※ 引述《carlchang (carlchang)》之铭言： : 不过选Wintermin还是会比较麻烦啦，sedation太强，没吃过的病人会睡成一团。 : 另外还有，Anticholinergic、alpha-1 antagonism的问题.... : 所以，要是我的话，我也是会先选Primperan吧？ : maybe加一点muscle relaxant/or BZD (一点evidence都没的乱搞) ^^^^^^^^^^^^^^^^^^^^^^ 我觉得这个就是重点了 现在一天到晚喊EBM 真的照着evidence的建议用药 结果却反而绑手绑脚 真的是很无奈啊 附注 : micromedex不是每个人或是医院都有买liscense 所以我把网址丢上来 大家也不见得连的上 简单贴一点重点上来罗 Simple, mechanical techniques should be tried before attempting drug therapy for intractable hiccups ........ holding your breath; slowly drinking a glass of water; pressure on eyeballs; swallowing; irritation of nasal mucosa to produce sneezing; mustard plaster, ice bag, ethyl chloride spray, or ether applied to the epigastrium; pressure over carotid sinus between thumb and forefinger for 1 minute, grasping the artery at the midpoint of the anterior border of the sternocleidomastoid; strong digital pressure over the phrenic nerves in their course behind the sternoclavicular points; forceable traction of the tongue; induction of nausea or vomiting by tickling the throat; gasping with sudden fright, the Valsalva maneuver, hyperventilation, and drinking water from the 'wrong side' of a glass ........... The only drug approved by the FDA for the treatment of intractable hiccups is chlorpromazine............ Only 1 randomized, double blind, placebo-controlled crossover study was conducted to assess the efficacy of oral baclofen 15 mg/day and 30 mg/day for the treatment of intractable hiccups. While patients reported no adverse effects secondary to baclofen, this drug was unable to completely resolve intractable hiccups in any patient.......... Evidence supporting drug treatment for intractable hiccups remains inconclusive.............. If intractable hiccups remain resistant to the non-pharmacological techniques, the strongest evidence to date supports the use of chlorpromazine 25 to 50 mg administered intravenously, with a second dose within 2 to 4 hours intravenously or intramuscularly. The patient should be monitored carefully for anticholinergic side effects, particularly sedation...... --

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