NCCN止吐临床指引(2005.1版)

1 目录 NCCN止吐专家组成员(附后) 肿瘤患者的止吐原则(AE-1) 化疗方面: 具有高度催吐反应的化疗-预防呕吐(AE-2) 具有中度催吐反应的化疗-预防呕吐(AE-3) 具有轻度和轻微催吐反应的化疗-预防呕吐(AE-4) 化疗引起的恶心呕吐的解救性治疗(AE-5) 化疗药的催吐潜能(AE-6) 持续多天化疗的止吐原则(AE-A) 治疗恶心呕吐的新药(AE-B) 解救性止吐治疗原则(AE-C)     

化疗止吐药物联合应用的研究进展

化疗所致恶心呕吐(CINV)是应用高度催吐风险化疗药物过程中最常见的不良反应,高度催吐风险化疗药物是临床医生在治疗恶性肿瘤过程中的必要选择,最大限度地减少其不良反应的发生可改善患者的生活质量,增加恶性肿瘤患者治疗的依从性,故探究CINV的有效防治措施始终是临床医师的重要课题。然而,在临床工作中,医师面临众多止吐药物,如何选择最佳的止吐药物联合方案仍在探索中。地塞米松、神经激肽1受体拮抗剂、5-羟色胺3受体拮抗剂是常用的化疗止吐药物,三者的联合方案一直受到多国止吐指南推崇。而上述止吐方案仍不能完全控制CINV,2017年2月,美国国家综合癌症网络首次将奥氮平与上述三药联合防治方案列入NCCN止吐指南,这是防治CINV新的突破。     

中医药治疗糖尿病及其并发症的实验研究进展

从中药单味药及其提取物和中药复方两个方面对中医药防治糖尿病及并发症的实验研究现状进行综述.采取单味中药或提取物治疗糖尿病具有用药方便、疗效稳定、针对性强等优点;中药复方则从不同途径、不同环节起到治疗糖尿病及其并发症的作用,发挥多靶点的治疗效果.     

耳穴埋籽、穴位按摩联合止吐药物预防肿瘤介入化疗术后恶心呕吐的效果观察

目的：观察耳穴埋籽、穴位按摩联合止吐药物预防肿瘤介入化疗术后恶心呕吐的效果。方法：选取江苏省中医院肿瘤介入科行介入治疗的40例患者,随机分为观察组和对照组各20例,观察组采用使用止吐药的基础上联合耳穴埋籽及穴位按摩,对照组采用止吐药单药治疗。对两组患者进行干预后的效果观察。结果：观察组中控制16例,有效2例,总有效率为95％;对照组中控制9例,有效6例,总有效率为75％。结论：耳穴埋籽、穴位按摩联合止吐药物预防肿瘤介入化疗术后恶心呕吐疗效显著,显著提高患者舒适度且病人满意度较高,今后值得在临床推广。     

中医药抗氧化损伤防治阿尔茨海默病

从氧化损伤方面简要阐述了Aβ在AD发生发展过程中的致病作用,举例说明中药单味药及其提取物、中药复方在抗氧化损伤方面作用显著,值得深入研究.     

中药缓释微球（丸）的研究进展

本文从中药单体化合物、中药有效部位、中药单味药和中药复方制剂等方面概述中药缓释微球的研究进展。     

绿茶提取物对大鼠服用氯氮平药动学的影响

氯氮平广泛用于治疗精神病，但副作用是易引起服药者肥胖。绿茶提取物具有减轻体重等多种药理作用，因而可能治疗药物和饮食引起的肥胖。然而绿茶提取物对能引起肥胖的抗精神病药物的药动学的影响鲜有报道。因此作者研究了绿茶提取物对大鼠服用氯氮平药动学的影响。     

5羟色胺拮抗剂类止吐药物的市场竞争态势

虽然止吐药在分类上属于消化系统药物的范畴,但在临床上却主要用在抗肿瘤药物所致的呕吐治疗中。止吐药目前主要有三类,分别通过不同的环节来抑制催吐化学感受区而止吐,除对晕动症所致的呕吐以外其他呕吐均有明显的作用,由于这类药物副作用较大,更多用于精神疾病因而目前较少用     

止吐药物的研究进展

近年来肿瘤分子靶向治疗得到了迅猛发展,但是化疗仍然是许多恶性肿瘤的主要治疗方法.化疗引起的恶心、呕吐(CINV)在临床中最常见,75％以上的化疗病人均会出现不同程度的恶心、呕吐[1].止吐治疗的目的是预防或减少与化疗有关的恶心、呕吐的频率和强度.早期用于临床的止吐药物有严重的神经中枢抑制或锥体外系不良反应.因此80年代以来相继开发了多种高选择性的5-H T3受体阻断剂,并逐渐发展成为治疗CINV的主流药物.目前止吐药按作用机制可以分为多巴胺阻断剂、呕吐中枢抑制剂、抗组胺药、皮质类固醇、5-H T3受体阻断剂、NK-1受体阻断剂等.本文主要对止吐药物的分类、作用机制、临床应用等研究进展综述如下.     

尿毒症患者应用胃复安引起全身大抽搐一例

胃复安为临床常用止吐药,本药主要通过抑制延脑催吐化学感受器而发挥止吐作用。近年已广泛用于胃、肠功能紊乱,以及各种原因引起的胃炎、幽门梗阻伴发呕吐,放射或化学治疗伴发胃肠道反应等。一般认为其副作用轻微而可逆,包括(1)疲乏、嗜睡;(2)肠痉挛;(3)注射后可以出现体位性低血压;(4)锥体外系症状。我院收治一尿毒症患者应用本     

Syrup of ipecacuanha as an emetic in adults.

The emetic actions of syrup of ipecacuanha have been evaluated in 105 adult patients presenting at the emergency department of the Royal Perth Hospital with a diagnosis of accidental or intentional poisoning. The australian Pharmaceutical Formulary (APF) and the United States Pharmacopeia (USP) formulations of the syrup were compared and gave similar overall emetic responses of 88% and 89% respectively at a dose level of 15 ml. A 30 ml dose regimen of the APF formulation gave a slightly but not significantly increased overall emetic response of 96%. There were no differences between the three groups of patients in the time taken to vomit, the duration of vomiting or the volume of stomach contents recovered.     

盐酸帕洛诺司琼注射液预防化疗呕吐的临床研究

目的探讨盐酸帕洛诺司琼注射液预防肿瘤化疗所致呕吐的有效性和安全性。方法采用双盲双模拟、随机、阳性药平行对照,对使用含顺铂或阿霉素高度致吐性化疗方案的患者,于化疗前30分钟分别静脉推注盐酸帕洛诺司琼注射液0.25mg（试验组）或盐酸格拉司琼注射液3mg（对照组）,观察患者急性呕吐、延迟性呕吐及不良反应发生情况。结果入组38例患者,其中试验组20例,对照组18例。试验组对化疗引起的急性呕吐（24小时内）有效率（RR）与对照组相比无显著性差异（85.00%vs.77.78%,P=0.566）,试验组对延迟性呕吐（24小时～120小时）有效率与对照组有统计学差异（65.00%vs 27.78%,P=0.028）。两组分别有15.00%和16.67%的受试者出现便秘、头痛等（P=0.888）。结论盐酸帕洛诺司琼注射液能够有效预防肿瘤化疗所致急性呕吐及延迟性呕吐,安全性好。     

Thyrotoxic hyperemesis: a case report

A male patient with hyperemesis as a result of hyperthyroidism was presented. Investigations for causes were negative except for hyperthyroxinaemia. Treatment with antithyroid drug relieved the symptom. Hyperemesis associated with hyperthyroidism occurs predominantly in females. A likely emetic factor oestrogen. Hyperthyroidism could have potentiated this effect. Levels of oestrogens are raised in thyrotoxicosis. The hyperthyroidism, the raised oestrogens and a low emetic threshold conspired to hyperemesis in this patient, a situation not unlike hyperemesis gravidarum. Thyrotoxic vomiting once recognised is readily by antithyroid treatment.     

欧必亭预防顺铂所致呕吐的临床研究

目的 观察欧必亭的止吐疗效和毒性。方法 对70例接受顺铂化疗的患者,采用随机自身对照的方法,比较欧必亭和枢丹的疗效和毒性。结果 欧必亭可预防顺铂化疗所致的呕吐,疗效满意,其止吐效果与枢丹相似,两药在化疗第1—5天的止吐平均有效率分别为84.7%和82.9%,两药的疗效无统计学差异(P>0.05),但欧必亭与枢丹比较使用方便且较经济。结论 欧必亭为肿瘤化疗安全,有效的止吐药,值得临床推广。     

Acupuncture Treatment of Vomiting

CASE HISTORY A female patient, 46 years old, head of the foreign affairs department of a certain university in Beijing, paid her first visit on October 9, 2006, with the chief complaint of vomiting for one month. She got vomiting after meals in early September. Before that, she had discomfortable sensation in the stomach due to angry with others, but she didn't pay much attention. Later, it developed into vomiting after eating. After the vomiting, the discomfort would be relieved, but with slight hypodynamia. She was once diagnosed as having 'neurogenic vomiting'. Having taken some western and Chinese drugs, the above symptoms were a little bit improved, but she would have nausea upon eating and with regurgitation. Because of the fear for vomiting, she did not dare to have food intake, with body weight reduction of 6 kilos in one month.     

Vomiting post tonsillectomy at the University Hospital of the West Indies

A three-year observational study of patients undergoing tonsillectomy at the University Hospital of the West Indies was conducted to determine the incidence of postoperative vomiting. Data were collected to assess possible risk factors for vomiting as well as possible alleviating agents. Two hundred and fifty-two patients were included in the study and a thirteen per cent incidence of postoperative vomiting was found. This is significantly less than that quoted in other studies (40-73%). Results also showed that steroids significantly reduced the incidence of postoperative vomiting in the study population. Muscle relaxants reversal agents and antibiotics particularly co-trimoxazole and ceftriaxone significantly increased its incidence. Usual antiemetic agents including dimenhydrinate (gravol) and promethazine (phenergan), as well as drugs known to possess antiemetic properties such as midazolam and propofol, lacked any significant protective effect against emesis. Opioid analgesia, inhalational induction and blood loss of greater than 10% of estimated blood volume appeared to increase emesis but failed to achieve statistical significance.     

Comparison of ondansetron, dexamethasone, ondansetron plus dexamethasone and placebo in the prevention of nausea and vomiting after laparoscopic tubal ligation

Laparoscopic tubal ligation is associated with an appreciably high rate of postoperative nausea and vomiting. This study was designed to compare the effectiveness of ondansetron, dexamethasone, ondansetron plus dexamethasone or placebo in the prevention of postoperative nausea and vomiting in patients after laparoscopic tubal ligation. In a prospective, randomised, double blind placebo controlled trial, 160 ASA I-II females received one of four regimens; ondansetron 4 mg, dexamethasone 8 mg, ondansetron 4 mg plus dexamethasone 8 mg or placebo (n=40 each) intravenously immediately before induction of anaesthesia. Patients were then observed for 24 hours postoperatively. The incidence of emetic episodes in the ondansetron with dexamethasone group was lower than in the placebo (p<0.001) and ondansetron (p=0.091) and dexamethasone (p=0.143) groups. A complete response (as no postoperative nausea and vomiting) was achieved in 60% of patients given ondansetron, 63% of the patients given dexamethasone, 78% of patients given ondansetron with dexamethasone and 37% of patients received placebo. The prophylactic use of ondansetron with dexamethasone is more effective in preventing postoperative nausea and vomiting.     

Gastrointestinal Disturbances Associated with Withdrawal of Ataractic Drugs

The psychological effects of abrupt withdrawal of ataractic drugs have been studied by others. Physical symptoms also occur under such circumstances and include abdominal pain, nausea and vomiting. Forty patients were divided into four groups of 10, each group receiving one of the following drugs: chlorpromazine, thioridazine, perphenazine or chlorprothixene. This medication was then suddenly withdrawn. In each of the chlorpromazine and thioridazine groups, three patients had gastrointestinal symptoms within 48 hours, lasting one to eight days. One patient on chlorprothixene, 450 mg. daily, experienced symptoms for six days. Perphenazine withdrawal produced no such symptoms. Thioridazine has little antiemetic action but perphenazine is prescribed for vomiting; hence it seems unlikely that the reported symptoms are due to a rebound action on the vomiting centre.

These findings are relevant to the situation of withdrawal of ataractics prior to administration of anesthetics and to drug studies involving cross-over from an active compound to a placebo. The increasing use of ataractics suggests that this additional diagnostic possibility should be considered in the presence of obscure gastrointestinal symptoms.

     

Acupuncture Treatment of Vomiting Caused by Chemotherapy

Chemotherapy is mainly used for treating malignant tumor. However, some patients can not withstand the side effects in the digestive system and had to abandon the treatment. In order to prevent vomiting, antiemetics, such as metoclopramide and ondansetron (a new kind of antiemetic), are used. But some patients still vomit after taking these drugs. Moreover, drugs like ondansetron are very expensive for many patients. Since March 1999, we have applied acupuncture to prevent vomiting caused by chemotherapy with satisfactory results. The following is a report of 34 cases observed.     

瓜蒂催吐作用有效部位的初步筛选

目的：分离并初步筛选瓜蒂催吐作用的有效部位。方法：以80%乙醇回流提取制得的瓜蒂总提取物后,以用硅胶柱溶剂极性依次递增分离法（石油醚-乙酸乙酯-甲醇连续洗脱）制得的分段提取物（石油醚I,乙酸乙酯II,甲醇III）为药效研究对象,筛选对犬致吐作用有活性的有效部位,最后通过特殊颜色反应确定有效部位化学性质。结果：瓜蒂中乙酸乙酯提取物具有催吐作用,与蒸馏水组相比有显著性差异（P<0.01）。颜色反应说明该部位主要含有葫芦素类等物质。结论：瓜蒂总葫芦素类部位可能是其催吐作用有效部位。