盐酸帕洛诺司琼预防硬膜外自控镇痛所致恶心呕吐的分析

【摘要】　目的 观察盐酸帕洛诺司琼预防术后硬膜外腔自控镇痛引起恶心呕吐副作用的效果。方法 选取择期硬膜外麻醉下开腹胆囊切除术后施行硬膜外腔自控镇痛(PCEA)的患者60例,PCEA采用吗啡6 mg+0.125%布比卡因混合液(100 mL)。将患者分为盐酸帕洛诺司琼组,氟哌啶组和对照组(每20例),在术前静脉给予盐酸帕洛诺司琼0.25 mg,氟哌啶2.5 mg和生理盐水100 mL。术后记录使用PCEA镇痛期间的恶心例数及其严重程度;呕吐例数及次数;出现呕吐后给予胃复安,非那根,地塞米松等药物止吐的控制率。结果 对照组13例出现Ⅰ~Ⅲ级恶心呕吐的不良反应,盐酸帕洛诺司琼组患者1例1级恶心呕吐的发生,与其他两组相比P<0.001;氟哌啶组出现5例Ⅰ~Ⅱ级恶心呕吐的,与对照组相比P=0.022。结论 术前预防性给予盐酸帕洛诺司琼可显著降低胆囊切除术后PCEA引起恶心呕吐副作用的发生。     

Postoperative nausea and vomiting prophylaxis: The efficacy of a novel antiemetic drug (palonosetron) combined with dexamethasone

BackgroundPalonosetron is a new, potent, and long-acting 5HT3-receptors antagonist that had been approved by the FDA for use in postoperative nausea and vomiting (PONV) prophylaxis. This study is designed to evaluate its efficacy combined with dexamethasone in PONV prophylaxis in highrisk patients scheduled for laparoscopic surgeries.MethodsIn this double-blind, active-controlled study, 150 patients aged 20–55 years, ASA I–II, and with Apfel’s PONV score 2–4 were equally randomized to receive dexamethasone 8 mg before anesthesia induction and saline 30 min before the end of surgery (group D + S), dexamethasone 8 mg before anesthesia induction and metoclopramide 25 mg 30 min before the end of surgery (group D + M), or dexamethasone 8 mg combined with palonosetron 0.075 mg before anesthesia induction and saline 30 min before the end of surgery (group D + P). Incidences of early and late PONV, complete response, adverse events from antiemetics used, and overall patients’ satisfaction were recorded.ResultsThe incidence of PONV was comparable in the three groups 0–6 h postoperatively. Palonosetron–dexamethasone and dexamethasone–metoclopramide combination therapies significantly reduced the incidence of PONV at 6–12 h postoperatively compared to dexamethasone monotherapy (12% and 16%, vs. 36%, respectively, with P < 0.05). Moreover, palonosetron–dexamethasone combination therapy significantly reduced the incidence of PONV at 12–24 h postoperatively compared to both dexamethasone monotherapy (16% vs. 48%, P < 0.01), and dexamethasone–metoclopramide combination therapy (16% vs. 40%, P < 0.05). The incidence of adverse drug effects was comparable in the three groups. The overall patients’ satisfaction was significantly higher in palonosetron–dexamethasone combination therapy compared to other groups.ConclusionPalonosetron–dexamethasone combination is effective and safe in PONV (early and late) prophylaxis in high-risk patients undergoing laparoscopic surgeries with known high-risk of PONV.     

防治术后恶心呕吐的研究进展

背景 术后恶心呕吐(postoperative nausea and vomiting,PONV)是麻醉手术后最常见的并发症之一,其发生率可高达30％.虽然国际上已公布了防治PONV共识和指南,但尚存在缺陷的PONV预测模型和复杂的防治策略成为临床防治PONV最大的障碍. 目的 探究在临床工作中防治PONV的主要障碍,为临床防治PONV工作提供更有效的途径. 内容 尚存在缺陷的PONV预测模型和复杂的防治策略是临床防治PONV最大的障碍,多模式防治PONV是一种简单、有效的预防PONV发生的方法. 趋向 多模式防治PONV更容易被临床麻醉医生接受和应用,新型的抗PONV药物和传统经典的抗呕吐药物为临床多模式防治提供了更大的选择空间.     

Review of evidence for the use of steroids in orthognathic surgery

Primarily, steroids are used routinely in orthognathic surgery to reduce swelling, but there is no nationally accepted regimen for the use of glucocorticoids in the UK. This article examines the evidence base for the use of steroids to reduce swelling, nausea, vomiting, and pain, and looks at evidence of the ratio of risks:benefits in orthognathic surgery and related publications. Evidence supports their use preoperatively, but the timing of this and their postoperative use may be contentious. The current regimens are associated with little morbidity and low cost. A well designed multi-centre study whose design would allow objective measures of swelling is required to resolve the areas of debate.     

术中胃减压对神经内镜经鼻颅底手术后恶心呕吐的影响

目的探讨术中胃减压对行神经内镜经鼻颅底手术患者手术后恶心呕吐(PONV)的影响。方法回顾性分析2019年1—8月在复旦大学附属华山医院神经外科接受神经内镜经鼻颅底手术的357例患者的临床资料。根据术中是否进行胃减压,分为胃减压组(146例)和对照组(211例)。比较两组的临床特征和术后24 h内PONV发生率的差异。对于包括胃减压在内的各因素对行神经内镜经鼻颅底手术患者PONV发生的影响,采用单因素和多因素logistic回归分析法探讨。结果所有患者术后24 h内的PONV发生率为11.8%(42/357)。胃减压组的女性比例[58.2%(85/146)对比46.4%(98/211),P=0.029]和Apfel评分为2~3分的比例[64.4%(94/146)对比50.2%(106/211),P=0.008]均高于对照组,而胃减压组PONV的发生率低于对照组[7.5%(11/146)对比14.7%(31/211),P=0.039]。单因素logistic回归分析结果提示,术中采用脂肪填塞修补脑脊液漏、术中采用黏膜瓣修补脑脊液漏、术中胃减压和术中失血量是神经内镜经鼻颅底手术患者PONV发生的影响因素(均P<0.05)。多因素logistic回归分析结果提示,术中胃减压(OR=0.397,95%CI:0.185~0.852,P=0.018)和术中失血量(OR=1.133,95%CI:1.026~1.250,P=0.013)为神经内镜经鼻颅底手术患者PONV发生的独立影响因素。结论实施术中胃减压可降低神经内镜经鼻颅底手术患者PONV的发生率。     

Guideline for the Treatment of Breakthrough and the Prevention of Refractory Chemotherapy‐Induced Nausea and Vomiting in Children With Cancer

This clinical practice guideline provides an approach to the treatment of breakthrough chemotherapy‐induced nausea and vomiting (CINV) and the prevention of refractory CINV in children. It was developed by an international, interprofessional panel and is based on systematic literature reviews. Evidence‐based interventions for the treatment of breakthrough and prophylaxis of refractory CINV are recommended. Gaps in the evidence used to support the recommendations made in this clinical practice guideline were identified. The contribution of these recommendations to breakthrough and refractory CINV control in children requires prospective evaluation.     

放松训练对肺癌患者顺铂致急性及延迟性恶心呕吐的影响

目的探讨渐进性肌肉放松训练对肺癌患者顺铂所致急性和延迟性恶心呕吐的干预效果。方法将72例肺癌顺铂化疗患者按时间段分为对照组和干预组各36例,两组均按常规治疗护理,干预组增加渐进性肌肉放松训练,连续7d后评价效果。结果急性期两组呕吐频次、恶心程度差异无统计学意义(均P0.05),呕吐例次干预组显著少于对照组(P0.01);延迟期干预组呕吐频次、恶心程度、呕吐例次显著少于对照组(均P0.01)。结论渐进性肌肉放松训练可有效降低顺铂所致的延迟期呕吐频次及恶心程度,对急性期恶心呕吐的缓解作用较弱。     

腰椎后路手术三种术后镇痛方式的比较分析

目的本研究对三种后路腰椎手术后疼痛控制的方法的镇痛效果和恶心呕吐(PONV)的情况进行观察比较。方法选取2013-2015间的65例患者,均行单节段腰椎后路减压融合内固定术。术后疼痛控制,20例接受小剂量吗啡硬膜外缓释法,22例患者接受了静脉自控镇痛泵,23例患者接受哌替啶注入。患者的评级疼痛强度(视觉模拟量表得分从0(没有痛苦)到10(最多剧烈的疼痛),恶心(从0(没有恶心)到10(严重恶心)),和呕吐(从0(没有呕吐)到10(严重呕吐)),记录术后4 h,1 d,2 d,3 d的数据。结果硬膜外小剂量吗啡缓释组和静脉自控镇痛泵组相比哌替啶组的镇痛增强效果在术后1 d和2 d无明显差异(P0.05)。在术后1 d、2 d和3 d,恶心、呕吐(PONV)并发症静脉自控镇痛泵组比其他两组更严重(P0.05)。结论硬膜外小剂量吗啡缓释法能够有效的控制腰椎后路手术术后的疼痛并最小化恶心呕吐(PONV)的程度。     

妇科肿瘤化疗防治恶心呕吐药物的应用评价

对妇科恶性肿瘤化疗防治恶心呕吐药物应用的合理性评价。收集本院妇科2018年4月接受化疗的住院患者病历111份,根据国内外肿瘤相关的恶心呕吐防治指南,分析应用防治恶心呕吐药物存在的问题。100例（90.09%）地塞米松（DXM）应用不合理;111例（100%）均应用5-羟色胺3受体拮抗剂,其中79例（71.17%）应用疗程不合理,17例（15.32%）超致吐风险级别用药,4例（3.60%）重复应用;104例（93.69%）无指征应用H2受体拮抗剂或质子泵抑制剂。化疗患者呕吐防治药物的应用存在不合理现象,建议加强医嘱审核,提高应用呕吐防治药物的合理性。