임신 중 구역과 구토의 관리
Nausea and Vomiting in Pregnancy
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임신 중 구역 및 구토는 복합적이고 다 인자적인 상황으로 태아뿐 아니라 산모의 삶의 질이나 건강에 좋지 않은 결과를 초래할 수 있으므로 빨리 인지하고 치료를 할 수 있도록 해야 한다. 먼저 편두통이나 그 밖의 위장 질환의 가능성들을 먼저 고려해야 하며, 일단 의심이 되는 환자의 경우 유발인자를 정확하게 파악하여야 하며 신장, 간 기능을 확인하고 전해질 및 아밀라아제 등을 평가해야 한다. 먼저 소량씩 자주 먹는 식습관이 도움이 될 수 있으며, pyridoxine과 doxylamine이 무작위 연구에서 효과가 입증이 되어 일차적인 약제로 고려될 수 있겠다. 일차 약제에 반응하지 않는 경우 phenothiazine, metoclopramide 등과 같은 D2 수용체 길항제나, 5 hydroxytryptamine 3-receptor (5-HT3)인 ondansetron 등이 이용될 수 있고, 구역 및 구토로 인한 위장 증상 및 위식도 역류증상이 동반된 경우 히스타민 2 수용체가 도움이 될 수 있다. 비약물 치료로는 생강이나 침술 등이 효과가 증명이 되어 있다. 임신 오조나 탈수가 심하게 되어 있는 환자의 경우 티아민이 포함된 비타민제제와 함께 정맥 수액 보충이 필요하며, 약물 치료에도 불구하고 체중감소가 계속되는 경우 비 위관 경장영양 혹은 비 경구 요법 등을 고려해야 할 것이다. 뿐만 아니라 이러한 임산부에 대한 정서적 지지도 치료의 중요한 부분이 되겠다. 임신 중 구역과 구토에 대한 치료 접근을 요약하면 다음과 같다(Fig. 1). 임신 중 구역과 구토에 대해 안전하면서도 효과적인 데이터들은 이러한 환자의 치료에 있어 많은 도움이 된다. 이를 바탕으로 담당의는 모든 산모에게 일률적인 것이 아니라 환자 각각에게 가장 적합하고 안전한 방향으로 접근해야 하겠다.
Abstract
Nausea and vomiting in pregnancy (NVP) is common medical condition during pregnancy and associated with hormonal change. Early recognition and active treatment is warranted because it can be associated with adverse healthy effect in both fetus and mother. First, the possibility of other gastrointestinal disorder should be considered and precipitating factor, renal and liver function should be evaluated. Primay recommended pharmacotherapy is the combination of oral pyridoxine hydrochloride and doxylamine succinate. Other options including dopamin (D2) receptor antagonist, antihistamine and serotonine 5 hydroxytryptamine 3-receptor (5-HT3) can be used. Fluid mixed with multivitamine including thiamine supplement should be considered in case of severe dehydration and hyperemesis gravidarum. Emotional support is also an important part in the management of NVP. The physician shoud apply individualized approach for the safest and most appripriate treatment. (Korean J Med 2012;82:525-531)
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