Monitoring,prevention and treatment of side effects of long-acting neuraxial opioids for post-cesarean analgesia

Long-acting neuraxial opioids such as morphine and diamorphine, administered via spinal or epidural routes, are staple components of a multimodal approach to postoperative analgesia following cesarean delivery. The widespread use of neuraxial opioids is due largely to their significant analgesic efficacy and favorable safety profile. The most common side effects of neuraxial opioids are pruritus, nausea and vomiting. These symptoms appear to be dose-related. The most serious complication of neuraxial opioids is respiratory depression, which occurs in 0–0.9% of cases. Hypothermia has also been reported in association with neuraxial morphine use at cesarean delivery. This article will review recent advances in prophylaxis, treatment and monitoring of the side effects of long-acting neuraxial opioids.     

昂丹司琼对比托烷司琼预防上腹部分割放疗所致恶心呕吐的临床研究

目的 比较昂丹司琼和托烷司琼预防上腹部分割放疗所致恶心呕吐的有效性与安全性。方法 选择84例接受上腹部分割放疗的肿瘤患者为研究对象,采用随机数字表法分为昂丹司琼组（O组）和托烷司琼组（T组）,每组42例。记录两组患者放疗期间恶心呕吐及其他不良反应的发生情况。结果 O组急性期恶心的完全缓解（CR）率显著低于T组（81.0% vs. 57.1%, P=0.018）;两组延迟期和全期恶心的CR率（61.9% vs. 50.0%, P=0.272; 61.9% vs. 45.2%, P=0.126）比较,差异无统计学意义。两组急性期、延迟期及全期呕吐的CR率（71.4% vs. 64.3%, P=0.483; 59.5% vs. 57.1%, P=0.825; 66.7% vs. 57.1%, P=0.369）比较,差异均无统计学意义。两组头晕、头痛、疲乏、腹泻和便秘的发生率比较,差异均无统计学意义（P>0.05）。结论 昂丹司琼和托烷司琼预防上腹部分割放疗所致恶心呕吐具有相似的疗效和安全性,昂丹司琼预防急性恶心的效果优于托烷司琼。     

初乳口腔按摩在早产儿中的应用效果

目的:观察初乳口腔按摩应用于早产儿的效果。方法:选取70例早产儿为研究对象,按照随机数字表法分为对照组和观察组各35例。对照组给予常规护理,观察组在对照组基础上应用初乳口腔按摩。比较两组完全经口喂养时间、住院时间、日体质量增长水平和不良反应发生率。结果:观察组完全经口喂养时间和住院时间均短于对照组,日体质量增长水平高于对照组,差异有统计学意义(P<0.05);观察组腹胀发生率和呕吐发生率分别为11.43%和5.71%,均低于对照组的34.29%和28.57%,差异有统计学意义(P<0.05);两组胃食管反流发生率和口腔感染发生率比较,差异均无统计学意义(P>0.05)。结论:在常规护理基础上采用初乳口腔按摩可缩短早产儿完全经口喂养时间和住院时间,降低腹胀发生率和呕吐发生率,以及提高日体质量增长水平的效果优于单纯常规护理效果。     

帕洛诺司琼注射液预防化疗引起呕吐的疗效观察

目的 观察帕洛诺司琼注射液预防化疗引起呕吐的有效性和安全性.方法 采用多中心、分层随机、双盲双模拟、自身交叉对照临床试验设计,入组149例应用顺铂或蒽环类方案的恶性肿瘤患者.全部入组患者分为中致吐性化疗组,即顺铂≤50 mg/m2或多柔比星≥40 mg/m2(或吡柔比星≥40 mg/m2或表柔比星≥60 mg/m2),高致吐性化疗组,即顺铂≥60 mg/m2.患者连续化疗2个周期,化疗前分别应用帕洛诺司琼和格拉司琼,如第1周期应用试验药物(帕洛诺司琼),则第2周期应用对照药物(格拉司琼),反之则相反.对比患者应用试验药物的化疗周期(试验组)与应用对照药物的化疗周期(对照组)急性和延迟性呕吐的完全控制率以及不良反应.结果 预防急性呕吐的完全控制率:中致吐性试验组和对照组分别为50.72％、48.00％,高致吐性试验组和对照组分别为45.76％、52.24％,差异均无统计学意义(x2=0.153,P=0.695x2=0.924,P=0.337).预防延迟性呕吐的完全控制率:中致吐性试验组和对照组分别为59.42％ 、41.33％,差异有统计学意义(x2=4.673,P=0.031);而高致吐性试验组与对照组分别为37.29％、28.36％,差异无统计学意义(x2=0.956,P=0.328).第24小时至第5天呕吐次数的比较:中致吐性试验组中位数0.0次、对照组1.0次,差异有统计学意义(x2=7.765,P=0.005).试验、对照两组不良反应发生率均较低,程度也较轻.结论 帕洛诺司琼预防中、高致吐性化疗引起的急性及延迟性呕吐疗效确切,特别是在预防延迟性呕吐方面,帕洛诺司琼优于格拉司琼,且帕洛诺司琼不良反应轻微,值得在临床上推广使用.     

大柴胡汤古方新用举隅

大柴胡汤是临床常用经方,主要治疗少阳邪热不解,病兼阳明里实的胆系感染、胰腺炎、阑尾炎、肠梗阻等多种疾病。本着"有是证,用是药"的辨证论治原则,一是掌握少阳兼阳明里实的病机,二是掌握大柴胡汤的四个主证,在临床用于治疗休息痢、黄疸、呕吐、泄泻、荨麻疹等病证,疗效满意,意使古方焕发新彩,在传承中创新。     

Cost-effectiveness of ondansetron for postoperative nausea and vomiting

The decision as to whether prophylaxis against postoperative nausea and vomiting is better than treatment of established postoperative nausea and vomiting could be made on the basis of cost-effectiveness. The cost-effectiveness of ondansetron was calculated using data from published quantitative systematic reviews of randomised trials. Milligrams of ondansetron required to achieve a desired endpoint were chosen as a cost unit. Modelling was based on a cohort of 1000 patients, and examined control event rates (i.e. incidence of postoperative nausea and vomiting without prophylaxis) of between 10 and 90%. In a sensitivity analysis, cost-effectiveness of recommended intravenous doses (4 mg for treatment and prophylaxis) was compared with minimal effective doses as shown by meta-analysis (1 mg for treatment, 8 mg for prophylaxis). Fewer patients experience any postoperative nausea and vomiting symptoms with prophylaxis compared with treatment. But prophylaxis is only marginally more effective than treatment, and treatment of established postoperative nausea and vomiting with effective doses (i.e. 1 or 4 mg) is more cost-effective and safer than prophylaxis with effective doses (i.e. 4 or 8 mg). Reasons for this are the selective treatment of patients who actually need treatment, the high success rate with a lowest dose tested (1 mg) in established postoperative nausea and vomiting, and the disappointing antinausea effect of prophylactic ondansetron even at an eight-fold higher dose.