Gastric emptying in hyperemesis gravidarum and non-dyspeptic pregnancy

BACKGROUND: Emesis and hyperemesis are significant problems associated with early pregnancy. However, gastric emptying of solids has never been studied during early pregnancy in humans. AIM: To investigate gastric emptying of solids in patients recovering from hyperemesis gravidarum and in non-dyspeptic pregnant women and to compare these results with a group of healthy non-pregnant women. METHODS: Fourteen patients with hyperemesis gravidarum, 10 non-dyspeptic pregnant women and 36 non-pregnant women in the first half of the menstrual cycle underwent a gastric emptying study. Seven non-pregnant women repeated the test in the post-ovulatory period. RESULTS: Gastric emptying of solids was not significantly delayed in non-dyspeptic pregnant women compared with non-pregnant women. The emptying rate tended to be impaired in the post-ovulatory period of the menstrual cycle. Solid emptying was significantly accelerated in patients recovering from hyperemesis gravidarum, correlating well with thyroid function in the latter group. CONCLUSION: Pregnancy in humans is not associated with decreased solid gastric emptying. In subjects recovering from hyperemesis gravidarum, solid emptying is increased, correlating well with thyroid function abnormalities. Nausea and vomiting in hyperemesis are therefore probably not due to upper gastrointestinal disorders.     

妊娠剧吐病人舒适度的影响因素及护理对策

目的调查了解影响妊娠剧吐病人舒适度的相关因素,提出个性化的舒适护理措施,促进疾病康复。方法采用自行设计的调查问卷对100例妊娠剧吐病人进行调查,并对结果进行分析。结果发放调查问卷100份,回收100份,有效回收率为100％。频繁恶心呕吐、静脉穿刺疼痛、静脉补钾所致的疼痛等因素严重影响病人的舒适度。结论针对妊娠剧吐病人不舒适的原因,实施个性化的舒适护理措施,增强服务质量和水平,树立“以人为本”的服务理念,促使病人尽快达到最舒适的状态。     

静脉营养用于妊娠剧吐的疗效观察

目的探讨静脉营养用于妊娠剧吐的有效治疗方法。方法 73例妊娠剧吐患者分为对照组35例与治疗组38例,分别采用单用静脉补液方法和常规静脉补充营养液方法。结果在治疗结束后3d,治疗组的患者体重表现出逐渐恢复的效果,同时饮食转向正常,从治愈率和总有效率的比较看,相对于对照组,治疗组显示出了差异具备显著性(均P<0.05),患者均顺利度过妊娠前3个月,没有终止妊娠的患者;对16例患者进行随访,都顺利分娩。结论针对妊娠剧吐的而患者给予静脉营养,其疗效显著。     

Raised serum human chorionic gonadotrophin concentrations in hyperemesis gravidarum.

Serum human chorionic gonadotrophin (HCG) concentrations were determined by radioimmunoassay with an antiserum specific to HCG beta-subunit in 42 patients with hyperemesis gravidarum and 115 women with normal pregnancies. Mean concentrations (+/- SE of mean) were higher in the women with hyperemesis gravidarum at 7-8 weeks (40.8 +/- 5.2 IU/ml v 22.1 +/- 1.4 IU/ml; P less than 0.001), 9-11 weeks (38.1 +/- 2.3 IU/ml v 27.1 +/- 2.1 IU/ml; P less than 0.0025), and 12-14 weeks of gestation (35.9 +/- 4.2 IU/ml v 25.1 +/- 1.7 IU/ml; P less than 0.005), but there was no difference between the two groups at 15-20 weeks of gestation. In the hyperemesis gravidarum group primigravid women had a higher (P less than 0.005) mean HCG concentration (41.8 +/- 4.0 IU/ml) than multigravid women (32.2 +/- 2.3 IU/ml). The results suggest a causal relation between a high serum HCG concentration and hyperemesis gravidarum.     

妊娠剧吐与微量元素的关系

目的：通过测定妊娠剧吐孕妇头发中微量元素的含量,与同期正常孕妇做对照,以探讨微量元素与妊娠剧吐的关系,为临床诊断、治疗、预防提供科学的依据。方法：选择妊娠剧吐孕妇200例及同期正常孕妇200例,分别检测其发中微量元素锌、铜、硒、锰的含量,结果进行统计学分析。结果：研究组孕妇发中锌和锰的含量显著低于对照组。结论：微量元素锌和锰的缺乏与妊娠剧吐的发生有一定的关系。     

心理干预对妊娠剧吐临床转归的影响

目的 研究心理干预对妊娠剧吐临床转归的影响.方法 选择2012年1月至2014年1月住院的100例妊娠剧吐的初产妇进行研究.随机均分为观察组和对照组,两组均给予常规的对症及支持治疗.对照组在此基础上给予患者常规护理干预,观察组则采用心理护理干预对患者进行护理.分别在入院时和出院时调查记录两组患者的恶心、呕吐频率及SAS、SDS评分状况,并对两组患者治疗的临床疗效进行比较分析.结果 护理干预后,两组患者的呕吐频率均明显降低（P＜0.01）,观察组出院时的呕吐频率明显低于对照组（P＜0.01）.观察组患者的SAS、SDS评分明显降低（P＜0.05）,出院时观察组患者的SAS、SDS评分明显低于对照组（P＜0.05）.观察组患者治疗总有效率（98.0％）明显高于对照组（78.0％）,两组比较差异有统计学意义（X^2=12.9752,P=0.0015）.结论 心理干预可显著改善妊娠剧吐患者的临床转归状况,减轻患者的痛苦,值得临床进行推广应用.     

苏叶黄连汤直肠滴入治疗重症妊娠剧吐32例

目的 探讨苏叶黄连汤直肠滴入治疗重症妊娠剧吐的临床疗效。方法 纳入2019年3月至2021年4月在南阳市中心医院产科住院治疗确诊为重症妊娠剧吐病人共64例,按随机数字表法分为治疗组和对照组,各32例。对照组按照妊娠剧吐临床处理专家共识给予治疗,治疗组在西医治疗基础上配合苏叶黄连汤直肠滴入,比较两组在改善症状、尿酮体转阴时间、复发率方面的差异。结果 治疗后5 d和治疗后10 d,两组恶心呕吐妊娠专用量化表评分（PUQE）均明显降低（P<0.05）;治疗组在治疗后5 d和治疗后10 d PUQE评分分别为（11.91±1.51）分、（7.97±1.47）分,均低于对照组（13.05±2.13）分、（11.13±2.20）分（均P<0.05）。治疗组尿酮体转阴时间显著短于对照组[（2.39±0.80）d比（2.81±0.83）d,P<0.05];随访至孕28周观察两组病人的复发情况,两组病人在治疗后复发率方面比较差异无统计学意义（P>0.05）。结论 苏叶黄连汤直肠滴入联合西药治疗重症妊娠剧吐疗效显著,能有效改善重症妊娠剧吐病人的症状、缩短尿酮体转阴时间。     

氢化可的松治疗妊娠剧吐疗效探讨

目的:探讨氢化可的松治疗妊娠剧吐的效果。方法:把观察对象分成两组,各30例。治疗组:加用氢化可的松,禁食、输液3000毫升、补足维生素、能量,静脉滴注;对照组:禁食、输液3000毫升、补足维维生素,能量、维生素B150m分别行双侧足三里穴位注射1次;以临床症状的改变及尿酮体程度的变化来作为疗效的判定。结果:治疗组尿酮体改善率92.3%,有效率97.2%;对照组尿酮体改善率72.7%,有效率87.5%。两组差异有统计学意义。结论:氢化可的松治疗妊娠剧吐疗效肯定,安全。     

针灸与穴位注射治疗妊娠剧吐的临床疗效观察

目的观察比较针灸与穴位注射治疗妊娠剧吐的疗效差异,探寻临床治疗该病的较好方法。方法把62例妊娠剧吐患者随机分为针灸组和穴位注射组,每组31例,针灸组给予针刺中脘、内关、足三里、下脘,关门,得气后用艾灸盒灸中脘穴,穴位注射组给予维生素B6注射液0.1g双侧内关穴位注射,观察比较两组妊娠剧吐评分的变化和显愈率。结果针灸组显愈率为93.55％,穴位注射组的显愈率为54.84％,两组显愈率差异有统计学（P〈0.01）,两组的妊娠剧吐评分在治疗前后有明显改变,差异有统计学意义（P〈0.001）,1个疗程结束后,两组的妊娠剧吐评分差异有统计学（P〈0.01）。结论针灸和穴位注射治疗妊娠剧吐均有效,针灸疗效优于穴位注射。     

妊娠剧吐60例临床观察

目的 探讨妊娠剧吐的临床治疗.方法 回顾性分析2002年5月2011年8月收治的60例妊娠剧吐病历资料,观察系统治疗的临床效果.结果 60例患者,治愈57例,占95%;有效减轻症状者2例,占3.33%;无效1例,占1.67%.总有效率为98.33%.结论 积极的营养支持和补液治疗,可以治愈妊娠剧吐,能有效防止孕妇发生重度电解质紊乱、酸碱失衡、Wernicke 脑病甚至死亡.     

The safety of drugs for the treatment of nausea and vomiting of pregnancy

Nausea and vomiting of pregnancy (NVP) is the most common medical condition of pregnancy, affecting up to 80% of all pregnancies to some degree. In most cases it subsides by the week 16 of pregnancy, although up to 20% of women continue to have symptoms throughout pregnancy. Severe NVP (Hyperemesis gravidarum) affects < 1% of women and in some severe cases can require hospitalization and rehydration of fluids. Women suffer not only physically but also psychologically, which has been documented in a number of studies. In addition, some women have decided to terminate their pregnancy rather than tolerate severe symptoms. Even less severe cases of NVP can have significant adverse effects on the quality of a woman's life, affecting her occupational, social, domestic functioning and general well being. Therefore, it is of great importance to treat this condition effectively to improve the quality of life for these women. In this paper, the authors review different classes of antiemetics used to treat this condition and discuss that some have better safety profiles than others, but most appear to be safe to use in pregnancy. Also included is a treatment algorithm that can assist the healthcare provider in treating this condition in pregnant safely and effectively.     

舒适护理在妊娠剧吐患者中的应用分析

目的探讨舒适护理在妊娠剧吐患者中的应用,以便为临床上提供有价值的参考。方法选取在2006~2010年间入我院分娩的78例妊娠妇女,年龄在19~34岁,将78例产妇随机分为两组,观察组40例,对照组38例,观察组对妊娠期妇女采用舒适护理,对照组对妊娠期妇女则采用常规护理。对两组妊娠期妇女的恢复情况进行跟踪观察,并记录所得数据。结果经过对分妊娠期妇女进行一系列的护理,两组妊娠期妇女的生命体征都较为稳定。观察组剧吐率、紧张导致难产率、新生儿窒息率明显低于对照组(P<0.05)。顺利生产明显高于对照组(P<0.05)。结论对分娩期的妊娠期妇女实行舒适护理的效果较为显著,可以有效减少妊娠期妇女的剧吐想象,稳定妊娠期妇女的各项生命体征,保证其顺利分娩,值得在临床推广应用。     

中医辨证施护在妊娠剧吐患者临床中的干预效果观察

目的 观察中医辨证施护在妊娠剧吐患者临床中的干预效果.方法 选取本院收治的102例妊娠剧吐患者为研究对象,分为观察组和对照组.给予对照组实施常规的整体护理,观察组在对照组基础上实施中医辨证施护.结果 护理后14d的焦虑评分观察组为(22.59±2.07),对照组为(30.52±2.48),两组比较差异有统计学意义(P＜0.05).观察组总满意48例(94.11％),对照组总满意40例(78.43％),两组比较差异有统计学意义(P＜0.05).结论 对妊娠剧吐患者实施中医辨证施护,能够有效改善妊娠剧吐患者的焦虑情况,提高患者的护理满意度和生活质量,能够在医学临床中广泛应用.     

以甲状腺功能亢进为首发表现的葡萄胎1例

葡萄胎（HM）是一种异常的人类妊娠,可将其分为完全性葡萄胎（CHM）和部分性葡萄胎（PHM）。其主要临床表现为停经后阴道不规则流血、子宫异常增大、妊娠呕吐、腹痛、卵巢黄素化囊肿及甲状腺功能亢进征象等,其中甲状腺功能亢进临床表现少见。我们报道1例以间断性怕热、多汗、心悸、消瘦为主要临床表现的育龄期女性患者,常规抗甲状腺药物治疗无效,后经阴道B超、血HCG检查诊为CHM。清宫术后患者临床症状好转,甲状腺功能完全恢复正常,从而证实甲状腺功能亢进继发于CHM。因此,临床医生对于育龄期女性甲状腺功能亢进患者,在排除甲状腺性、垂体性以及医源性因素后,应注意葡萄胎及其他妊娠滋养细胞疾病等妇科情况及疾病。     

Use of antiemetic drugs during pregnancy in Sweden

Background More than one-half of all pregnant women suffer from nausea and vomiting during pregnancy (NVP), primarily during the first trimester. Methods Prospectively ascertained information on drug use during pregnancy was obtained from the Swedish Medical Birth Register during the period July 1, 1995 to 2002. Antiemetics (antiemetic antihistamines, dopamine modulators, and ondansetron) primarily used for NVP were studied, and women reporting the use of these drugs were compared with all women who gave birth during the study period. Results Use of these antiemetics was reported in 4.5% of the pregnant women – 86% of whom reported their use before the first antenatal visit (usually weeks 10–12). Meclozine, followed by other antihistamines, accounted for 68% of the drugs reported. Young maternal age, multiparity, non-smoking, and a period of unwanted childlessness increased the probability of using any of the antiemetics during pregnancy. Women with a low education used these drugs more often than women with a relatively higher education. Neonates born to women who used any of the antiemetics had a reduced risk for low birthweight, prematurity, being small-for-gestational age, and having a malformation. No specific differences were observed with respect to the outcome following a comparison of different antiemetic drugs. Conclusions Women using antiemetics as a rule have a better delivery outcome than other women, probably due to an effect of a well-functioning placenta, which is associated with NVP. There were no signs of any significant teratogenicity of the drugs studied, but for some drugs the number of exposures was low.     

A risk-benefit assessment of pharmacological and nonpharmacological treatments for nausea and vomiting of pregnancy

Despite evidence of fetal safety, most antiemetics are contraindicated in pregnancy. We summarise a risk-benefit analysis of the literature on safety and effectiveness of pharmacotherapy and nontraditional therapy for nausea and vomiting of pregnancy (NVP) to provide evidence-based guidelines on the management of NVP. The medical literature was scanned for controlled studies on the human teratogenicity and effect of various antiemetics in pregnant women. Data were pooled based on drug/therapy class and summarised to determine relative risk with 95% confidence interval (for malformations and failure rates for NVP) and homogeneity (chi-square test). Evidence from controlled trials has demonstrated the safety and efficacy of the following drugs for the treatment of varying degrees of NVP: doxylamine/pyridoxine+/-dicycloverine (dicyclomine), antihistamine H1 receptor antagonists, and phenothiazines (as a group). However, pooled data for doxylamine/pyridoxine+/-dicycloverine, H1 antagonists and phenothiazines were not homogeneous. Other therapies, such as pyridoxine alone, metoclopramide, ondansetron and the corticosteroids may be beneficial in managing NVP. However, limited efficacy studies and the paucity of well-controlled safety studies may limit the use of some of these agents among patients not responsive to first-line agents. Well-controlled safety and effectiveness trials in patients with NVP are lacking for nonpharmacological treatments (e.g. acupressure). NVP can be managed safely and effectively. Further trials must be conducted in order to determine the true effectiveness of certain agents in patients with NVP.     

综合干预在妊娠剧吐孕妇中应用的效果评价

目的探讨综合干预对妊娠剧吐孕妇的应用效果。方法按随机数字表法将100例妊娠剧吐孕妇随机分为观察组和对照组各50例,对照组给予补充能量,纠正水、电解质、酸碱平衡失调等常规疗法,实施临床常规护理和健康教育。观察组在此基础上进行综合干预,包括中药治疗、认知干预、行为干预及家庭干预。比较两组孕妇的临床护理效果及其对护理工作的满意度。结果观察组孕妇的临床护理效果及其对护理工作的满意度明显高于对照组,差异有统计学意义（P〈0．01）。结论对妊娠剧吐孕妇实施综合干预可提高临床护理效果及其对护理工作的满意度,改善生活质量,促进疾病康复,值得在临床推广应用。     

Therapeutic options for the prevention and treatment of postoperative nausea and vomiting: a pharmacoeconomic review

Even with the development of the serotonin 5-HT(3) receptor antagonists in recent years, postoperative nausea and vomiting (PONV) remains a significant concern for clinicians and patients. For the selection of an appropriate antiemetic strategy for PONV, economic considerations should be taken into account. A literature search covering the period from September 1996 to August 2005 yielded 16 economic evaluations on antiemetics used for the prevention or treatment of PONV. In these studies, a variety of different antiemetic regimens were evaluated, with different doses and timing of administration, in many different populations, for various types of surgery, and in different settings. In addition, there were many differences in the design of these economic evaluations in terms of the extent of the costs considered and the decision rules used when forming conclusions. Therefore, despite the availability of economic evaluations on antiemetics in PONV, it is difficult to draw clear conclusions with such disparate information. In spite of these limitations, key learning can be drawn from these economic evaluations. From studies where a placebo was used as a comparator, we can conclude that there is clinical benefit in using an antiemetic for the prevention of PONV versus no therapy. The dose of the 5-HT(3) receptor antagonist seems more important in determining cost effectiveness than the selection of the agent itself, and less expensive agents such as droperidol, dexamethasone and prochlorperazine may also represent cost-effective alternatives to 5-HT(3) receptor antagonists. In an additional six studies where a willingness to pay (WTP) to avoid or reduce the incidence of PONV was estimated, the average WTP amounts varied from $US29 to $US117. Many questions remain unanswered about the cost effectiveness of existing antiemetics and their regimens, and little is known about the impact of new agents, such as the neurokinin-1 receptor antagonists, in the control of PONV.     

Prevention and treatment of postoperative nausea and vomiting

Pain, nausea and vomiting are frequently listed by patients as their most important perioperative concerns. With the change in emphasis from an inpatient to outpatient hospital and office-based medical/surgical environment, there has been increased interest in the 'big little problem' of postoperative nausea and vomiting (PONV). Currently, the overall incidence of PONV is estimated to be 25 to 30%, with severe, intractable PONV estimated to occur in approximately 0.18% of all patients undergoing surgery. PONV can lead to delayed postanaesthesia care unit (PACU) recovery room discharge and unanticipated hospital admission, thereby increasing medical costs. The aetiology and consequences of PONV are complex and multifactorial, with patient-, medical- and surgery-related factors. A thorough understanding of these factors, as well as the neuropharmacology of multiple emetic receptors [dopaminergic, muscarinic, cholinergic, opioid, histamine, serotonin (5-hydroxy-tryptamine; 5-HT)] and physiology [cranial nerves VIII (acoustic-vestibular), IX (glossopharyngeal) and X (vagus), gastrointestinal reflex] relating to PONV are necessary to most effectively manage PONV. Commonly used older, traditional antiemetics for PONV include the anticholinergics (scopolamine), phenothiazines (promethazine), antihistamines (diphenhydramine), butyrophenones (droperidol) and benzamides (metoclopramide). These antiemetics have adverse effects such as dry mouth, sedation, hypotension, extrapyramidal symptoms, dystonic effects and restlessness. The newest class of antiemetics used for the prevention and treatment of PONV are the serotonin receptor antagonists (ondansetron, granisetron, tropisetron, dolasetron). These antiemetics do not have the adverse effects of the older, traditional antiemetics. Headache and dizziness are the main adverse effects of the serotonin receptor antagonists in the dosages used for PONV. The serotonin receptor antagonists have improved antiemetic effectiveness but are not as completely efficacious for PONV as they are for chemotherapy-induced nausea and vomiting. Older, traditional antiemetics (such as droperidol) compare favourably with the serotonin receptor antagonists regarding efficacy for PONV prevention. Combination antiemetic therapy improves efficacy for PONV prevention and treatment. In the difficult-to-treat PONV patient (as in the chemotherapy patient), suppression of numerous emetogenic peripheral stimuli and central neuroemetic receptors may be necessary. This multimodal PONV management approach includes use of: (i) multiple different antiemetic medications (double or triple combination antiemetic therapy acting at different neuroreceptor sites); (ii) less emetogenic anaesthesia techniques; (iii) adequate intravenous hydration; and (iv) adequate pain control.