奥氮平治疗化疗所致恶心、呕吐疗效及副反应的关系研究

目的:研究不同奥氮平单次给药剂量疗效及不良反应,探讨最佳用药剂量。方法:75例接受中、高度致吐性化疗药物的患者随机分为5组:对照组和4个不同奥氮平剂量组(A、B、C、D奥氮平用药剂量分别为2.5,5,7.5,10mg)。用药时间与化疗时间一致,观察恶心、呕吐的发生率及不良反应。结果:对照组恶心、呕吐的发生率最高,随奥氮平剂量递增,恶心、呕吐发生率递减,但不良反应亦递增。结论:奥氮平对化疗所致恶心、呕吐的缓解存在剂量依赖,增加剂量可以提高疗效,但不良反应亦随着增加。治疗时应对患者的焦虑、抑郁、睡眠质量进行评估,个体化用药。     

Intermediate dose metoclopramide is not more effective than standard dose metoclopramide for patients who present to the emergency department with nausea and vomiting: a pilot study

Objective: To determine whether intermediate dose metoclopramide is more effective than standard dose metoclopramide for patients who present to the ED with nausea and vomiting. Methods: This prospective, single‐blind, randomized trial was conducted in the ED of two community teaching hospitals in a convenience sample of adult patients who presented to ED with nausea and vomiting. Patients were randomized to receive either 10 mg metoclopramide IV or 0.4 mg/kg IV (up to a maximum dose of 32 mg). The outcomes measured were: change in nausea score (measured on a 11‐point verbal rating scale), requirement for other anti‐emetic drug administration, and presence of side‐effects. Results: Fifty‐eight patients were eligible for analysis (34 in 10 mg group and 24 in 0.4 mg/kg group). Median reduction in nausea score in 10 mg group was four (range 0–10, 95% CI 3–5) compared with five for 0.4 mg/kg group (range ?1–10, 95% CI 4–6). This difference was not statistically significant (P = 0.629). Five patients in the 10 mg group required rescue anti‐emetic, compared with three in the 0.4 mg/kg group (P = 1.00). There were no side‐effects in the 10 mg group and two in the 0.4 mg/kg group. Conclusion: This study suggests that there is no difference in effectiveness between 10 mg and 0.4 mg/kg of metoclopramide in the ED population with nausea and vomiting.     

The ‘Hyperactive’ Child

A new, more apt designation, attentional deficit disorder (ADD), may help dispel some of the myths that have surrounded the “hyperactive” child. An abnormally high level of physical activity is a common but not universal finding in these children but is not their central problem. In most affected children, early diagnosis and specific drug treatment can ward off the often disastrous psychiatric and social consequences of ADD.     

Tachykinin NK1 receptor antagonists for the control of chemotherapy-induced nausea and vomiting

The treatment of neoplastic disease with chemotherapeutic cytotoxic drugs has long been associated with profound nausea and vomiting (emesis). This became the most feared side effect of this type of treatment and was so severe that some patients would withdraw from further treatment, thus jeopardising their clinical outcome and possibly life expectancy. The introduction of the 5-HT₃ receptor antagonists had a significant impact in this area, offering substantial reductions in emesis, largely through prophylactic treatment. Unfortunately, some forms of emesis were resistant to treatment with these drugs, so the search has continued to identify new chemical entities with a higher level of efficacy and a broader spectrum of activity. Data generated in animals has identified tachykinin NK₁ receptors as highly important in the emetic reflex and experimental evidence strongly supports NK₁ receptor antagonists as highly efficacious anti-emetic agents, with unparalleled broad spectrum activity. Several novel antagonists have recently entered clinical development and data are emerging to support their anti-emetic activity. This area continues to attract substantial medicinal chemical research effort. Most major pharmaceutical companies are seeking new matter through structural refinement of early leads or discovery of novel compounds from library screening. The scope of chemical lead matter has advanced from early piperidine and quinuclidines to a spectrum of templates that improve expectations for a well-tolerated therapeutic agent. Recent success in combining 5-HT₃ and NK₁ antagonists in emesis treatment is expected to greatly advance clinical outcomes with newer and safer agents.     

中西医结合治疗新生儿呕吐51例

目的:观察中西医结合治疗新生儿呕吐的临床疗效。方法:选择2012年4月—2014年4月本院收治的102例患儿,随机分为观察组与对照组,每组各51例。对照组行西医常规治疗,观察组在对照组的基础上服用生大黄水,比较两组患儿的临床疗效。结果:观察组有效率为90.20%,对照组有效率为60.78%,两组有效率比较,差异具有统计学意义(P0.05)。观察组患儿呕吐停止时间与鼻饲停止时间分别为(51.67±30.02)h、(63.32±31.30)h,均显著优于对照组患儿的(74.35±30.22)h、(85.32±31.28)h,差异均有统计学意义(P0.05)。结论:中西医结合治疗新生儿呕吐可明显提高临床疗效,缩短疗程。     

ACR Appropriateness Criteria Vomiting in Infants up to 3 Months of Age

Vomiting is a commonly reported symptom in infants less than three months of age. There are a multitude of pathologies to consider, both within and outside the gastrointestinal tract. In addition to conducting a thorough history and physical examination, a clinician formulates a reasonable differential diagnosis by consideration of two main factors: the infant’s age and the characterization of the vomit as bilious or nonbilious. In this endeavor, the clinician is able to determine if an imaging study is needed and, if so, the urgency of the request. A review of the appropriate imaging evaluation of vomiting infants in the newborn to three-month-old age group is provided by organizing the discussion around the following three clinical scenarios: bilious vomiting, intermittent nonbilious vomiting since birth, and new-onset bilious vomiting.The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every three years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.