Possible azithromycin-associated hiccups

OBJECTIVE: To report a case of persistent hiccups associated by azithromycin therapy. CASE SUMMARY: A 76-year-old man presented with persistent hiccups after beginning azithromycin for the treatment of pharyngitis. Hiccups were persistent and exhausting. Discontinuation of azithromycin and therapy with baclofen finally resolved hiccups. No organic cause of hiccups was identified despite extensive investigation. DISCUSSION: Pharmacotherapeutic agents have been uncommonly associated with hiccups. Corticosteroids (dexamethasone and methylprednisolone), benzodiazepines (midazolam) and general anaesthesia have been the specific agents mentioned most frequently in the literature as being associated with the development of hiccups. Few cases of drug-induced hiccups have been reported related to macrolide antimicrobials. Using the Naranjo adverse effect reaction probability scale this event could be classified as possible (score 5 points), mostly because of the close temporal sequence, previous reports on this reaction with other macrolides and the absence of any alternative explanation for hiccups. Our hypothesis is that a vagal mechanism mediated by azithromycin could be the pathogenesis of hiccups in our patient. CONCLUSIONS: Diagnosis of drug-induced hiccups is difficult and often achieved only by a process of elimination. However, macrolide antimicrobials have been reported to be associated with hiccups and vagal mechanism could explain the development of this side-effect.     

沉香粉治疗肝癌介入术后顽固性呃逆临床观察

目的:观察沉香粉联合甲氧氯普胺治疗原发性肝癌介入术(TACE)后顽固性呃逆的治疗效果。方法:选择原发性肝癌介入术后顽固呃逆患者56例,随机分治疗组和对照组两组,每组28例。治疗组采用口服沉香3g,研粉冲服,3次/d;联用肌注甲氧氯普胺注射液10mg,1次/d。对照组采用常规肌注甲氧氯普胺注射液10mg1,次/d。所有病例按显效、有效和无效标准进行评定。结果:治疗组28例病人中治疗有效27例(96.4%),对照组28例病人治疗有效20例(71.4%),两组比较,差异有统计学意义(P<0.05)。结论:原发性肝癌介入术后出现顽固性呃逆的患者使用沉香粉联合甲氧氯普胺注射液治疗,效果显著。     

中西医对肿瘤所致顽固性呃逆的认识和治疗

顽固性呃逆可出现在恶性肿瘤患者手术、放化疗过程中以及治疗结束后的各个阶段,因其发作时间长,一般治疗难以缓解,或缓解后容易反复,故严重影响着肿瘤病人的心理与治疗。文章在中西医对其发病机理的认识上,探讨目前临床上使用的各种治疗方法,结果认为对肿瘤所致顽固性呃逆的治疗上,强调中西医结合,优势互补,既能减轻西药的毒副作用,又能改善中药起效缓慢的弱点,不失为一种安全、有效的治疗方法。     

沉香粉治疗肝癌介入术后顽固性呃逆临床观察

目的：观察沉香粉联合甲氧氯普胺治疗原发性肝癌介入术（TACE）后顽固性呃逆的治疗效果。方法：选择原发性肝癌介入术后顽固呃逆患者56例,随机分治疗组和对照组两组,每组28例。治疗组采用口服沉香3g,研粉冲服,3次/d;联用肌注甲氧氯普胺注射液10mg,1次/d。对照组采用常规肌注甲氧氯普胺注射液10mg1,次/d。所有病例按显效、有效和无效标准进行评定。结果：治疗组28例病人中治疗有效27例（96.4%）,对照组28例病人治疗有效20例（71.4%）,两组比较,差异有统计学意义（P〈0.05）。结论：原发性肝癌介入术后出现顽固性呃逆的患者使用沉香粉联合甲氧氯普胺注射液治疗,效果显著。     

CO2 retention: The key to stopping hiccups

Background

While investigating the mechanisms behind hiccups, our team discovered what could be the sufficient physiological conditions for terminating even persistent cases.

Methods

To investigate the role of CO₂ retention, a healthy male volunteer was asked to perform three kinds of rebreathing experiments using different materials: (I) a 20 L air‐filled plastic bag, (II) a 20 L air‐filled plastic bag with a 1.5 × 1.5 cm hole and (III) a 20 L oxygen‐filled plastic bag. During each experiment, CO₂ level upon expiration (EtCO₂) and inspiration (InspCO₂) were measured until the volunteer gave up. Once the safety of this manoeuvre was demonstrated with the volunteer, we performed the technique using the materials from experiment (I) on two actual patients with persistent hiccups.

Results

In experiments (I) and (III), InspCO₂ increased from the beginning and reached almost the same level as EtCO₂ after 90 seconds. Both levels continued simultaneously increasing, finally reaching 56 mm Hg in (I) and 79 mm Hg in (III), respectively. In (II), both increased; however, after 120 seconds, EtCO₂ plateaued at 47 mm Hg and InspCO₂ at 37 mm Hg. In the actual patients, both CO₂ levels reached the same value of 35.9 mm Hg at 60 seconds and 37.0 mm Hg at 90 seconds, and hiccups stopped at 195 seconds and at 359 seconds when EtCO₂ reached 50 mm Hg and 53 mm Hg, respectively.

Conclusion

The study determined that to successfully obstruct the mechanisms causing hiccups, it is necessary that the level of InspCO₂ not only increases at the same level as EtCO₂, but also reaches approximately 50 mm Hg.     

镇肝熄风汤加减治疗顽固性呃逆35例

[目的]观察镇肝熄风汤治疗顽固性呃逆疗效。[方法]方用镇肝熄风汤加减治疗,剂/d,连续5～7d为1疗程。[结果]治疗35例中,治愈15例,显效10例,有效9例,无效1例。[结论]镇肝熄风汤加减治疗顽固性呃逆疗效显著。     

现代针灸教材呃逆“同功穴”分析

目的整理现代针灸教材中主治呃逆的腧穴,归纳总结呃逆的"同功穴"及其规律谱,为腧穴配伍及针灸处方提供理论依据。方法基于网络检索和人工检索两种途径,检索27部现代针灸教材中主治呃逆的腧穴,分析呃逆的"同功穴"及其规律,并对其进行频次、归经、所在部位、规律谱分析,同时与《腧穴主治·国家标准GB/T30233-2013》进行对照。结论通过统计27部现代针灸教材中主治呃逆的"同功穴"有56个,经脉以足太阳膀胱经、任脉、足阳明胃经、足少阴肾经为主,部位以胸腹、上肢为主。把频次在11~25次的腧穴定为一级谱,有13个穴位;出现频次在2~10次的腧穴定为二级谱,有19个穴位;出现频次为1次的腧穴定为三级谱,有24个穴位。腧穴主治国家标准中主治呃逆的腧穴有13个穴位,其中在一级谱中有8个,二级谱中有3个,三级谱中有2个,全部包括腧穴主治国家标准中主治呃逆的13个穴位。     

中药配合穴位注射治疗肿瘤顽固性呃逆临床研究

目的：观察旋覆代赭汤加减配合内关穴穴位注射治疗肿瘤顽固性呃逆的临床疗效。方法：将70例肿瘤顽固性呃逆患者随机分为治疗组和对照组。治疗组35例患者采用旋覆代赭汤加减,配合内关穴穴位注射山莨菪碱治疗。对照组35例患者给予口服山莨菪碱片治疗。10 d为1个疗程,1个疗程后评价疗效。结果：治疗组治愈26例,好转7例,无效2例,有效率为94.29%;对照组治愈16例,好转12例,无效7例,有效率为80.00%,治疗组临床疗效优于对照组,差异有统计学意义（P〈0.05）。结论：旋覆代赭汤加减配合内关穴穴位注射治疗肿瘤顽固性呃逆疗效显著。     

华蟾素穴位注射治疗顽固性呃逆的临床疗效观察

目的:探讨穴位注射华蟾素对顽固性呃逆的临床疗效。方法:对32例顽固性呃逆患者采用穴位注射华蟾素治疗。其中男19例,女13例,年龄32~68岁。消化性溃疡8例,反流性食管炎4例,肝硬化失代偿期4例,胃癌6例,肝癌2例,食道癌4例,结肠癌3例,胰腺癌1例。每日2次,五天为一个疗程。结果:13例患者穴位注射治疗后三天呃逆症状消失,9例症状明显减轻,呃逆次数明显减少;注射五天后,29例患者呃逆症状消失或明显减轻,3例患者无效。总显效率达90.6%,其中2例患者出现局部疼痛,未给予特殊处理,均自行缓解或消失,其他患者未见明显不良反应。结论:穴位注射华蟾素治疗顽固性呃逆疗效显著,不良反应少,且操作简单,安全有效。     

中西医结合药物配合针灸治疗顽固性呃逆的临床观察

目的：探讨中西医结合药物配合针灸治疗顽固性呃逆的临床治疗效果.方法：选取我院自2012年2月-2014年2月收治的92例顽固性呃逆患者,将之随机分为观察组与参考组,各46例,观察组采用西药联合针灸治疗,参考组单纯采用西药治疗,比较两组患者临床治疗效果、2年内复发率.结果：观察组与参考组治疗总有效率分别为93.5%、69.6%,比较有统计学意义（P〈0.05）;观察组两年内出现1例复发,参考组两年内出现9例复发,两组患者复发情况差异有统计学意义（P〈0.05）.结论：药物配合针灸能够有效治疗顽固性呃逆,同时复发率较低,具有显著的临床意义.