Vomiting after ophthalmic surgery

The usefulness of intra-operative antiemetics and postoperative oral fluid restriction in the prevention of vomiting following anaesthesia for ophthalmic surgery, was studied in 200 patients. They were allocated into four groups of 50 and given either saline (as control), droperidol, metoclopramide or prochlorperazine. Oral intake was restricted postoperatively in half of the patients of each group. Anaesthesia comprised morphine and atropine premedication and a halothane, nitrous oxide and oxygen spontaneous breathing technique. No significant beneficial effects resulted from intra-operative antiemetics; vomiting incidences of 26% after saline and droperidol, 28% after metoclopramide and 14% after prochlorperazine were observed. Younger patients and females vomited most frequently. Restriction of oral fluids did not decrease the incidence of vomiting but demonstrated that approximately half of those patients who vomit do so with their first postoperative oral intake. Vomiting was observed more frequently after non intra-ocular surgery than after intra-ocular surgery (37% cf. 16%, p less than 0.01) and postoperative analgesics were required by more non intra-ocular patients than by intra-ocular patients (25% cf. 5%, p less than 0.001). Squint patients vomited most frequently (48%) and most frequently required postoperative analgesia (35%).     

对大肠癌术后早期炎性肠梗阻诊治的探讨

目的：探讨大肠癌术后早期炎性肠梗阻的特点及治疗方法；方法：分析10例大肠癌术后出现早期炎性肠梗阻的临床表现并进行综合保守治疗；结果：10例患者保守治疗全部成功；结论：术后早期炎性肠梗阻是一种非细菌性炎性肠梗阻，以发生在术后早期，腹胀、呕吐明显，腹痛轻或无为主要临床特点，治疗应采用保守治疗。     

枢星联合方案预防顺铂(DDP)致恶心呕吐的观察及护理

目的:研究枢星联合方案(枢星联合地塞米松及胃复安)预防顺铂联合化疗所致恶心呕吐的疗效及护理干预。方法:将93例接受以顺铂为主联合化疗的患者随机分为两组,实验组53例接受70周期化疗并给予护理干预;对照组40例接受57周期常规化疗,观察1~5d,对两组恶心、呕吐控制率进行比较。结果:实验组对急性恶心、呕吐控制率分别为90%及94.3%,均较对照组(77.2%和80.87%)明显提高(P<0.05)。结论:枢星联合方案结合护理干预可较好地预防顺铂所致的急性恶心、呕吐,使患者以更为舒适的状态接受化疗。     

A survey of postoperative nausea and vomiting

A prospective interview-based survey on the incidence of postoperative nausea and vomiting in 1107 in-patients aged 4–86 years was conducted during a 3-month period. Nausea, emetic episodes and the need for anti-emetic medication were recorded for 24 h postoperatively. In the recovery room, the incidence of nausea and vomiting was 18% and 5%, respectively. Over the whole 24-h period, these figures were 52% and 25%, respectively; severe nausea was experienced by 8%. The highest incidence of emetic sequelae was observed in gynaecological patients; 52% of the 822 patients who received general anaesthesia and 38% of the 285 patients who received regional anaesthesia reported nausea. The most important predictive factors associated with an increased risk for nausea and vomiting were female gender, a previous history of postoperative sickness, a longer duration of surgery, nonsmoking and a history of motion sickness. Based on these five items, a simple score predicting the risk of nausea and vomiting was constructed with a moderately good discriminating power.     

Efficacy of ondansetron and metoclopramide for preventing postoperative emesis following strabismus surgery in children

A double-blind, randomised, placebo-controlled trial was conducted to compare the efficacy of metoclopramide with the 5-HT₃ antagonist, ondansetron, for the prevention of postoperative emesis in children undergoing elective strabismus surgery. None of the children received any premedication and a similar anaesthetic technique was used for all. Ondansetron 0.15 mg.kg⁻¹, metoclopramide 0.25 mg.kg⁻¹ or saline placebo were administered following intravenous catheter placement. Episodes of emesis were recorded for the first 24 h for the intervals of 0–2, 2–6 and 6–24 h. The incidence of emesis in the first 24 h was observed to be 71.7% in the placebo group, 34.4% in the ondansetron group (p < 0.001) and 61.4% in the metoclopramide group (p = NS). The severity of vomiting was less in the ondansetron group as compared with metoclopramide (p < 0.01) and placebo (p < 0.001). Recovery room scores were comparable in all the groups. No serious side-effects were observed in the ondansetron group. We conclude that prophylactic ondansetron is effective and superior to metoclopramide in the prevention of postoperative emesis in children following elective strabismus surgery.     

The central pattern generator for vomiting may exist in the reticular area dorsomedial to the retrofacial nucleus in dogs

There is some controversy over whether or not a discrete site that integrates vomiting activities in somatic and autonomic nerves is present in the medulla oblongata. On the basis of our previous studies, we hypothesized that the temporal patterns of muscle contractions in vomiting are generated by a central pattern generator in the retrofacial area of the rostral medulla. To investigate this hypothesis further, the effects of electrical and chemical lesions of the medullary area were observed in decerebrate paralyzed dogs. Efferent activities of the phrenic and abdominal muscle nerves were recorded to recognize fictive vomiting. The right half of the medulla oblongata was transversely severed about 3 mm rostral to the obex. Fictive vomiting responses to vagal stimulation still appeared after hemisection in all 11 dogs. In addition, stimulation of the contralateral reticular area dorsomedial to the retrofacial nucleus produced fictive vomiting even after hemisection. An electrical lesion or injection of kainic acid (0.5–1.0 μl) was applied at the point where reticular stimulation induced fictive vomiting. After this destruction, no activities that corresponded to fictive vomiting could be induced by stimulation of vagal afferents or the reticular site. Salivation was decreased by hemisection, and decreased further, but was not completely abolished, with destruction of the reticular area. Kainic acid is known to selectively destroy neural cell bodies. Therefore, we concluded that neuronal somata in the reticular formation dorsomedial to the retrofacial nucleus play an essential role in the central patterning of vomiting activities in peripheral motor nerves. Received: 10 September 1996 / Accepted: 2 July 1997     

四类新药盐酸栈拉司琼注射液预防抗肿瘤药物所致呕吐的Ⅱ期临床观察

目的在肿瘤的治疗中化疗药物所引起的恶心、呕吐是极为常见的,通过对盐酸格拉司琼注射液预防肿瘤化疗所致呕吐的Ⅱ期临床研究,探讨该药的止吐疗效及毒性反应.方法对31例病人的观察,采用自身对照新药盐酸格拉司琼与恩丹西酮预防抗肿瘤药物(DDP及蒽环类药物)所致呕吐进行比较.结果格拉司琼对强致吐剂顺铂所引起的呕吐其总的缓解率＞90%,恩丹西酮对顺铂引起的呕吐其缓解率＞85%.两止吐药毒性反应主要为便秘,恩丹西酮致便秘发生率高达41%,而格拉司琼所致便秘发生率为16%.结论两药预防呕吐的疗效相当,但格拉司琼的副反应明显低于恩丹西酮     

国产四类新药盐酸格拉司琼注射液与恩丹西酮预防化疗引起的恶心和呕吐的疗效比较

目的 验证国产盐酸格拉司琼注射预防恶性肿瘤患者化疗所致恶心与呕吐的有效性和安全性。方法 对６９例接受以顺铂为主化疗和４０例接受以蒽环类抗肿瘤药为主化疗的恶性肿瘤患者,采用前瞻性多中心随机对照试验,比较国产格拉司琼和国产上市恩丹西酮预防化疗所致恶心与呕吐的疗效和不良反应。结果 格拉司琼和恩丹西酮对预防强致吐和中度致叶化疗药物所致的急性和迟发性恶心与呕吐的疗效基本相同;不良反应变基本相似,以便秘、疲倦     

恩丹西酮（齐鲁）预防非顺铂化疗所致呕吐的Ⅲ期临床研究

目的改进用药方法,进一步确定恩丹西酮的临床应用价值。方法首次用非顺铂药出现呕吐者为入组对象。再次化疗时,给予恩丹西酮（齐鲁）８ｍｇ静脉注射,每日１次。化疗结束后口服８ｍｇ,每日２次,用１天的简化方法。结果经多中心１９３例患者应用,第１天止吐有效率达９３．３％,对迟发性呕吐也有很好疗效。第１～５天平均呕吐次数为０．４～０．０１。结论本法疗效高,副作用小,且经济方便,更适于临床推广应用。