简介:大麻素以其治疗恶心和呕吐的能力而闻名。最近的报道,然而,强调了大麻素的矛盾促吐作用。大麻素剧吐综合征(CHS)的特征是周期性的恶心和呕吐,长时间伴有腹痛,大剂量使用大麻,可以通过热水澡和淋浴来缓解。对这种综合症的病因知之甚少。讨论:大麻素对恶心和呕吐产生双相作用,低剂量具有止吐作用,高剂量产生呕吐。CHS的表现和治疗与周期性呕吐综合征以及化疗相关的预期性恶心和呕吐相似,这表明这些现象可能具有共同的机制。由于与其他疾病的症状重叠以及公众和医生对该综合征缺乏了解,因此尚不清楚CHS的患病率。用典型的止吐药治疗对CHS无效,但是抗焦虑和镇静药物,连同热水淋浴,似乎在减轻症状方面一直有效。唯一已知的永久结束CHS的方法,然而,是对大麻素的禁欲。关于CHS的案例研究和有限的临床前数据表明,大麻中主要精神药物化合物的长期高剂量,Δ9-四氢大麻酚(THC),通过作用于大麻素1(CB1)受体导致内源性大麻素系统的变化。这些内源性大麻素系统的变化可以失调的压力和焦虑反应,体温调节,瞬时受体电位香草素系统,和几个神经递质系统,因此是介导CHS病理生理学的潜在候选者。结论:过量服用大麻素破坏内源性大麻素系统的正常功能,这可能会导致CHS。需要更多的临床和临床前研究来充分了解这种疾病的潜在病理生理学以及长期使用大剂量大麻的负面影响。
Introduction: Cannabinoids have long been known for their ability to treat nausea and vomiting. Recent reports, however, have highlighted the paradoxical proemetic effects of cannabinoids. Cannabinoid hyperemesis syndrome (CHS) is characterized by cyclical episodes of nausea and vomiting, accompanied by abdominal pain following prolonged, high-dose cannabis use, which is alleviated by hot baths and showers. Little is known about the cause of this syndrome. Discussion: Cannabinoids produce a biphasic effect on nausea and vomiting, with low doses having an antiemetic effect and high doses producing emesis. Presentation and treatment of CHS are similar to cyclical vomiting syndrome as well as chemotherapy-related anticipatory nausea and vomiting, suggesting that these phenomena may share mechanisms. The prevalence of CHS is not known because of the symptomatic overlap with other disorders and the lack of knowledge of the syndrome by the public and physicians. Treatment with typical antiemetic drugs is ineffective for CHS, but anxiolytic and sedative drugs, along with hot showers, seem to be consistently effective at reducing symptoms. The only known way to permanently end CHS, however, is abstinence from cannabinoids. Case studies and limited pre-clinical data on CHS indicate that prolonged high doses of the main psychotropic compound in cannabis, Δ9-tetrahydrocannabinol (THC), result in changes to the endocannabinoid system by acting on the cannabinoid 1 (CB1) receptor. These endocannabinoid system changes can dysregulate stress and anxiety responses, thermoregulation, the transient receptor potential vanilloid system, and several neurotransmitters systems, and are thus potential candidates for mediating the pathophysiology of CHS. Conclusions: Excessive cannabinoid administration disrupts the normal functioning of the endocannabinoid system, which may cause CHS. More clinical and pre-clinical research is needed to fully understand the underlying pathophysiology of this disorder and the negative consequences of prolonged high-dose cannabis use.