盐酸帕洛诺司琼预防化疗致延迟性恶心、呕吐的临床观察

恶心、呕吐是化疗最常见的不良反应,发生率高达80％～90％,严重影响患者的生活质量和治疗的依从性,甚至影响化疗疗效。近年来,由于5-TH3受体拮抗剂的广泛应用,使得化疗所致恶心、呕吐的预防及治疗取得了飞速的进步。目前临床上常用的5-TH3受体拮抗剂大多属于短效,     

盐酸帕洛诺司琼预防化疗致延迟性恶心、呕吐的临床观察

恶心、呕吐是化疗最常见的不良反应,发生率高达80%～90%,严重影响患者的生活质量和治疗的依从性,甚至影响化疗疗效[1].近年来,由于5-TH3受体拮抗剂的广泛应用,使得化疗所致恶心、呕吐的预防及治疗取得了飞速的进步.目前临床上常用的5-TH3受体拮抗剂大多属于短效,对于呕吐的完全缓解率可以达到50%～70%［2-3］.现将本院2008年6月～2010年6月使用盐酸帕洛诺司琼预防化疗所致恶心、呕吐情况报告如下.     

盐酸帕洛诺司琼在乳腺癌化疗中的止吐疗效观察

目的观察盐酸帕洛诺司琼预防由乳腺癌TEC方案化疗所引起的恶心、呕吐反应的效果。方法 84例(淋巴结转移的)乳腺癌改良根治术后患者随机分为盐酸帕洛诺司琼治疗组(n=42)和盐酸托烷司琼治疗组(n=42),2组患者均为首次接受TEC方案化疗。观察72 h内恶心、呕吐发生的情况并作比较。结果盐酸帕洛诺司琼与盐酸托烷司琼对化疗后恶心、呕吐的有效控制率分别为92.9%和71.4%,2组差异有统计学意义(P<0.05)。在24 h内2组止吐效果相近,差异无显著性(P>0.05);在487、2 h内盐酸帕洛诺司琼治疗组优于盐酸托烷司琼治疗组,2组差异有显著性(P<0.05)。结论 盐酸帕洛诺司琼能有效控制化疗引起的恶心、呕吐,是理想的长效止吐药物。     

盐酸帕洛诺司琼预防化疗所致恶心、呕吐的临床疗效观察

<正>恶心、呕吐等消化道反应是肿瘤患者在化疗过程中最常见的不良反应之一,它明显降低了患者的生活质量,进而使患者产生了对化疗的消极心理,使患者继续接受化疗的依从性降低[1],化疗难以继续,疗效无法得到最大程度的体现。根     

盐酸帕洛诺司琼对鞘内麻醉下剖宫产术后恶心、呕吐的效果观察

观察盐酸帕洛诺司琼对鞘内麻醉下剖宫产术后恶心、呕吐的作用效果。选取2015年9月~2016年7月在我院行剖宫术的60例产妇,均分为两组,观察组使用盐酸帕洛诺司琼联合鞘内麻醉;对照组使用鞘内麻醉。观察并比较两组在术后出现的恶心,呕吐情况。观察组手术后的控制恶心反应有效率86.7%高于对照组56.7%,两组比较差异显著(P<0.05);观察组的急性呕吐的有效率(80.0%)高于对照组(53.3%),且观察组延迟性呕吐反应有效率(70.0%)高于对照组(43.3%),两组的差异具有统计学意义(P<0.05)。盐酸帕洛诺司琼注射液能有效降低鞘内麻醉下剖宫产术后出现急性和迟发性恶心呕吐症状。     

国产盐酸帕洛诺司琼注射液预防化疗所致恶心呕吐的随机对照研究

目的评价盐酸帕洛诺司琼预防高度催吐危险的化疗方案所致恶心、呕吐的疗效和安全性。方法将符合纳入标准的恶性肿瘤患者随机分入AB组和BA组,于化疗前30min缓慢静推盐酸帕洛诺司琼或盐酸托烷司琼。观察化疗后5d内恶心、呕吐情况,以及不良反应。结果共纳入24例患者,可评价18例。2种药物对恶心、急性呕吐的完全控制率及有效控制率,以及对迟发性呕吐的完全控制率比较,无显著差异,而盐酸帕洛诺司琼对迟发性呕吐的有效控制率显著高于盐酸托烷司琼。2种药物不良反应较少且程度较轻。结论盐酸帕洛诺司琼预防高度催吐危险的化疗方案所致恶心和急性呕吐的疗效与盐酸托烷司琼相当,但预防迟发性呕吐的疗效优于盐酸托烷司琼,且不良反应发生率低、程度轻。     

心理护理联合奥氮平和盐酸帕洛诺司琼预防焦虑、抑郁患者化疗所致呕吐的疗效观察

目的观察心理护理联合奥氮平和盐酸帕洛诺司琼用于焦虑、抑郁患者化疗所致呕吐的疗效。方法将70例焦虑、抑郁的肿瘤化疗患者分为干预组和对照组,两组均行常规护理,化疗前均给予奥氮平和盐酸帕洛诺司琼治疗,干预组在此基础上给予心理护理。观察两组患者治疗前后焦虑、抑郁评分及呕吐情况。结果干预组健康问卷、焦虑抑郁评分低于对照组,呕吐发生率也低于对照组,差异均有统计学意义(P<0.05)。结论实施心理护理对于预防焦虑、抑郁患者化疗所致恶心呕吐有更好的效果。     

盐酸帕洛诺司琼治疗高致吐性化疗药物所致恶心、呕吐的临床观察

目的 观察盐酸帕洛诺司琼治疗高致吐性化疗药物所致恶心、呕吐的疗效.方法 对68例接受高致吐性化疗药物治疗的恶性肿瘤患者随机分为2组,观察组35例用盐酸帕洛诺司琼联合地塞米松,对照组33例用昂丹司琼联合地塞米松.结果 2组急性期呕吐的完全缓解率差异无统计学意义(P＞0.05),观察组对延迟期呕吐的完全缓解率为57.1％( 20/35),高于对照组33.3％( 12/33),差异具有统计学意义(P＜0.05).观察组对患者的食欲、精神状态及与人交往方面的改善优于对照组[生活质量评分:观察组分别为(3.85±0.95)、(4.01±1.91)、(4.03±0.91)分,对照组分别为(2.69±0.94)、(3.14±0.90)、(3.25±0.82)分,P均＜0.05].2组不良反应主要为便秘、腹部不适等,耐受性好.结论 盐酸帕洛诺司琼联合地塞米松能有效治疗高致吐性化疗药物所致的急性期和延迟期恶心、呕吐,能改善化疗患者的生活质量.     

奥氮平联合帕洛诺司琼预防顺铂化疗所致呕吐的临床研究

目的:观察奥氮平联合帕洛诺司琼预防顺铂化疗引起呕吐的疗效。方法:将使用顺铂(30 mg/m2)化疗的胃癌术后患者84例随机分为对照组和观察组,每组42例。两组患者每周期化疗前30 min给予盐酸帕洛诺司琼0.25 mg静脉滴注。观察组于化疗前1晚口服奥氮平5 mg/次,连服8 d。观察两组患者化疗急性期、延迟期恶心呕吐的发生率。结果:两组急性期呕吐发生率比较差异无统计学意义(P0.05)。两组延迟期呕吐发生率比较差异有统计学意义(P0.05)。两组患者腹胀、便秘、乏力、头痛发生率比较差异均无统计学意义(P0.05)。结论:在使用帕洛诺司琼止吐的基础上加用奥氮平,预防顺铂化疗所致恶心呕吐有较好的效果,用于预防迟发性呕吐效果更佳。     

盐酸托烷司琼胶囊防治化疗所致恶心呕吐的临床研究

目的:观察国产盐酸托烷司琼胶囊预防化疗所致恶心呕吐的临床疗效和安全性,同时选用格拉司琼胶囊作对照组进行分析。方法:24例均接受含顺铂或阿霉素或吡喃阿霉素的联合化疗者随机分为两组,采用双盲法随机双交叉设计,于每组化疗两个周期中交叉用药。观察第1~8天患者恶心、呕吐控制的有效率及药物不良反应。结果:国产盐酸托烷司琼胶囊和国产盐酸格拉司琼胶囊在治疗化疗药引起的恶心、呕吐反应以及安全性指标检测均无显著性差异(P>0.05)。结论:国产盐酸托烷司琼胶囊治疗化疗药所引起的恶心、呕吐反应的疗效和用药安全性与国产盐酸格拉司琼胶囊相当。     

肺癌化疗后病人恶心与呕吐危险因素Logistic分析

目的探讨肺癌病人化疗后恶心、呕吐的相关危险因素。方法采用两分类Logistic回归分析,对459例接受化疗的晚期肺癌病人临床资料进行回顾性分析,统计学处理采用SPSS 11.5软件。结果恶心、呕吐相关危险因素有性别、年龄、饮酒、是否含铂制剂、铂制剂用量和化疗次数。结论在临床选择化疗方案时,应综合考虑恶心、呕吐相关危险因素,以减少病人的不良反应。     

多发性骨髓瘤病人血清sgp130与IL-6变化及意义

目的探讨多发性骨髓瘤（MM）病人血清可溶性糖蛋白130（sgp130）和白细胞介素6（IL-6）的动态变化及临床意义。方法采用双抗体夹心酶联免疫吸附（ELISA）法,检测60例MM病人和20例健康体检者（对照组）血清sgp130及IL-6的水平,并观察二者与血清β2-微球蛋白（β2-MG）水平的相关性。结果 MM病人血清sgp130、IL-6水平均明显升高,与对照组比较差异有显著性（t=5.51、8.29,P〈0.01）,并随MM临床分期增加、病情加重而逐渐升高（F=23.21、21.86,P〈0.05）,但不同免疫亚型间差异无显著性（F=7.37、4.12,P〉0.05）。血清sgp130、IL-6水平的变化与化疗效果有关,化疗有效病人血清sgp130、IL-6水平均明显下降,其中BD组（硼替佐米＋地塞米松）下降程度明显大于VAD组（长春地辛＋表柔比星＋地塞米松）,差异有显著性（t=11.77、5.31,P〈0.05）。血清sgp130、IL-6水平与血清β2-MG水平呈正相关（r=0.683、0.549,P〈0.01）。结论血清sgp130及IL-6水平变化与MM的肿瘤负荷和化疗效果有关,可作为评估病情变化和治疗效果的有效指标。     

A COMPARISON OF CONTROLLED RELEASE METOCLOPRAMIDE AND DOMPERIDONE IN THE TREATMENT OF NAUSEA AND VOMITING

SUMMARY Dopamine antagonists are effective anti-emetics. Domperidone does not readily cross the blood-brain barrier and is less likely to cause central nervous system side-effects than metoclopramide. However, a direct comparison of the safety and efficacy of the two drugs has not hitherto been made. Ninety-five patients, with symptoms of nausea and vomiting due to a variety of oesophageal or gastric disorders, were recruited into a randomised, double-blind, three-part, parallel-group comparative study of controlled release metoclopramide 15 mg (Gastrobid Continus tablets, Napp Laboratories) given twice daily, and domperidone 10 mg or 20 mg given three times daily. Assessments for nausea, vomiting, reflux symptoms and adverse events were made on entry to the study. Patients were randomly allocated to one of the three treatment regimes for a period of seven days, throughout which daily symptomatology and use of escape medication were recorded on a diary card. At the end of the treatment period, nausea, vomiting and reflux symptoms, adverse events and a global assessment of patients' symptom control were recorded by the investigator. Both controlled release metoclopramide and high and low dose domperidone significantly reduced symptoms of belching, flatulence, distension, heartburn, regurgitation, reflux, nausea and vomiting compared to baseline. There were no significant differences between the three treatments in efficacy or in the number and severity of side-effects.     

ECF与DCF方案治疗晚期胃癌效果比较

目的比较ECF与DCF方案治疗晚期胃癌的近期疗效和不良反应。方法将45例经病理检查确诊的晚期胃癌病人分为2组。ECF组21例,给予表阿霉素60 mg/m^2静脉注射,第1天;顺铂75 mg/m^2分3-4 d静脉滴注;氟尿嘧啶每天500 mg/m^2持续输注96 h。DCF组24例,给予多烯紫杉醇75 mg/m2静脉滴注2 h,第1天;顺铂与氟尿嘧啶用法同ECF组。每3周为1个周期,2-3个周期评价疗效,对两组缓解率、生活质量改善率及不良反应进行比较。结果ECF组与DCF组的缓解率分别为56.2%和58.3%,两组差异无显著性（P〉0.05）;两组神经系统毒性反应有明显差异（P=0.001）。结论ECF和DCF方案对晚期胃癌病人近期疗效均较好,不良反应可以耐受,生活质量明显提高。     

THE MECHANISM OF THE VOMITING INDUCED BY ANTIMONY AND POTASSIUM TARTRATE (TARTAR EMETIC)

1. It has been shown that tartar emetic acts on the stomach to induce emesis after its oral administration, that only traces are present in the vomitus following its intravenous injection (Kleimann and Simonowitsch), and that it does not induce emesis when it is applied directly to the vomiting center (Thumas). 2. In the present study, which was made with cats except when otherwise specifically stated, the intravenous injection of tartar emetic caused emesis (typical vomiting movements) after the removal of the entire gastrointestinal tract from the esophagus to the anus. 3. Cutting the vagi inhibits emesis after the intravenous injection of any dose of tartar emetic, though nausea may be induced. 4. Cutting the vagi and simultaneously extirpating the stellate ganglia inhibits both nausea and vomiting after the intravenous injection of tartar emetic. 5. Extirpation of the celiac ganglion and simultaneous cutting of the vagi just below the level of the diaphragm does not prevent emesis following the intravenous injection of tartar emetic. 6. Cutting the vagi prevents vomiting after the introduction of large doses of tartar emetic into the stomach, but massive doses may still cause emesis. Vagotomy probably has less influence on the emetic action of a moderately large dose of tartar emetic introduced into a loop of the duodenum. 7. Atropine has very nearly the same effect on the emetic action of tartar emetic as cutting the vagi, but much larger doses are necessary to abolish the effect of the introduction of tartar emetic into the stomach in moderate amounts than that of equal amounts injected intravenously. 8. The facts just stated point to the heart as the seat of reflex vomiting following the intravenous injection of tartar emetic. 9. The intravenous injection of tartar emetic induces afferent emetic impulses which pass from the heart to the vomiting center mainly by way of the vagus, to a much less extent by way of the sympathetic nerve and the stellate ganglia. 10. The introduction of tartar emetic into the stomach induces afferent emetic impulses which pass upward mainly by way of the vagus, to a much less extent by way of the sympathetic nerve. 11. The introduction of tartar emetic into the duodenum induces afferent emetic impulses which pass upward partly by way of the sympathetic nerve, partly by way of the vagus. 12. It seems probable that the path taken by afferent emetic impulses induced in the gastrointestinal tract by tartar emetic depends on the innervation of the organ concerned, and not on any selective action of the poison on the afferent nerve.     

盐酸羟考酮控释片治疗慢性颈椎源性疼痛急性发作的疗效和安全性

目的:本研究探讨盐酸羟考酮控释片(oxycodone hydrochloride controlled-release tablets)作为首选用药对慢性颈椎源性疼痛急性发作的治疗效果、副反应和安全性。方法:慢性颈椎源性疼痛急性发作中到重度疼痛患者共116例,随机分为实验组(盐酸羟考酮控释片组)和对照组(安慰剂组)。连续应用盐酸羟考酮控释片(5~10 mg/q12h)和安慰剂1至4周。监测用药后第1天,3天,1周,2周,3周和4周疼痛发作频率(次/天)、疼痛强度(VAS)、生活质量、睡眠质量、不良反应发生率。实验结束时监测有无戒断症状不良反应、SF-36。结果:盐酸羟考酮控释片组用药后第3天即可以明显降低疼痛的发作率和VAS(P<0.05~0.01)。第1周后生活质量有明显改善(P<0.01)。第3天和以后各周睡眠质量明显改善(P<0.05~0.01)。不良反应第1周多见,第4周各不良反应基本消失。实验结束时SF-36大部分项目有明显好转(P<0.05~0.01)。所有患者未出现停药戒断不良反应。结论:盐酸羟考酮控释片对慢性疼痛急性发作的镇痛效果迅速、肯定,可以考虑作为临床治疗慢性颈椎源性疼痛急性发作的一线首选药物之一。     

自控经皮电刺激耳神门穴对剖宫产术恶心及呕吐影响

目的探讨自控经皮电刺激耳神门穴对剖宫产术病人恶心及呕吐发生率的影响。方法 160例择期剖宫产产妇,随机分为自控经皮电刺激耳神门穴组（A组）与对照组（B组）,各80例。A组产妇入手术室后行自控耳穴电刺激,取神门穴,频率为1.5Hz,强度由产妇自己掌握,刺激30min后行腰麻-硬膜外联合麻醉,术中持续刺激至术后2h;B组不进行电刺激。观察两组病人麻醉开始至胎儿剖出（T1）、胎儿剖出至子宫缝合完毕（T2）、探查腹腔至缝合皮肤切口（T3）、硬膜外腔给予吗啡至术后2h（T4）恶心及呕吐发生率,低血压、低心率发生率;术中甲氧氯普胺、缩宫素、麻黄碱、阿托品使用率,新生儿Apgar评分及术中出血量。结果 A组较B组T3、T4时间段的恶心及呕吐发生率降低（χ2=6.135～17.670,P〈0.05）,甲氧氯普胺使用率降低（χ2=26.467,P〈0.05）;两组T1、T2时间段恶心及呕吐发生率,低血压、低心率发生率,缩宫素、麻黄碱、阿托品使用率,术中出血量及新生儿Apgar评分差异无显著性（P〉0.05）。结论自控经皮电刺激耳神门穴可明显降低剖宫产术中探查腹腔后与硬膜外使用吗啡后恶心及呕吐的发生率,但对麻醉开始至胎儿剖出时间段恶心及呕吐发生率无影响。