Ondansetron versus a chlorpromazine and dexamethasone combination for the prevention of nausea and vomiting: a prospective, randomised study to assess efficacy, cost effectiveness and quality of life following single-fraction radiotherapy

 Lower hemibody radiotherapy is an effective palliative treatment for patients with widespread bone metastases, but is frequently associated with the unpleasant side effects of nausea and vomiting. Patients often require admission to hospital for at least an overnight stay, with its inevitable costs. This study has investigated the clinical efficacy and safety profile of ondansetron, a 5HT₃ receptor antagonist, and compared it to a standard antiemetic combination, chlorpromazine and dexamethasone. Sixty-six patients were randomised to receive antiemetic prophylaxis with either oral ondansetron or a combination of chlorpromazine and dexamethasone (33 patients in each arm): 60 were treated with lower abdominal radiotherapy (8 Gy mid-plane dose) and 6 with radiotherapy to the upper lumbar spine (12.5 Gy incident dose). Patients were assessed for severity of nausea and vomiting and for whether they would use the same antiemetic again. Quality of life was assessed using the Functional Living Index Cancer (FLIC) and Functional Living Index Emesis (FLIE) quality-of-life questionnaires. A detailed cost–benefit analysis was also performed. Ondansetron scored highly as an antiemetic, being significantly better at controlling emesis on all four study days (P<0.001) and significantly better at controlling nausea on day 1 (P<0.001) than the standard combination of chlorpromazine and dexamethasone. Quality of life was better in the ondansetron-treated group, and ondansetron was found to be safe with no significant adverse effects. As a result, 98% of patients and investigators would use ondansetron again. Cost–benefit analysis revealed that, when complete control of emesis is the aim, ondansetron is not unduly expensive compared to the standard antiemetic regimen. As ondansetron was clearly effective in patients receiving hemibody irradiation it seems it would be prudent to adopt it for use in such patients routinely. The use of ondansetron would allow them to be treated as outpatients, with the attendant financial and psychosocial benefits of such an approach.     

Parenteral chlorpromazine and frusemide: safe and effective treatment for hypertensive emergencies

Summary

Hypertensive emergencies present a difficult problem of management. Although many treatment regimens have been described over the years, their application has presented problems of adverse effects and all have required detailed and intensive supervision of patients. After favourable results obtained in a preliminary study using a combination of parenteral chlorpromazine and frusemide, a 5-year prospective study was conducted using this treatment to produce rapid reduction in blood pressure in patients with acute onset severe hypertension (blood pressure greater than 225/130 mmHg). The patients involved covered a wide range from 22 to 74 years (mean 47 years) and, on subsequent or previous investigation, were all considered to have essential hypertension. Twenty-seven patients were treated successfully with a single administration of the regimen. Two women required a second treatment before adequate control of blood pressure was achieved and 1 man died of extensive dissecting abdominal aortic aneurysm before the effects of the therapy could be fully assessed. The reduction in blood pressure was gradual but progressive over 4 hours and the pattern of response was uniform. No significant adverse effects related to the treatment were found. Only basic measurement of pulse and blood pressure was considered necessary and so this regimen of therapy is suitable for general use even when sophisticated monitoring facilities are not available and staff levels are limited.     

氯丙嗪双侧内关穴位注射治疗脑卒中顽固性呃逆临床研究

目的：探讨氯丙嗪双侧内关穴位注射治疗脑卒中顽固性呃逆的临床效果。方法选取2011‐01—2014‐12我院脑卒中顽固性呃逆患者160例作为研究对象，随机分为观察组和对照组，对照组给予常规治疗，观察组给予氯丙嗪双侧内关穴位注射。对比2组治疗效果和患者满意度。结果观察组治愈率显著高于对照组，差异有统计学意义（P＜0.05）。观察组总体满意率高达93.75％，显著高于对照组的77.50％，差异有统计学意义（ P＜0.05）。结论应用氯丙嗪双侧内关穴位注射治疗脑卒中顽固性呃逆，能够有效提高治疗效果和患者满意度。     

氯丙嗪对精神分裂症患者心电图的影响

目的探讨口服盐酸氯丙嗪片对精神分裂症患者心电图的影响，为临床合理用药提供参考。方法选择笔者所往医院2009年2月～2011年1月收治的120例精神分裂症患者，给予盐酸氯丙嗪片单一用药治疗，分别t开始治疗1、3、6个月后检查患者心电图，比较3次检查结果心电图异常发生率的变化。结果治疗6个月的患者心电图异常率明显高于治疗3个月后的，差异有统计学意义（P〈0．05）。治疗后3个月患者心电图异常率明显高于治疗后1个月，差异有统计学意义（P〈0．05）。结论长期使用氯丙嗪可造成精神分裂症患者心电图异常，用药时间越长，其对心脏功能的影响程度越大，在今后的临床用药过程中应注意保护心脏功能。     

采用梅花形注射点氯丙嗪肌注的研究

为探讨梅花形注射法肌注氯丙嗪用于精神科临床的可能，对１００例住院病人随机分为实验组和对照组各５０例，采用上述方法与常规肌肉注射对照。结果表明：两线完成观察期全程的例数，注射部位出现局部反应的例数，接受注射平均天数，注射部位最初出现局部反应平均天数，注射部位红、肿、硬结、疼痛反应每天评分等方面，经ｘ＾２检验或ｔ检验，Ｐ值小于０．００１，差异有高度显著性。实验组采用梅花形注射法效果明显优于对照组。作者     

氯丙嗪联合山茛菪碱治疗肺结核大咯血36例临床观察

目的观察氯丙嗪联合山莨菪碱治疗肺结核大咯血的止血效果.方法将肺结核大咯血69例随机分为治疗组和对照组,治疗组36例采用氯丙嗪联合山莨菪碱治疗,对照组33例采用垂体后叶素治疗.结果治疗组的止血总有效率为94.4%,对照组的止血总有效率为78.8%,两组比较差异具有显著性(P<0.05).结论氯丙嗪联合山莨菪碱是治疗肺结核大咯血的确切有效的止血方法.     

氨磺必利与氯丙嗪对以阴性症状为主的精神分裂症认知功能影响的对照研究

目的比较氨磺必利和氯丙嗪对以阴性症状为主的精神分裂症患者认知功能的影响。方法应用随机对照的方法,将76例符合条件的以阴性症状为主的精神分裂症患者随机分为氨磺必利组和利培酮组各38例,进行为期12周的治疗。于治疗前及治疗后12周末采用威斯康星卡片(WCST)和连续作业测验(CPT)评定患者的认知功能。结果治疗12周末氨磺必利组的各项认知功能指标均有不同程度的改善(χ2=4.12,P0.05;t=3.41,P0.05),且氨磺必利组的总体疗效优于氯丙嗪组。结论氨磺必利较氯丙嗪能显著改善以阴性症状为主的精神分裂症患者的认知功能,其具体作用机制尚需进一步探讨。     

氯丙嗪上调大鼠脑皮质中凝血因子Ⅲ的表达

目的 对氯丙嗪(chlorpromazine,CPZ)处理后的大鼠脑皮质中凝血因子Ⅲ表达进行检测及分析.方法 按每组6只,将wistar大鼠随机分为:正常对照组、CPZ高、中、低剂量(20 mg/kg、10 mg/kg、5 mg/kg)单次注射组以及中剂量连续注射组(10 mg/kg/2周),采用腹腔注射CPZ的方法制备动物模型.免疫组化和Western印迹法检测大鼠脑皮质中凝血因子Ⅲ的表达.结果 免疫组化结果显示,中剂量(10 mg/kg)的CPZ单次注射及连续注射均能显著增加大鼠脑皮质中凝血因子Ⅲ的表达(P值分别为0.0007、0.0005).Western印迹结果显示,与正常对照组相比,CPZ高、中剂量(20 mg/kg、10 mg/kg)单次注射(P值分别为0.0141、0.0163)以及中剂量(10 mg/kg)长期连续注射组大鼠脑皮质中凝血因子Ⅲ表达显著增加(P =0.0094).结论 CPZ能够上调大鼠脑皮质中凝血因子Ⅲ的表达.除了已知的多巴胺受体和钙调素之外,凝血因子Ⅲ也是CPZ调控的靶分子之一.     

冬眠灵与维思通治疗精神分裂症的临床效果对比

目的比较冬眠灵和维思通治疗精神分裂症的临床效果。方法 123例精神分裂症患者被分为实验组和对照组,对照组给予冬眠灵治疗,实验组给予维思通治疗。结果实验组在GQOLI评分、PANSSE评分和副反应等方面均显著优于对照组。结论相比于冬眠灵,维思通具有更加显著的临床效果和更低的药物副反应,是值得考虑的临床药物之一。     

Chlorpromazine and pimozide alter reinforcement efficacy and motor performance

This study evaluated the effects of chlorpromazine and pimozide on reinforced responding. In each session, rats were exposed to a series of five variable-interval reinforcement schedules. The response requirement was a lever press, the reward was a small portion of water, and the reinforcement rate varied from about 20 to 660 reinforcers per hour. Response rate was a negatively accelerated function of reinforcement rate, and the relationship between the two variables was described by the equation for a rectangular hyperbola (the matching law). One parameter of the hyperbola is equivalent to the asymptotic response rate and the other parameter is equivalent to the rate of reinforcement that maintains a one-half asymptotic response rate. Chlorpromazine (0.75–3.0 mg/kg) and pimozide (0.1–0.4 mg/kg) dose-dependently decreased response rates. At low doses, the response rate decreases were, for the most part, restricted to the low reinforcement rate schedules. In contrast, the highest dose tested decreased response rates at both low and high reinforcement rates. The patterns of response rate decreases resulted in dose-dependent changes in the parameters of the matching law equation. The shifts in the matching law parameters were discussed in terms of the motoric and motivational interpretations of neuroleptic-induced response rate changes. Offprint requests to: G.M. Heyman