Kumar A, Dromerick A W
Division of Rehabilitation, Washington University School of Medicine, St Louis, MO, USA.
Arch Phys Med Rehabil. 1998 Jun;79(6):697-9. doi: 10.1016/s0003-9993(98)90047-8.
To study the frequency of intractable hiccups during stroke rehabilitation and the impact on rehabilitation management.
Case series, retrospective chart review.
Inpatient stroke rehabilitation floor within a tertiary care teaching hospital.
Three patients admitted for stroke rehabilitation with hiccups of at least 48 hours out of 270 consecutive cases.
None.
Response to pharmacologic treatment.
All three subjects had pontine infarcts and required gastrostomy tube feedings and lengthy rehabilitation stays. Subjects suffered from significant complications including aspiration pneumonia, respiratory arrest, and nutritional depletion. Chlorpromazine treatment was terminated in all three subjects because of sedation that interfered with therapies. Treatment with carbamazepine was successful in only one patient; in the other two subjects, their hiccups were controlled with haloperidol or baclofen. All subjects were ultimately managed with a single agent.
Pharmacologic interventions for intractable hiccups must be tailored to the unique circumstances of the stroke rehabilitation patient. Intractable hiccups can be associated with potentially fatal consequences, and safe management may require an inpatient rehabilitation setting and multidisciplinary team approach to optimize the feeding management of this challenging population.
研究中风康复期间顽固性呃逆的发生率及其对康复管理的影响。
病例系列，回顾性病历审查。
三级护理教学医院的住院中风康复病房。
270例连续病例中，3例因中风康复入院且呃逆至少持续48小时。
无。
药物治疗的反应。
所有3名受试者均为脑桥梗死，需要胃造瘘管喂养且康复住院时间较长。受试者出现了包括吸入性肺炎、呼吸骤停和营养消耗在内的严重并发症。由于镇静作用干扰治疗，所有3名受试者的氯丙嗪治疗均终止。卡马西平治疗仅在1例患者中成功；在另外2例受试者中，呃逆通过氟哌啶醇或巴氯芬得到控制。所有受试者最终均采用单一药物治疗。
针对顽固性呃逆的药物干预必须根据中风康复患者的独特情况进行调整。顽固性呃逆可能会带来潜在的致命后果，安全管理可能需要住院康复环境和多学科团队方法，以优化对这一具有挑战性人群的喂养管理。
