Wheeler-Usher D H, Wanke L A, Bayer M J
Med Toxicol. 1986 Mar-Apr;1(2):142-53. doi: 10.1007/BF03259833.
This review examines the various clinical options used to elicit gastric emptying, viz. drug-induced emesis, mechanical pharyngeal stimulation, gastric lavage, and catharsis. Apomorphine and syrup of ipecac are the 2 drugs most frequently used for induction of emesis. Both agents act centrally and, in addition, syrup of ipecac has a peripheral action. Toxins ingested or foods previously eaten may inhibit or enhance emetic action by interfering with mediating and conducting mechanisms. Studies indicate that both syrup of ipecac and apomorphine are similarly effective in inducing emesis; however, apomorphine has a shorter reaction time compared with syrup of ipecac. There are more risks involved with the use of apomorphine, since it causes central nervous system and respiratory depression. Syrup of ipecac has been shown to be relatively safe when used in its recommended dosage for emesis. However, several toxicities have been reported with the use of the fluid extract of ipecac. Emesis is contraindicated in patients who are obtunded or comatose, and in patients who have ingested stimulants, some hydrocarbons, or corrosives. Mechanical pharyngeal stimulation is a simple method of inducing emesis; however, it is often unsuccessful and rarely recovers a significant portion of the gastric contents. Gastric lavage is a procedure which has been relied upon for over a century. Its effectiveness is dependent on the nature, form, and dosage of the poison, latency between time of ingestion and lavage, and technique. In clinical experiments studying gastric lavage, it has been noted that the procedure is most beneficial 1 to 2 hours postingestion for the majority of poison ingestions. Lavage also provides an excellent route for activated charcoal and selected antidotes. Gastric lavage may pose several risks to the patient, including obstruction and contamination of the airways and oesophageal damage. Contraindications for gastric lavage are similar to those for emesis except that it may be safer to use in obtunded, comatose, or uncooperative patients. Cathartics used during initial poisoning therapy are usually the saline cathartics. They elicit an osmotic reaction in the small intestine which results in increased intraluminal fluid bulk, hyperperistalsis, and subsequent propulsion of contents. Cathartics have also been shown to stimulate the secretion of cholecystokinin, which is thought to have similar effects on the intestine. Cathartics have not been shown to significantly enhance drug elimination from the gastrointestinal tract.(ABSTRACT TRUNCATED AT 400 WORDS)
本综述探讨了用于引发胃排空的各种临床方法，即药物诱发呕吐、机械性咽部刺激、洗胃和导泻。阿扑吗啡和吐根糖浆是最常用于诱发呕吐的两种药物。这两种药物均作用于中枢，此外，吐根糖浆还有外周作用。摄入的毒素或之前食用的食物可能通过干扰介导和传导机制来抑制或增强催吐作用。研究表明，吐根糖浆和阿扑吗啡在诱发呕吐方面同样有效；然而，与吐根糖浆相比，阿扑吗啡的反应时间更短。使用阿扑吗啡存在更多风险，因为它会导致中枢神经系统和呼吸抑制。吐根糖浆按推荐剂量用于催吐时已被证明相对安全。然而，使用吐根流浸膏已报告有几种毒性反应。对于意识不清或昏迷的患者以及摄入了兴奋剂、某些碳氢化合物或腐蚀性物质的患者，催吐是禁忌的。机械性咽部刺激是一种诱发呕吐的简单方法；然而，它通常不成功，很少能排出大部分胃内容物。洗胃是一个已被依赖了一个多世纪的程序。其有效性取决于毒物的性质、形态和剂量、摄入时间与洗胃时间之间的间隔以及技术。在研究洗胃的临床实验中，已注意到对于大多数毒物摄入情况，该程序在摄入后1至2小时最为有益。洗胃还为活性炭和特定解毒剂提供了一条极佳的途径。洗胃可能给患者带来多种风险，包括气道阻塞和污染以及食管损伤。洗胃的禁忌证与催吐的禁忌证相似，只是在意识不清、昏迷或不合作的患者中使用可能更安全。初始中毒治疗期间使用的泻药通常是盐类泻药。它们在小肠中引发渗透反应，导致肠腔内液体量增加、蠕动亢进，随后促使内容物推进。泻药还被证明能刺激胆囊收缩素的分泌，而胆囊收缩素被认为对肠道有类似作用。尚未证明泻药能显著增强药物从胃肠道的清除。（摘要截取自400字）
