Metoclopramide加Diphenhydramine對於懷孕時的嚴重噁心、嘔吐有幫助


  May 18, 2009 — 根據5月European Journal of Obstetrics & Gynecology and Reproductive Biology期刊中報導的回溯世代研究結果,併用metoclopramide與diphenhydramine有助於妊娠劇吐(hyperemesis gravidarum,HG),也就是懷孕時的嚴重噁心與嘔吐。
  
  加拿大魁北克蒙特婁大學的Anais Lacasse等人寫道,HG是懷孕期間住院的第二高原因。自2002年,新的HG治療規範納入併用metoclopramide加diphenhydramine,於加拿大魁北克蒙特婁大學附屬的CHU Sainte-Justine施行。
  
  本研究的目標在評估這個新的HG規範的效果,包括因為HG住院的天數、再度住院比率、噁心與嘔吐症狀的改變、副作用比率。
  
  從2002至2006年,CHU Sainte-Justine有130名診斷有HG的孕婦使用新的規範,包括靜脈(IV)注射metoclopramide、速率1.2-1.8 mg/小時,加上每6小時注射diphenhydramine 50 mg。將這些婦女的結果和歷史對照組的99個HG婦女:於1998至2001年間,同樣在CHU Sainte-Justine、使用IV droperidol 0.5 -1 mg/小時,加上每6小時注射diphenhydramine 25- 50 mg的結果進行比較。
  
  相較於使用droperidol的舊規範,新規範與嘔吐症狀改善較多有關(36% vs 21%;P = .0397),且較少副作用。兩種規範在減少噁心症狀、住院期間(3.7天vs 3.1天)、因為HG再度住院率(19.23% vs 24.44%)的比率相似。
  
  研究作者寫道,新規範併用metoclopramide以及diphenhydramine,可以作為妊娠劇吐處置的好選項。併用metoclopramide以及diphenhydramine可改善較多的嘔吐症狀且副作用較少。
  
  研究限制包括,兩個研究組之間初次住院時的HG狀態不同(但兩組之間在首次住院的第1天的嘔吐症狀嚴重度沒有差異)。其他限制包括缺乏血比容、肝功能、血中尿素或肌酸酐的資料;研究樣本少,懷孕期間併用metoclopramide 以及diphenhydramine的安全性相關結論有限。
  
  研究作者結論表示,新的HG規範在改善噁心症狀、住院天數以及因為HG再度住院這些方面,並未優於併用droperidol以及diphenhydramine。不過,就使用droperidol的安全性考量 ,新方法是正確的。
  
  研究作者宣告沒有相關財務關係。
  

Metoclopramide Plus Diphenhydramine Helpful for Severe Nausea, Vomiting During Pregnancy

By Laurie Barclay
Medscape Medical News

May 18, 2009 — A protocol including metoclopramide plus diphenhydramine may be helpful for hyperemesis gravidarum (HG), the most severe form of nausea and vomiting during pregnancy, according to the results of a retrospective cohort study reported in the May issue of the European Journal of Obstetrics & Gynecology and Reproductive Biology.

"[HG] is the second most common reason for hospitalisation during pregnancy," write Anais Lacasse, BSc, from the University of Montreal in Quebec, Canada, and colleagues. "Since 2002, a new HG treatment protocol consisting of metoclopramide plus diphenhydramine was put in place at CHU Sainte-Justine, affiliated to University of Montreal, Quebec, Canada.

The objectives of this study were to evaluate the effectiveness of this new HG protocol regarding length of hospitalisation for HG, rate of rehospitalisation, evolution of nausea and vomiting symptoms, and rate of adverse events."

From 2002 to 2006, 130 pregnant women diagnosed with HG were treated at CHU Sainte-Justine with the new protocol, consisting of intravenous (IV) metoclopramide 1.2 to 1.8 mg/hour plus diphenhydramine 50 mg every 6 hours. Outcomes in these women were compared with those in a historical control group of 99 women with HG who were treated in the same institution between 1998 and 2001 with IV droperidol 0.5 to 1 mg/hour plus diphenhydramine 25 to 50 mg every 6 hours.

Compared with the old protocol including droperidol, the new protocol was associated with greater improvement in vomiting symptoms (36% vs 21%; P = .0397), with fewer adverse events. Both protocols were associated with similar rates of reduction in nausea symptoms, length of hospitalization (3.7 days vs 3.1 days), and rate of rehospitalisation for HG (19.23% vs 24.44%).

"The new protocol consisting of the combination of metoclopramide and diphenhydramine appears to be a good option in the management of hyperemesis gravidarum," the study authors write. "The combination metoclopramide and diphenhydramine was associated with a higher improvement of vomiting symptoms, and fewer adverse events."

Limitations of this study include that the baseline HG status at first hospitalization was different between the 2 study groups (but the severity of vomiting symptoms on day 1 of the first hospitalization was not different between groups). Other limitations include a lack of data for hematocrit, liver function, blood urea, or creatinine; and a small sample size, limiting conclusions on the safety of metoclopramide plus diphenhydramine during pregnancy.

"The new HG protocol was not better than the droperidol and diphenhydramine combination when looking at improvement of nausea symptoms, length of hospitalisation, and rehospitalisations for HG," the study authors conclude." However, its use is justified given safety concerns regarding the use of droperidol."

The study authors have disclosed no relevant financial relationships.

Eur J Obstet Gynecol Reprod Biol. 2009:143:43-49.

    
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