妊娠恶心呕吐的妊娠期管理现状与展望

Current Situation and Prospect of Pregnancy Management of Nausea and Vomiting in Pregnancy

妊娠恶心呕吐(nausea and vomiting of pregnancy,NVP)是妊娠期最常见的症状之一,严重、持续的NVP会进展为妊娠剧吐(hyperemesis gravidarum,HG),对母胎均有不同程度的影响,严重者可导致终止妊娠。目前NVP的发病机制尚不清楚,但普遍认为其与遗传、内分泌和感染等因素密切相关。故临床上对NVP的妊娠期管理主要以对症治疗、防治严重的并发症为主,同时尽量减少对母胎的不良影响,主要包括非药物治疗、止吐药物治疗及常规补液治疗等。非药物治疗包括调整生活方式和饮食习惯,以及建议孕妇在妊娠前3个月禁止服用含铁补充剂或含铁维生素。常用止吐药物包括维生素B6或联合多西拉敏、甲氧氯普胺、昂丹司琼、异丙嗪和糖皮质激素等。

Nausea and vomiting of pregnancy(NVP)is one of the most common symptoms of pregnancy,severe and persistent NVP can progress to hyperemesis gravidarum(HG),affecting both the mother and fetus to varying degrees.Severe cases lead to the termination of pregnancy.At present,the pathogenesis of NVP is not clear,but it is generally believed that it is closely related to genetic,endocrine and infection factors.Therefore,the current clinical management of NVP during pregnancy mainly focuses on symptomatic treatment,prevention and treatment of serious complications,while minimizing adverse effects on the mother and fetus,including non-drug treatment,antiemetic drug treatment and routine rehydration treatment.Non-pharmacological treatments include adjustments to lifestyle and diet,as well as advising women not to take iron supplements or iron-containing vitamins during the first three months of pregnancy.Common antiemesis drugs include vitamin B6 or combined doxylamine,metoclopramide,ondansetron,promethazine,glucocorticoids,etc.