Taylor Grace H, Schwaitzberg Steven D
Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States.
Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States.
Int J Surg Case Rep. 2015;11:121-123. doi: 10.1016/j.ijscr.2015.04.036. Epub 2015 May 5.
Symptoms of severe intestinal dysmotility decrease patients' quality of life and may prevent them from sustaining adequate oral intake. Dronabinol is a synthetic cannabinoid that is labeled for use in AIDS-related anorexia and chemotherapy-associated nausea and vomiting that has additional efficacy in patients with other etiologies of nausea, vomiting, and anorexia.
We present a 58-year-old female with a history of nausea, vomiting, abdominal pain, and inability to maintain oral intake after multiple laparotomies for ectopic pregnancy, recurrent caecal volvulus, and cholecystitis. After eight years of unsuccessful trials of medicines, dietary modifications, and a partial colectomy, she began a trial of dronabinol, which caused almost complete remission of her symptoms. When this medication was discontinued by her payer, she was unable to maintain oral intake and therefore, was admitted to the hospital for fluid resuscitation and resumption of dronabinol.
The use of dronabinol in this patient with severe intestinal dysmotility allowed her to maintain her nutritional status orally and obviated the need for enteral or parenteral feeding. Unfortunately, it was not covered by her insurance company for this indication.
Dronabinol has the potential to improve quality of life for patients beyond those undergoing chemotherapy or suffering from AIDS. Lack of access to this medicine for patients with intestinal dysmotility after all other modalities have been tried can lead to morbid and expensive complications, such as inpatient admission and surgery for enteral access.
严重肠道动力障碍的症状会降低患者的生活质量，并可能使他们无法维持足够的经口摄入量。屈大麻酚是一种合成大麻素，被批准用于治疗艾滋病相关的厌食症以及化疗引起的恶心和呕吐，对患有其他病因引起的恶心、呕吐和厌食症的患者也有额外疗效。
我们报告一名58岁女性，有恶心、呕吐、腹痛病史，因异位妊娠、复发性盲肠扭转和胆囊炎多次剖腹手术后无法维持经口摄入。在经过八年的药物试验、饮食调整和部分结肠切除术均未成功后，她开始试用屈大麻酚，症状几乎完全缓解。当她的付款人停用这种药物后，她无法维持经口摄入，因此入院进行液体复苏并重新使用屈大麻酚。
在这名严重肠道动力障碍患者中使用屈大麻酚，使她能够通过口服维持营养状况，避免了肠内或肠外营养的需要。不幸的是，保险公司未为此适应症承保。
屈大麻酚有可能改善除接受化疗或患有艾滋病之外的患者的生活质量。在尝试了所有其他治疗方法后，肠道动力障碍患者无法获得这种药物可能会导致诸如住院和进行肠内通路手术等病态且昂贵的并发症。
