胃轻瘫的症状管理:止吐药、镇痛药和症状调节剂。
Symptomatic management for gastroparesis: antiemetics, analgesics, and symptom modulators.
作者信息
Hasler William L
机构信息
Division of Gastroenterology, University of Michigan Health System, 3912 Taubman Center, SPC 5362, Ann Arbor, MI 48109, USA.
出版信息
Gastroenterol Clin North Am. 2015 Mar;44(1):113-26. doi: 10.1016/j.gtc.2014.11.009. Epub 2014 Dec 26.
Although prokinetic agents typically are used for gastroparesis, antiemetic, analgesic, and neuromodulatory medications may help manage nausea, vomiting, pain, or discomfort. Antiemetic benefits are supported by few case reports. An open series reported symptom reductions with transdermal granisetron in gastroparesis. Opiates are not advocated in gastroparesis because they worsen nausea and delay emptying. Neuromodulators have theoretical utility, but the tricyclic agent nortriptyline showed no benefits over placebo in an idiopathic gastroparesis study raising doubts about this strategy. Neurologic and cardiac toxicities of these medications are recognized. Additional controlled study is warranted to define antiemetic, analgesic, and neuromodulator usefulness in gastroparesis.
尽管促动力药通常用于治疗胃轻瘫,但止吐药、镇痛药和神经调节剂可能有助于控制恶心、呕吐、疼痛或不适。仅有少数病例报告支持止吐药的疗效。一项开放性研究系列报告称,透皮应用格拉司琼可减轻胃轻瘫患者的症状。胃轻瘫患者不提倡使用阿片类药物,因为它们会加重恶心并延迟胃排空。神经调节剂在理论上有应用价值,但在一项特发性胃轻瘫研究中,三环类药物去甲替林并未显示出比安慰剂更有优势,这引发了对该策略的质疑。这些药物的神经和心脏毒性是公认的。有必要进行更多对照研究,以明确止吐药、镇痛药和神经调节剂在胃轻瘫治疗中的有效性。