Flake Zachary A, Linn Becky S, Hornecker Jaime R
Banner Medical Group, Loveland, CO, USA.
University of Wyoming, Fort Collins, CO, USA.
Am Fam Physician. 2015 Mar 1;91(5):293-6.
Nausea and vomiting are mediated primarily by three neurotransmitter pathways: visceral stimulation releases dopamine and serotonin; vestibular and central nervous system activation release histamine and acetylcholine; and chemoreceptor trigger zone activation releases dopamine and serotonin. Clinicians can improve the effectiveness and cost-effectiveness of treatments by targeting the appropriate pathways. Antihistamines and anticholinergics are most effective in patients with vestibular-mediated nausea secondary to vertigo. Serotonin antagonists block serotonin in the intestines and chemoreceptor trigger zone, and are most effective for treating gastroenteritis. Dopamine antagonists block dopamine in the intestines and chemoreceptor trigger zone; indications for these agents are similar to those for serotonin antagonists. For treatment of mild pregnancy-induced nausea, pyridoxine with or without doxylamine is recommended, and ginger may also be effective. In patients with migraine headache-associated nausea, metoclopramide improves response to oral anti-migraine agents. Ondansetron reduces nausea and vomiting in children with acute gastroenteritis and in women with hyperemesis gravidarum.
内脏刺激释放多巴胺和5-羟色胺；前庭及中枢神经系统激活释放组胺和乙酰胆碱；化学感受器触发区激活释放多巴胺和5-羟色胺。临床医生可通过针对适当途径来提高治疗的有效性和成本效益。抗组胺药和抗胆碱能药对因眩晕继发前庭介导性恶心的患者最为有效。5-羟色胺拮抗剂可阻断肠道及化学感受器触发区的5-羟色胺，对治疗肠胃炎最为有效。多巴胺拮抗剂可阻断肠道及化学感受器触发区的多巴胺；这些药物的适应证与5-羟色胺拮抗剂相似。对于轻度妊娠剧吐，推荐使用含或不含多西拉敏的维生素B6，生姜可能也有效。对于偏头痛相关性恶心患者，甲氧氯普胺可改善口服抗偏头痛药物的疗效。昂丹司琼可减轻急性肠胃炎患儿及妊娠剧吐女性的恶心和呕吐。
