18-晕动病-

Source text Target text 不翻译 Motion sickness 晕动病 Contributors 作者 不翻译 http://www.firstconsult.com/das/pdxmd/body/410460402-2/0?type=med&eid=9-u1.0-_1_mt_1014468&tab=V Key points 不翻译 · Motion sickness is a common response to real or apparent motion 晕动病是由于实际运动或视运动引起的一种常见性病理反应。 · Unlikely to present with acute, severe motion sickness in routine setting 在常规环境中，发生严重急性晕动病的可能性较小。 · May see acutely ill patient while in motion, for example, on a ship or airplane 晕动病患者可能在运动中发病，例如，乘船或乘飞机时。 · Severely ill patients may require intravenous fluid to correct dehydration, hypotension, and electrolyte imbalance from vomiting 严重的病人可能需要接受静脉注射来缓解脱水、低血压以及由于呕吐导致的电解质紊乱症状。 · Intramuscular or per rectum drugs are useful if patient is unable to swallow or keep down tablets 如果病人无法吞咽药片，需要对病人进行肌肉注射或直肠给药。 Background 背景 不翻译 Description 描述 不翻译 · Motion sickness (characterized by nausea, vomiting, dizziness/vertigo, and malaise) is caused by and is a common response to real or apparent motion 晕动病（症状：恶心、呕吐、头晕/眩晕以及不适）是由实际运动或视运动引起的一种常见疾病。 · Often a mild prodrome with epigastric discomfort and sweating 轻微症状通常现为上腹部不适，出汗。 · Requires an individual to have an intact vestibular apparatus 这就需要个体拥有完整的前庭感官。 · Symptoms and signs increase in intensity ('avalanche effect') 随着运动强度的增大，患者症状和体征愈加明显（所谓的“雪崩效益”）。 · Symptoms are often relieved by vomiting 通常情况下，呕吐可以缓解晕动病症状。 · A variety of pharmacologic and other agents are used to prevent and treat; of numerous treatments, none is highly effective 目前，有各种药物和药剂被用来防治晕动病；但在众多治疗方法中，并没有一种方法特别有效。 · Majority of patients affected will eventually adapt spontaneously 大多数病人最终会不药而愈。 Back to Top Back to Top 不翻译 http://www.firstconsult.com/das/pdxmd/body/410460402-2/0?type=med&eid=9-u1.0-_1_mt_1014468&tab=V 不翻译 Epidemiology 流行病学 不翻译 Incidence and prevalence: 发病率和患病率: 不翻译 · Exact figures unknown, but it is common 确切数字未知，但这种疾病很常见。 · Depends on degree of motion; usually at sea more than in air or on land 取决于运动程度；通常情况下，在海上的发病率要高于在空中或陆地上的发病率。 · Only 5% of patients affected have severe symptoms 在患有晕动病的患者当中，只有5%的人症状严重。 Demographics: 人口统计资料： 不翻译 · Rare in pediatric patients aged less than 2 years; common among children aged 2 to 12 years; becomes less common with increasing age (uncommon in adults aged >50 yr) 2岁以下的儿童患者罕见；2岁至12岁儿童发病普遍；随年龄的增加，患病率降低（50岁以上的成年人患晕动病现象不常见）。 · More common in females; female to male ratio is approximately 1.7 to 1.0 与男性相比，晕动病在女性中更为常见；比例大概为1.7：1.0。 · Individuals of Chinese descent seem more likely to be affected; seems more common in patients of Chinese descent, likely due to a genetic susceptibility 有中国血统的个体更感染晕动病；中国血统的个体患者更为常见，这很有与遗传易感性有关。 Back to Top Back to Top 不翻译 http://www.firstconsult.com/das/pdxmd/body/410460402-2/0?type=med&eid=9-u1.0-_1_mt_1014468&tab=V 不翻译 Causes and risk factors 诱因及危险因素 不翻译 Causes: 病因 不翻译 · Common causes include roller coaster and other amusement park rides; land (eg, automobile, bus), air, or sea travel; and flight/motion simulator with controlled movement 乘坐过山车和其他游乐园游乐设施；陆地乘车（例如汽车、公交车等）、飞行或航海；以及乘坐受控运动飞行/运动模拟装置都是导致晕动病发病的常见原因。 · Apparent motion including from a flight simulator without actual movement or from a three-dimensional 'action' movie is a rare cause of motion sickness 没有进行真正运动，而是通过飞行模拟装置或三维“运动”电影完成的视运动是导致晕动病发病的不常见原因。 · Predisposition to motion sickness by some neurologic pathology including tumors of the posterior fossa, especially affecting the cerebellopontine angle is a serious cause 某些神经病理容易引起晕动病的发生，其中包括后颅窝肿瘤，尤其是影响小脑桥脑角的肿瘤更是一种严重的发病原因。 Risk factors: 风险因素 不翻译 · Fear or anxiety 恐惧或焦虑 · Sleep deprivation and fatigue 睡眠不足、疲劳 · Discordant visual cues such as reading while in motion 视觉不和谐，如在运动中阅读。 · Pregnancy 怀孕 不翻译 · Alcohol and a variety of other drugs 饮酒或服用各类其他药物。 · Confined space, poor ventilation 身处密闭空间，通风不畅。 · History of migraine 有偏头痛病史 · Noxious fumes (diesel, gasoline, exhaust) or food odors 周围弥漫着有毒气体（如柴油、汽油、废气等）或食物气味。 Back to Top Back to Top 不翻译 http://www.firstconsult.com/das/pdxmd/body/410460402-2/0?type=med&eid=9-u1.0-_1_mt_1014468&tab=V 不翻译 Associated disorders 相关疾病 不翻译 Motion sickness is more common in those with migraine, in which some symptoms may overlap, particularly in children. 患有偏头痛的人群中晕动病患病现象更加普遍。其中很多症状可能发生重叠，尤其是儿童。 http://www.firstconsult.com/das/pdxmd/body/410460402-2/0?type=med&eid=9-u1.0-_1_mt_1017198 不翻译 Screening 筛查 不翻译 Not applicable. 不适用 不翻译 Primary prevention 初步预防 不翻译 Back to Top Back to Top 不翻译 http://www.firstconsult.com/das/pdxmd/body/410460402-2/0?type=med&eid=9-u1.0-_1_mt_1014468&tab=V 不翻译 Summary approach 诊断方法 不翻译 · Patient should be advised to minimize exposure to stimulus: stay in the middle of an airplane or boat (least movement), minimize head and body movements, and adopt semirecumbent position 建议患者尽可能少地接触刺激：静坐在飞机或船只的中央（这个位置运动幅度最小），尽可能不要晃动头部和身体，保持半卧姿势。 · Patient should be advised to restrict visual activity: keep eyes fixed on the horizon 建议患者不要进行视觉运动：视线保持水平。 · Patient should be advised to maintain good ventilation; ensure adequate sleep before travel; and provide distraction, where possible 建议患者待在通风良好的地带;旅行前要保持充足的睡眠；如果可能，做些消遣性活动，转移注意力。 · Experience with motion may be of additional benefit 拥有运动经验可能会带来额外的好处。 · Risk factors include the following: 风险因素包括以下几个方面： · Alcohol use, which exacerbates susceptibility to motion sickness 饮酒，加剧了晕车的可能性。 · Diet; large meals before travel and eating during travel increase likelihood of vomiting 饮食；在旅行前用餐过量或在旅行途中进餐增加了呕吐的可能性。 · Smoking, which seems to increase motion sickness 吸烟，增加晕动病的发病可能。 · Environment; poor ventilation and unpleasant olfactory stimuli increase sickness 环境；通风不畅以及令人不舒服的嗅觉刺激增加了发病的可能。 · Drug history; patients should be made aware of drugs that exacerbate nausea and vomiting 用药史：患者应被告知哪些药物能够加重恶心和呕吐。 Back to Top Back to Top 不翻译 http://www.firstconsult.com/das/pdxmd/body/410460402-2/0?type=med&eid=9-u1.0-_1_mt_1014468&tab=V 不翻译 Preventive measures [EBM] 不翻译 Modifiable risk factors: 可改变的危险因素 · Patients should be advised to avoid smoking, which may increase the likelihood of motion sickness 建议患者戒烟，因为吸烟可能加大晕动病患病机率。 · Patients should be advised to avoid alcohol before and during travel, which may increase the likelihood of motion sickness 建议患者在旅行前和旅行途中不要饮酒，因为饮酒可能加大晕动病患病机率。 · Large meals before and during travel should be avoided. 应避免在旅行前和旅行途中进食过量。 Fatty foods may increase likelihood of motion sickness 油腻的食物可能加大晕动病患病机率。 · Physical activity involving repetitive movements may increase the tolerance to motion sickness, though the evidence for this is not definitive 尽管没有明确的证据，但进行涉及到重复动作的体育活动能够增加对晕动病的抵抗能力； · Environment is a factor in motion sickness. 环境也是诱发晕动病的一个因素。 Patients should be advised to maintain good ventilation where possible and remain in the middle of a boat or airplane. 建议患者尽可能待在通风顺畅的船只或飞机中央位置。 In aircraft cool air blown directly onto the face may be beneficial. 乘坐飞机时，让清凉的空气吹面可能会缓解不适感。 Strong odors, fumes, and smoke should be avoided 应避免接触强烈的气味、废气和烟雾。 · Some prescribed medications increase likelihood of nausea and vomiting; clinician should check that treatment for motion sickness does not interact with patient's regular medications 某些处方药物可能会增加恶心与呕吐的程度：临床医生应该检查确定晕动病与患者服用的常规药物相互之间不发生作用。 Chemoprophylaxis: 不翻译 · Use of scopolamine appears effective in preventing motion sickness. 服用莨菪碱在预防晕动病方面效果明显。 The long-acting patch is particularly applicable for preventing motion sickness in cruise travelers. 针对乘坐油轮的游客晕动病的防治，长期有效的贴剂尤其适用。 Cyclizine may be helpful in preventing nausea associated with motion sickness. 服用赛克利嗪有可能缓解与晕动病有关的恶心症状。 Ginger is an alternative remedy that may be effective 服用姜也是能够有效缓解晕动病症状的一种可替代性方法。 http://www.firstconsult.com/website/view?area=fc&URL=http%3A%2F%2Fwww.mdconsult.com%2Fdas%2Fpharm%2Fbody%2F334282334-6%2F0%2Ffull%2F558 http://www.firstconsult.com/website/view?area=fc&URL=http%3A%2F%2Fwww.mdconsult.com%2Fdas%2Fpharm%2Fbody%2F334282334-5%2F0%2Ffull%2F1276 http://www.firstconsult.com/das/pdxmd/body/410460402-2/0?type=med&eid=9-u1.0-_1_mt_1014468 Evidence 证据 不翻译 · A systematic review included 14 randomized, controlled trials (RCTs) with a total of 1,025 subjects comparing scopolamine with no therapy, placebo, and other therapies (methscopolamine, antihistamines, calcium channel blockers, scopolamine plus ephedrine) for the prevention of motion sickness. 系统性检查包括14项随机检查，以及1025个莨菪碱与预防晕动病的无疗法、安慰剂和其他治疗方法（甲基东莨菪碱、抗组胺、钙通道阻滞剂、加有麻黄素的莨菪碱）等试验项目之间的对照试验。 #VALUE! It concluded that scopolamine was more effective than placebo or methscopolamine and as effective as antihistamine in the prevention of motion sickness, but no conclusions could be drawn from the comparative studies with other agents. 结论就是，在晕动病的防治方面，莨菪碱与抗组胺剂一样有效，两者作用效果要好于安慰剂或甲基东莨菪碱；但不能据此得出与其他药剂比对研究的结论。 The researchers were unable to find any RCTs investigating the use of scopolamine in the treatment of established motion sickness.[1]Level of evidence: 在已有的晕动病治疗方法中，研究人员无法寻找到任何莨菪碱使用的随机对照试验。 2 2 不翻译 javascript:void(null); 不翻译 · A double-blind, within-subject trial compared dimenhydrinate with cyclizine in 23 subjects for the prevention of motion sickness induced by exposure to a rotating optokinetic drum. 一个试验者与受试者均对实验不知情的试验，将乘晕宁与赛克利嗪就二十三个项目进行比较，来比较二者在预防因视动力鼓室旋转引起的晕动症上的效果 Subjective symptoms were assessed, as were electrogastrogram readings. 对自觉症状进行评估，比如胃动电流图读数。 There was no significant difference in terms of the overall mean subjective symptoms of motion sickness. 就总体晕动病自觉症状而言，并无明显差异。 However, cyclizine was associated with lower scores for gastrointestinal symptoms and less drowsiness.[2]Level of evidence: 然而，赛克利嗪用于治疗较轻微的胃肠道症状和睡眠缺少症状。[2]证据等级: 2 2 不翻译 javascript:void(null); 不翻译 · A systematic review of six RCTs assessed the effect of ginger on nausea and vomiting related to a variety of disorders in 436 subjects. 6次随机对照试验系统性检查对姜在治疗436个试验项目中，与各类疾病有关的恶心呕吐症状的效果进行评估。 It included one RCT studying the use of 1 g ginger versus placebo in preventing seasickness in 80 cadets. 包括在80名学员中使用1克姜与使用安慰剂进行的对照试验。 After 4 hours significantly fewer cadets reported seasickness with ginger versus placebo. Ginger may be effective in preventing seasickness, but this study is too small to draw any firm conclusions.[3]Level of evidence: 姜可以有效预防晕船，但此项调查研究不足以得出任何结论。[3]证据等级: 2 2 不翻译 javascript:void(null); 不翻译 Learn about evidence grading system 不翻译 javascript:void(null);//Show%20EBM%20Help; 不翻译 Diagnosis 诊断 不翻译 Back to Top Back to Top 不翻译 http://www.firstconsult.com/das/pdxmd/body/410460402-2/0?type=med&eid=9-u1.0-_1_mt_1014468&tab=V 不翻译 Summary approach 诊断方法 不翻译 The diagnosis of motion sickness is made on the basis of the history and clinical assessment. Back to Top Back to Top 不翻译 http://www.firstconsult.com/das/pdxmd/body/410460402-2/0?type=med&eid=9-u1.0-_1_mt_1014468&tab=V 不翻译 Clinical presentation 临床表现 不翻译 Symptoms 症状 不翻译 · Symptoms can range from mild to severe, usually developing in an ordered sequence 患病症状从轻微到严重不等，通常按照有序序列顺序发展。 · A prodrome of inattention, drowsiness, inactivity, and gasping may occur 可能发生注意力不集中、困倦、行动迟缓以及呼吸运动失调等前驱症状。 · Common early symptoms are epigastric discomfort ('stomach awareness') and nausea 常见的前期症状为上腹部不适（“胃部不适”）、恶心呕吐。 · Further symptoms may develop such as yawning, salivation, lightheadedness, and malaise 可能会出现如打哈欠、流口水、头晕和心神不安等症状。 · Progression of minor symptoms culminates in vomiting (avalanche effect). 呕吐是轻微症状中最严重的症状（雪崩效益）。 Vomiting may relieve symptoms but sometimes only temporarily if stimulus persists 呕吐有可能缓解晕动病症状，但如果刺激性因素继续存在，则这种缓解作用的暂时的。 · Anorexia, vomiting, and volume depletion can result in electrolyte imbalance and ultimately (but rarely) death 厌食、呕吐以及高渗透和高钠血症能够导致电解质紊乱，并最终导致死亡（非常罕见）。 · Most of those affected will adapt over a period of 2 to 3 days 2-3天后，大多数晕动病患者会不药自愈。 · Following adaptation a return to a 'stable' environment, as from ship to shore, can trigger a mild exacerbation of symptoms (mal de debarquement syndrome) 回到“稳定”环境中，比如从船上回到海岸上，能够引发轻微症状的恶化（综合症）。 Signs 体征 不翻译 · Circumoral or facial pallor (early sign) 口围苍白或面部苍白（早期症状） · Cold sweating, particularly of the face and hands (early sign) 出冷汗，尤其是面部和双手（早期症状） · Vomiting may lead to hypotension, tachycardia, dry mucous membranes, loss of skin tone, and sunken eyes 呕吐可能导致低血压、心跳过速、粘膜干燥、皮肤失色以及眼睛凹陷等症状。 Examination 检查 不翻译 · Look for sweating and pallor of the patient's face. 察看患者是否出现流汗和面部苍白症状。 These are common signs of impending motion sickness 这些都是晕动病即将发病的常见症状。 · Look at the tongue and feel for skin turgor. 察看患者舌头和皮肤肿胀情况。 A dry tongue and loss of skin turgor are indicative of dehydration 舌头干燥和皮肤失去充盈都是脱水的表现。 · Check the patient's blood pressure (lying and standing). 测量患者的血压（患者站立或平躺均可）。 A low blood pressure or loss of pressure on standing suggests volume depletion 血压低或者 · Examine the patient for nystagmus. 检查患者是否出现眼球震颤症状。 This suggests a vestibular disorder 如果出现这种症状，说明患者患有前庭功能障碍。 · Determine if the patient has disconjugate eye movements or difficulty with visual pursuit. 判断患者是否出现 This suggests central nervous system pathology 如果出现该症状，说明患者患有中枢神经系统疾病。 · Check for adaptation, which may occur after continued exposure. 检查患者的适应症, 在持续暴露在刺激环境下, Motion sickness usually improves with continued exposure 如果持续暴露在运动的环境中,通常晕动病症状有可能有所缓解。 Questions to ask 肺水肿问诊 不翻译 Presenting condition: 症状表现 不翻译 · What is the sickness caused by? 这种疾病是由什么引起的？ Confirm that sickness is associated with real or apparent motion 确定疾病与实际晕动或视觉晕动有关。 · Do any factors precipitate or make it worse? 是否存在某些因素促进或加剧了病症？ Advise avoidance of contributory or predisposing factors Advise avoidance of contributory or predisposing factors · Does anything help relieve the sickness? 是否存在某些因素利于病症的缓解？ Promote these and other preventive measures 其他预防措施 · Are you taking medication? 您正在服用什么药物吗？ Some treatments interact with other medications, for example, central nervous system depressants 一些治疗方法与其他药物相互作用，例如，镇静剂。 · Do you have any chronic medical problems? 您患有慢性疾病吗？ Some medications are contraindicated in medical conditions, for example, anticholinergic drugs for closed-angle glaucoma 在某种健康状况下，某些药物是禁用的。例如，用于治疗青光眼的抗胆碱药 · Have you taken any medications previously that helped or did not help? 您之前是否服用过有效或无效的药物？ Some medications work better than others for different individuals 针对不同的个体，某些药物的效果好于其他药物。 Contributory or predisposing factors: 病因： 不翻译 · Are you anxious about flying or sailing? 您对乘坐飞机或船只感到焦虑吗？ Fear and anxiety increase the risk of motion sickness 担心和焦虑增加了晕动病发病的危险。 · Do you sleep well prior to travel? 在旅行前，您睡的好吗？ Lack of sleep and fatigue increase the risk of motion sickness 缺少睡眠和疲劳增加了晕动病发病的危险。 · Do you drink alcohol when you travel? 旅行时，您饮酒了吗？ This should be avoided, as it is likely to exacerbate motion sickness 旅行途中应避免饮酒，因为饮酒很可能使晕动病加重。 · Do you like to read when you travel (particularly by car)? 您在旅行途中喜欢阅读吗（尤其是在乘坐汽车的途中）？ This should be avoided, as it will often make motion sickness worse 应避免在旅行途中阅读，因为这可能使晕动病加重。 · Are you taking any prescribed medications? 您是否正在服用处方类药物？ Some medications might increase the likelihood of nausea and vomiting 某些处方类药物可能加剧恶心呕吐发生的可能性。 · Are you pregnant or menstruating when scheduled to travel? 旅行时，您是否处于怀孕期或月经期。 Both are said to increase risk of motion sickness 无论是怀孕还是处于月经，都增加了晕动病发病的危险。 Back to Top Back to Top 不翻译 http://www.firstconsult.com/das/pdxmd/body/410460402-2/0?type=med&eid=9-u1.0-_1_mt_1014468&tab=V 不翻译 Diagnostic testing 诊断检查 不翻译 · In uncomplicated cases, no diagnostic studies are necessary 在简单的情况下，没有必要进行诊断性研究。 · If the symptoms are atypical or the neurologic examination is abnormal, further investigation and referral may be needed 如果症状不典型，或神经系统检查不正常，可能需要进行进一步检查和转诊。 Back to Top Back to Top 不翻译 http://www.firstconsult.com/das/pdxmd/body/410460402-2/0?type=med&eid=9-u1.0-_1_mt_1014468&tab=V 不翻译 Differential diagnosis 鉴别诊断 不翻译 Acute vestibular syndrome 急性前庭综合症 javascript:void(null); 不翻译 · Acute vestibular syndrome is an acute episode of prolonged vertigo, nausea, and vomiting unrelated to motion exposure 急性前庭综合症是一种急性疾病，表现为持续性眩晕、恶心呕吐 · May have tinnitus and sensation of fullness in the ear 可能会出现耳鸣和耳堵等不适感觉。 · Nystagmus is often present along with vertigo worsened by head movement 头部运动可能导致眼球震颤以及眩晕情况加剧。 http://www.firstconsult.com/das/pdxmd/body/410460402-2/0?type=med&eid=9-u1.0-_1_mt_2001189 不翻译 · Often preceded by an upper respiratory illness 通常由上呼吸道疾病引起。 Benign paroxysmal positional vertigo 良性阵发性位置性眩晕 javascript:void(null); 不翻译 · Benign paroxysmal positional vertigo lasting for minutes, precipitated by change of head position 良性阵发性位置性眩晕持续数分钟，头部位置的改变可能加剧眩晕程度。 · Dix-Hallpike positioning may elicit characteristic torsional nystagmus with affected ear down Dix-Hallpike positioning may elicit characteristic torsional nystagmus with affected ear down Gastroenteritis 不翻译 javascript:void(null); 不翻译 · The symptoms and signs of gastroenteritis occur from 1 to 16 hours after ingestion, if cause is toxic 如果是有毒物质，在食物消化后的1到16小时内可能发生肠胃炎症状。 http://www.firstconsult.com/das/pdxmd/body/410460402-2/0?type=med&eid=9-u1.0-_1_mt_1017208 · Features include fever, nausea and vomiting, cramping abdominal pain (sometimes), and diarrhea 临床特征包括发烧、恶心呕吐、腹部绞痛（间接发生），以及腹泻。 Metabolic disorders 不翻译 javascript:void(null); 不翻译 · Some metabolic disorders such as uremia, metabolic acidosis or alkalosis, hyperglycemia, and thyrotoxicosis can have vomiting as a significant feature. 某些代谢紊乱，如尿毒症、代谢性酸中毒或碱中毒、高血糖症以及甲状腺功能亢进 Vomiting is not necessarily related to motion 呕吐症状不一定与运动有关。 · Other features and laboratory findings are specific to cause 其他临床病症和实验室检查结果由特定原因引起。 Altitude sickness 不翻译 javascript:void(null); 不翻译 · Symptoms of altitude sickness begin to occur approximately 4,900 feet above sea level. 在海拔4900英尺以上，可能出现高原病症状。 Rate of ascent and individual susceptibility affect the onset 海拔的升高以及个体易感性对于发病有影响。 http://www.firstconsult.com/das/pdxmd/body/410460402-2/0?type=med&eid=9-u1.0-_1_mt_1014691 不翻译 · Features include frontal headache, nausea and vomiting, loss of balance, malaise, anorexia, decreased physical performance, and periodic breathing and breathlessness 临床表现包括额痛、恶心呕吐、身体失衡、心神不宁、厌食、身体活动能力降低以及周期性呼吸及呼吸困难。 Back to Top Back to Top 不翻译 http://www.firstconsult.com/das/pdxmd/body/410460402-2/0?type=med&eid=9-u1.0-_1_mt_1014468&tab=V 不翻译 Consultation 咨询 不翻译 · Intravenous fluid should be given to correct volume depletion if patient is acutely ill due to vomiting and anorexia 如果患者由于呕吐和厌食导致病情加重，应对其进行静脉注射，缓解高渗透性和高钠血症。 · Consider consultation if prolonged or atypical features present 如果患者呈现出长期或非典型性病理特征，要考虑咨询专家。 Treatment 治疗 不翻译 Back to Top Back to Top 不翻译 http://www.firstconsult.com/das/pdxmd/body/410460402-2/0?type=med&eid=9-u1.0-_1_mt_1014468&tab=V 不翻译 Summary approach 诊断方法 不翻译 · The goal of treatment is to identify specific exacerbating factors (useful in prevention) and to avoid any complications related to treatment 治疗的目的是发现特定的加剧病情的因素（这是一种有效的预防方法），并避免任何与治疗有关的并发症的出现。 · Patient should be removed from stimulus or exacerbating factors immediately, if possible; intravenous fluids should be administered if patient is markedly dehydrated/hypotensive due to vomiting; a fast-acting drug should be prescribed immediately (ie, promethazine 25-50 mg intramuscularly) 如果可能，患者需要立刻脱离刺激性或加剧病情的因素；如果患者由于呕吐产生明显的脱水或低