Johnson W H, Fenton R S, Evans A
Laryngoscope. 1976 Jul;86(7):946-54. doi: 10.1288/00005537-197607000-00007.
The chemo-therapy of vestibular disease has involved a wide spectrum of pharmacological agents insofar as their mode of action is concerned. In our experience, however, droperidol is one pharmaceutical agent which is remarkably effective in depressing vestibular disturbance regardless of etiology. This medication (also called Inapsine) belongs to a relatively new class of compounds known as butyrophenones and its pharmacological action can best be described as a dopa blocking agent. The activity of droperidol on the nervous system first became evident when it was used in combination with the potent analgesic fentanyl citrate in order to produce an anesthetic condition that has been termed neuroleptanalgesia. This mixture (also called Innovar) is rapid in action and results in complete suppression of vestibular activity of both normal subjects and those with Ménière's disease as described by Dowdy, et al., in a preliminary report. These impressive results have prompted us to evaluate the effectiveness of this medication in the treatment of different disorders of the labyrinth. The patients chosen for evaluation were referred for vestibular examination at the Toronto General and St. Michael's Hospitals. Electronystagmography was used to record objectively the effects of the drugs being tested while subjective symptoms including side effects were also noted. These studies involved 20 patients receiving Innovar while 12 patients were tested with Inapsine. Innovar administered in a single dose (droperidol 5 mg, fentanyl 0.1 mg) to patients undergoing acute episodes of vestibular disease (vestibular neuronitis and Ménière's disease) was found effective in the following symptoms and/or signs: nausea, vertigo, nystagmus, the positive past-pointing test and the Romberg test. Innovar appeared to be effective in the amelioration of vomiting although the population was too small to demonstrate statistical significance in this regard. The drug mixture appeared to have no effect on improving auditory acuity and had no significant effects on tinnitus. Adverse reactions to the drug combination were unusual, and, occurring in three patients, were mild as manifested by drowsiness. Since the above findings confirmed the marked effectiveness of the fentanyl-droperidol mixture in the management of vestibular disease, it was decided to determine the relative effectiveness of the droperidol component alone and this was determined by comparing the effectiveness of the drug with placebo in a double-blind study. Review of our findings involving this double-blind study indicates significant responses to Inapsine. This therapy clearly provided the statistically significant response (p less than 0.1, Fisher's Exact Test). This was particularly apparent at the 60-minute evaluation point. While some of the patients receiving Inapsine had recovered earlier, by 60 minutes none of the placebo patients but all of the Inapsine patients had recovered from the vestibular symptoms of Ménière's disease...
就作用方式而言，前庭疾病的化学疗法涉及多种药理剂。然而，根据我们的经验，氟哌利多是一种无论病因如何，在抑制前庭紊乱方面都非常有效的药剂。这种药物（也称为氟哌啶醇）属于一类相对较新的化合物，称为丁酰苯类，其药理作用最好描述为多巴胺阻断剂。当氟哌利多与强效镇痛药枸橼酸芬太尼联合使用以产生一种称为神经安定镇痛的麻醉状态时，其对神经系统的活性首次变得明显。这种混合物（也称为 Innovar）起效迅速，正如 Dowdy 等人在一份初步报告中所描述的那样，能完全抑制正常受试者和梅尼埃病患者的前庭活动。这些令人印象深刻的结果促使我们评估这种药物在治疗不同迷路疾病中的有效性。被选来进行评估的患者是被转诊到多伦多综合医院和圣迈克尔医院进行前庭检查的。眼震电图被用来客观记录所测试药物的效果，同时也记录包括副作用在内的主观症状。这些研究涉及 20 名接受 Innovar 治疗的患者，而 12 名患者接受了氟哌啶醇的测试。给患有前庭疾病急性发作（前庭神经炎和梅尼埃病）的患者单次注射 Innovar（氟哌利多 5 毫克，芬太尼 0.1 毫克），发现对以下症状和/或体征有效：恶心、眩晕、眼球震颤、指向试验阳性和闭目直立试验阳性。Innovar 在改善呕吐方面似乎是有效的，尽管样本量太小，无法在这方面显示出统计学意义。这种药物混合物似乎对提高听力没有作用，对耳鸣也没有显著影响。对这种药物组合的不良反应并不常见，有三名患者出现了不良反应，表现为嗜睡，症状较轻。由于上述发现证实了芬太尼 - 氟哌利多混合物在前庭疾病治疗中的显著有效性，因此决定确定单独使用氟哌利多成分的相对有效性，这是通过在一项双盲研究中比较该药物与安慰剂的有效性来确定的。对我们涉及这项双盲研究的结果进行回顾表明，患者对氟哌啶醇有显著反应。这种疗法显然提供了具有统计学意义的反应（p 小于 0.1，Fisher 精确检验）。这在 60 分钟的评估点尤为明显。虽然一些接受氟哌啶醇治疗的患者恢复得更早，但到 60 分钟时，没有一名安慰剂组患者从梅尼埃病的前庭症状中恢复，而所有氟哌啶醇组患者都已恢复……
