no longer being treated with chemotherapy or radiation therapy, AIDS, COPD, progressive heart failure, ALS or MS.
Two different electronic databases (PubMed und Embase) were used to identify studies. Furthermore, a hand search for related articles was performed. No restriction was made concerning study types. Studies with patients undergoing chemotherapy radiation therapy or suffering from postoperative nausea, pediatric studies and studies published neither in English nor in German were excluded.
A total of 30 studies fulfilling the inclusion criteria were found. All studies focused on cancer patients. Despite intensive research studies in patients with AIDS, COPD, heart failure, ALS or MS were not detected. Metoclopramide is seen as an effective drug in many studies whereas the evidence for it is moderate at best. Within the group of neuroleptics, levosupiride and levomepromazine seem to have good antiemetic potential but the evidence level is low.
In patients with advanced cancer not being treated with chemotherapy or radiation therapy, metoclopramide can be used to reduce nausea and vomiting. Neuroleptics, such as levosulpiride or levomepromazine are alternatives but their adverse effects have to be considered carefully. The evidence level for prokinetics and neuroleptics is moderate to low. Concerning palliative care of patients with diseases other than cancer no studies exist. More well designed studies in palliative care patients are needed in order to facilitate evidence based antiemetic therapy. The English full text version of this article will be available in SpringerLink as of November 2012 (under "Supplemental").
关于姑息治疗患者恶心和呕吐的治疗存在许多建议，但这些建议的依据是什么？大多数涉及该主题的研究都集中在接受化疗和/或放疗的癌症患者或术后恶心的患者身上。到目前为止，未接受化疗或放疗的癌症患者、无术后恶心的患者以及患有其他具有姑息治疗问题的疾病（如获得性免疫缺陷综合征（AIDS）、慢性阻塞性肺疾病（COPD）、进行性心力衰竭、肌萎缩侧索硬化症（ALS）和多发性硬化症（MS））的患者在恶心和呕吐研究中的代表性不足。
本综述的目的是确定在患有晚期癌症且不再接受化疗或放疗、AIDS、COPD、进行性心力衰竭、ALS或MS的姑息治疗患者中，使用促动力药和抗精神病药治疗恶心和呕吐的证据水平。
使用两个不同的电子数据库（PubMed和Embase）来识别研究。此外，还对手头相关文章进行了检索。对研究类型没有限制。排除了接受化疗放疗的患者或患有术后恶心的患者、儿科研究以及非英文或德文发表的研究。
共发现30项符合纳入标准的研究。所有研究都集中在癌症患者身上。尽管对AIDS、COPD、心力衰竭、ALS或MS患者进行了深入研究，但未检测到相关研究。在许多研究中，甲氧氯普胺被视为一种有效的药物，但其证据充其量只是中等水平。在抗精神病药组中，左舒必利和左美丙嗪似乎具有良好的止吐潜力，但证据水平较低。
在未接受化疗或放疗的晚期癌症患者中，可使用甲氧氯普胺来减轻恶心和呕吐。抗精神病药，如左舒必利或左美丙嗪是替代药物，但必须仔细考虑其不良反应。促动力药和抗精神病药的证据水平为中等至低水平。关于非癌症疾病患者的姑息治疗，尚无相关研究。需要对姑息治疗患者进行更多设计良好的研究，以促进基于证据的止吐治疗。本文的英文全文版本将于2012年11月在SpringerLink上提供（在“补充材料”下）。
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