盐酸恩丹西酮预防小儿斜视矫正术后恶心呕吐的临床研究

目的探讨应用高选择性5-HT3受体拮抗剂盐酸恩丹西酮(以下简称恩丹)预防小儿斜视矫正术后恶心呕吐的效果.方法选择3～10岁择期行斜视矫正术的患儿60例随机分为A组(对照组,n=30):手术结束前10 min静脉注射生理盐水5 ml;B组(恩丹组,n=30):手术结束前10 min静脉注射恩丹0.2 mg/kg.观察每组患儿术后8 h和24 h恶心呕吐发生率及严重程度.结果术后8 h和24 h内恩丹组恶心呕吐发生率及严重程度均显著低于对照组(P＜0.01).结论盐酸恩丹西酮能有效预防小儿斜视矫正术后恶心呕吐的发生.     

《伤寒论》吐法探讨

对《伤寒论》中有关吐法的五个条文，从其理法方药及禁忌证作一探讨，认为仲景之用吐法继承于《内经》而又有所发展。创制瓜蒂散治病应在上“因而越之”、“以苦吐之”正合内经之语，使《内经》的原则具体化。     

Oculocardiac reflex and postoperative vomiting in paediatric strabismus surgery. A randomised controlled trial comparing four anaesthetic techniques

Background : Oculocardiac reflex (OCR) and postoperative vomiting are major complications of paediatric strabismus surgery.
Methods : Children (3–16 yr) undergoing elective strabismus surgery as inpatients were randomly allocated to four anaesthetic techniques: (A) thiopentone induction and isoflurane maintenance; (B) as (A) plus ondansetron 5 mg · m^-2 iv; (C) propofol induction and maintenance; (D) as (C) plus lignocaine 2 mg · kg^-1 iv. All children received prophylactic atropine 0.02 mg · kg^-1 and alfentanil. Nitrous oxide was omitted.
Results : Data on 157 children were analysed. The cumulative incidence of vomiting within 6 and 24 h after surgery with thio-pentone-isoflurane was 26% and 46%, respectively. Adding ondansetron decreased the incidence to 8% and 33%, respectively. This improvement was significant within 6 h only; the number-needed-to-treat was 5.5 (95% CI 2.9–46). Propofol was not different from thiopentone-isoflurane. The addition of lignocaine to propofol was of no benefit. The risk of an OCR was significantly increased with propofol (incidence 40%) compared with isoflurane (14%); the number-needed-to-harm was 3.9 (95% CI 2.6–8).
Conclusions : Thiopental-isoflurane-air/O₂-alfentanil resulted in a moderate risk of vomiting. Adding ondansetron significantly decreased this risk, but 6 children have to be treated for one to benefit in the early postoperative period. Propofol and propofol-lignocaine showed no benefit on vomiting but significantly increased the risk of an OCR despite high-dose prophylactic atropine.     

甲磺酸托烷司琼预防化疗引起胃肠道反应的临床研究

目的 :比较甲磺酸托烷司琼和盐酸托烷司琼 (商品名 :欧必亭 )控制由顺铂、多柔比星 (阿霉素 )化疗所致胃肠道反应的疗效和不良反应。方法 :采用开放、随机自身交叉对照方法。 39例接受含顺铂和 (或 )多柔比星化疗的肿瘤患者随机进入AB ,BA组。AB组第 1周期化疗止吐给予甲磺酸托烷司琼 ,第 2周期给予盐酸托烷司琼 ;BA组则相反。同一患者接受的第 1 ,2周期化疗方案完全相同。结果 :入组患者中 ,9例未按试验要求完成观察 ,故可评价疗效患者 30例。A周期可评价不良反应 35例 ,B周期 36例。全组患者用甲磺酸托烷司琼后对食欲的影响 ,对恶心和呕吐的控制与盐酸托烷司琼相似 ,两组间差异无显著性 (均为P >0 .0 5 )。与两药可能相关的不良反应为轻度 ,均可耐受。结论 :国产甲磺酸托烷司琼治疗顺铂、多柔比星化疗所致胃肠道反应的疗效和不良反应与进口药盐酸托烷司琼相似     

化疗病人恶心呕吐的护理

从恶心呕吐的定义、恶心呕吐对机体的影响、引起恶心呕吐的相关因素等方面综述了化疗病人的护理．目的在于提高化疗病人的生活质量。     

腹腔镜术后并发呕吐相关因素分析

目的探讨分析影响腹腔镜术后呕吐的诱因和发生机制。方法对5346例腹腔镜各类手术病人发生呕吐的853例进行病种、术种、性别、手术时间等因素的统计,分析相关影响因素。结果通过统计分析发现,女性呕吐发生率(79.6%)高于男性(20.4%);40￣60岁病人的呕吐发生率最高(60.3%);腔镜手术发生率(16.0%)高于非腔镜手术;普外科腔镜手术(19.0%)高于其他科腔镜手术(2.0%￣13.4%);上腹手术呕吐发生率(19.0%)高于下腹部手术(11.3%￣13.4%);手术时间大于3h者的呕吐发生率高达21.3%。结论腹腔镜术后呕吐与诸多影响因素有明显相关性,这些影响因素导致5-羟色胺等递质释放增加,出现恶心、呕吐症状。     

格拉司琼预防颅脑外科手术后恶心呕吐的临床研究

目的 :观察格拉司琼预防颅脑外科手术后恶心呕吐的效果。方法 :70例ASAI～Ⅱ择期开颅手术病人 ,随机分为格拉司琼组和对照组 ,两组病人在缝合头皮时分别静脉注射格拉司琼 3mg或生理盐水 ,观察术后 2 4h、4 8h和 72h恶心呕吐的次数和程度。结果 :格拉司琼组恶心呕吐发生率及程度低于对照组 (2 5 7%vs5 7.1% ,P <0 .0 1) ,严重恶心伴呕吐发生率亦低于对照组 (17 2 %vs4 8.6 % ,P <0 .0 1) ,且不影响病人神志的恢复。结论 :格拉司琼可安全用于预防和治疗颅脑手术后的恶心呕吐     

Intestinal electrical stimulation improves delayed gastric emptying and vomiting induced by duodenal distension in dogs.

The aim of this study was to investigate the effects of short-pulse intestinal electrical stimulation (IES) on duodenal distention-induced delayed gastric emptying and vomiting in dogs and its possible mechanisms. The study was performed in 12 dogs with jejunal electrodes and a duodenal cannula in three separate experiments to investigate the effects of IES on duodenal distension (DD)-induced delayed gastric emptying and discomfort signs, vagal efferent activity, and jejunal tone. We found that: (i) IES significantly accelerated gastric emptying of liquid delayed by distension (18.05 +/- 4.06%vs. 7.18 +/- 1.99%, P = 0.036 at 60 min). (ii) IES significantly reduced vomiting and discomfort/pain induced by distension. The average signs score was 15.33 +/- 1.37 during distension which decreased to 6.50 +/- 0.91 (P = 0.0002) with IES. (iii) IES did not change vagal afferent activity, which was assessed by the spectral analysis of the heart rate variability. (iv) IES decreased jejunal tone. In conclusion, IES with parameters commonly used in gastric electrical stimulation for nausea and vomiting associated with gastroparesis improves DD-induced delayed gastric emptying and prevents DD-induced vomiting and discomfort signs. Further studies are warranted to investigate the therapeutic potential of IES for gastrointestinal symptoms associated with disturbances in motility and sensory function in small intestine.     

定眩颗粒镇静催眠及镇吐作用的实验研究

目的研究定眩颗粒的镇静、催眠、镇吐及对毛细血管通透性的影响.方法采用阈下剂量戊巴比妥钠致小鼠睡眠法、小鼠走动时间和举双肢法,研究受试药的镇静作用;采用硫酸铜和顺铂致家鸽呕吐的模型,观察受试药的镇吐作用;采用小鼠腹腔毛细血管通透性实验,观察受试药对小鼠腹腔毛细血管通透性的影响. 结果定眩颗粒可明显缩短小鼠入睡潜伏期,减少小鼠自发活动次数;延长硫酸铜和顺铂致家鸽呕吐潜伏期,并能减少硫酸铜所致家鸽呕吐次数;降低腹腔毛细血管通透性.结论定眩颗粒具有一定的镇静、催眠及镇吐作用,并能降低毛细血管通透性.