化疗致恶心呕吐的研究进展

摘 要化疗所致的最常见的消化道反应是恶心、呕吐。剧烈的呕吐可以导致患者脱水、电解质紊乱、摄入不足、一般状况衰弱,有时还可能导致吸入性肺炎。恶心、呕吐控制不佳会使患者对化疗产生畏惧甚至拒绝,也可能因此而更改化疗方案。因此,有效控制恶心、呕吐对化疗的顺利进行、提高患者生活质量和依从性具有重要的意义。近年来,对化疗相关恶心、呕吐的新药研发有了很大的进步,但是仍然存在许多不足之处。因为恶心、呕吐的病理生理学仍然未完全清楚。本文综述了近年来在化疗相关性止吐药物的研究进展,旨在为临床医生、临床药师提供参考。     

不同药物预防腹腔镜胆囊切除术后患者恶心呕吐的临床观察

目的评价地塞米松联合托烷司琼对腹腔镜胆囊切除术(LC)后恶心呕吐(PONV)的预防作用。方法 157例行LC的患者随机分为4组,分别给予地塞米松和托烷司琼(A组40例)、托烷司琼(B组39例)、地塞米松和氟哌利多(C组38例)、治疗对照组(D组40例),观察术后24h内PONV的发生情况。结果术后24h内PONV的发生例数分别为A组3例,B组8例,C组5例,D组22例;术后2～24h内PONV发生次数A组低于D组(P<0.01),也低于B、C组(P<0.05),术后12～24hA组低于D组(P<0.05)。结论地塞米松联合托烷司琼能有效预防PONV的发生,其疗效优于单独应用托烷司琼或地塞米松联合氟哌利多。     

氢化泼尼松预防腹腔镜手术后恶心呕吐的疗效观察

目的:观察氢化泼尼松对预防腹腔镜手术后恶心呕吐的疗效。方法:择期行腹腔镜手术的病人80例,ASAⅠ-Ⅱ级,年龄27～66岁,体重指数≤26,随机分成4组:空白对照组(C组),托烷司琼组(T组),地塞米松组(D组)和氢化泼尼松组(H组)。分别记录术后24h后患者对恶心呕吐程度的评分,术毕至术后3h和术后3～24h恶心呕吐的发生情况和清醒程度,并记录头晕眩晕烦躁排尿困难和锥体外系症状等。结果:在术后3h内,与C组比较,T组、D组、H组手术术后恶心呕吐的程度均得到明显的改善,恶心呕吐的发生率明显降低(P<0.05);T组、D组和H组3组之间的差异均无统计学意义(P>0.05)。在术后3～24h内,与C组比较,T组、D组、H组手术术后恶心呕吐的程度均得到明显的改善,恶心呕吐的发生率明显降低(P<0.05);T组、D组和H组3组之间的差异均无统计学意义(P>0.05)。术后24h内,与C组比较,T组、D组、H组患者对术后恶心呕吐的评分明显降低(P<0.05);与H组和D组比较,T组术后恶心呕吐的评分明显降低(P<0.05)。4组病人术后24h内清醒程度的评分比较差异无统计学意义(P>0.05)。结论:氢化泼尼松有预防腹腔镜手术后恶心呕吐的疗效,但疗效较托烷司琼差。     

康泉防治化疗引起恶心呕吐的临床观察

康泉（ｇｒａｎｉｓｅｔｒｏｎ）是５＿ＨＴ３受体拮抗剂,为人工合成的止吐新药,与５＿ＨＴ３受体特异性结合,与其它受体如多巴胺受体不结合,因而不产生锥体外系症状［１］。较传统的止吐剂有显著的优越性。我们对４７例接受顺铂或阿霉素和环磷酰胺为主联合化疗的患者,采用康泉防治呕吐,并与胃复安进行对照观察,现将结果报道如下。１材料和方法１１病例选择①经病理检查确诊为恶性肿瘤患者,需要行含顺铂或阿霉素和环磷酰胺联合化疗者。②无颅内高压、肠梗阻或与药物相关的顽固性呕吐者。③化疗前２４ｈ没有呕吐及用过止吐药物者。１２一般资…     

联合应用止吐药对全麻术后恶心呕吐的影响的临床研究

术后恶心呕吐（PONV）是全麻后最常见的并发症之一，PONV导致伤口张力增加、静脉压增高，水、电解质紊乱、酸碱平衡失调以及误吸、窒息等合并症。止吐药最早用于化疗药物引起的恶心呕吐，国外新近研究发现能防治PONV，国内对此研究较少。本文以腹部吸入手术患者为对象，研究不同种类止吐药对PONV的影响。     

围术期不同时间应用曲马多对术后镇痛和恶心呕吐的影响

目的 探讨围术期不同时间给予曲马多对术后镇痛和恶心呕吐并发症的影响.方法 选择54例全身麻醉妇科手术患者,按照静脉给予曲马多的时间不同分为手术结束组、手术结束前组、麻醉诱导前组3组.术后3组均安装艾克孚静脉患者自控镇痛泵(PCA),术后随访24 h,记录3组患者的生命体征、镇痛效果和恶心呕吐情况.结果 各时间点3组患者的一般情况和视觉模拟评分之间差异无统计学意义(P＞0.05);麻醉诱导前组8 h内患者的PCA按压次数明显少于其他2组[(0.6±0.8)次比(1.9±1.1)次、(1.6±1.0)次,P＜0.05];术后1 h,手术结束前组恶心呕吐程度最重,手术结束组、麻醉诱导前组与其比较,差异有统计学意义[(1.6±0.9)分比(0.6±0.5)分、(0.5±0.6)分,P＜0.05],术后4、8和12 h,手术结束组的恶心呕吐程度最严重,与其他2组相比,差异有统计学意义(P＜0.05).结论 麻醉诱导前给予曲马多,既可增强术后镇痛的作用,又能降低曲马多术后镇痛恶心呕吐的发生率.

Abstract：

Objective To investigate the analgesic effect and the influence on nausea and vomiting of tramadol during the different periods of perioperation. Methods Fifty-four patients undergoing gynecologic surgery under general anesthesia were randomly divided into three groups according to the time of using tramadol: after operation instantly group, before the end of surgery group and before induction of anesthesia group. All the patients received intravenous patient controlled analgesia(PCA) pump. The vital signs, pain scores and postoperative nausea and vomiting were observed 24 hours after operation. Results There was no significant difference of the vital signs and visual analogue scale (VAS) scores among the three groups( P ＞ 0.05 ). At 8 h after PCA, the number of PCA in before induction of anesthesia group was obviously reduced(P ＜0.05). At 1 h after PCA, the patients in before the end of surgery group experienced the severest nausea and vomiting( P ＜0. 05 ). At 4 h, 8 h and 12 h after PCIA, the patients in after operation instantly group experienced the severest nausea and vomiting ( P ＜ 0.05 ).Conclusion Using tramadol before induction of anesthesia not only has a good analgesic effect, but also decreases the incidence of nausea and vomiting after postoperative analgesia.     

围术期不同时间应用曲马多对术后镇痛和恶心呕吐的影响

Objective To investigate the analgesic effect and the influence on nausea and vomiting of tramadol during the different periods of perioperation. Methods Fifty-four patients undergoing gynecologic surgery under general anesthesia were randomly divided into three groups according to the time of using tramadol: after operation instantly group, before the end of surgery group and before induction of anesthesia group. All the patients received intravenous patient controlled analgesia(PCA) pump. The vital signs, pain scores and postoperative nausea and vomiting were observed 24 hours after operation. Results There was no significant difference of the vital signs and visual analogue scale (VAS) scores among the three groups( P ＞ 0.05 ). At 8 h after PCA, the number of PCA in before induction of anesthesia group was obviously reduced(P ＜0.05). At 1 h after PCA, the patients in before the end of surgery group experienced the severest nausea and vomiting( P ＜0. 05 ). At 4 h, 8 h and 12 h after PCIA, the patients in after operation instantly group experienced the severest nausea and vomiting ( P ＜ 0.05 ).Conclusion Using tramadol before induction of anesthesia not only has a good analgesic effect, but also decreases the incidence of nausea and vomiting after postoperative analgesia.     

围术期不同时间应用曲马多对术后镇痛和恶心呕吐的影响

Objective To investigate the analgesic effect and the influence on nausea and vomiting of tramadol during the different periods of perioperation. Methods Fifty-four patients undergoing gynecologic surgery under general anesthesia were randomly divided into three groups according to the time of using tramadol: after operation instantly group, before the end of surgery group and before induction of anesthesia group. All the patients received intravenous patient controlled analgesia(PCA) pump. The vital signs, pain scores and postoperative nausea and vomiting were observed 24 hours after operation. Results There was no significant difference of the vital signs and visual analogue scale (VAS) scores among the three groups( P ＞ 0.05 ). At 8 h after PCA, the number of PCA in before induction of anesthesia group was obviously reduced(P ＜0.05). At 1 h after PCA, the patients in before the end of surgery group experienced the severest nausea and vomiting( P ＜0. 05 ). At 4 h, 8 h and 12 h after PCIA, the patients in after operation instantly group experienced the severest nausea and vomiting ( P ＜ 0.05 ).Conclusion Using tramadol before induction of anesthesia not only has a good analgesic effect, but also decreases the incidence of nausea and vomiting after postoperative analgesia.     

托烷司琼用于预防神经外科术后恶心呕吐的研究

目的：观察5-HL受体拮抗剂盐酸托烷司琼与盐酸恩丹西酮预防神经外科开颅术患者术后恶心呕吐（PONV）的有效性和安全性。方法：选择神经外科行幕上开颅手术患者150例，随机分为3组：盐酸托烷司琼组、盐酸恩丹西酮组和空白对照组，每组50例。各组于手术至缝合硬膜时分别静脉滴注盐酸托烷司琼5mg，盐酸恩丹西酮4mg及注射用水。术后中、重度呕吐患者追加使用抗呕吐药物盐酸恩丹西酮。术后观察并记录以下指标：（1）恶心发生率。（2）呕吐发生率。（3）疼痛视觉模拟评分（VAS）。（4）镇静评分（OAA／S）。（5）平均动脉压（MAP）、心率（HR）。（6）追加使用抗呕吐药物的药名及剂量。（7）不良反应的发生情况。结果：术后2h内托烷司琼组、恩丹西酮组恶心及呕吐的发生率低于对照组（P〈0．01或P〈0．05）；但两治疗组间差别无统计学意义（P〉0．05）。恩丹西酮组术后24h内恶心的发生率较托烷司琼组呈增加趋势，但差异无统计学意义（X^2=3．326，P〉0．05）。结论：托烷司琼、恩丹西酮均可降低恶心呕吐的发生率。托烷司琼作用时限较恩丹西酮长，可能具有更好的预防效果。     

Fosaprepitant for the Treatment of Refractory Postoperative Nausea and Vomiting

Postoperative nausea and vomiting (PONV) is a debilitating condition that occurs in approximately 30% of patients undergoing general anesthesia. Premedication with 5-HT3 receptor antagonists and glucocorticoids is effective in clinical practice; however, 10% to 20% of patients still develop PONV. Currently, little is known about the treatment of refractory PONV. We present a case that illustrates the use of fosaprepitant for the treatment of refractory postoperative nausea and vomiting.Key Words: breakthrough, Emend, fosaprepitant, nausea, postoperative, refractory, vomitingPostoperative nausea and vomiting (PONV) occurs in approximately 30% of patients undergoing general anesthesia without antiemetic prophylaxis.¹ With antiemetic prophylaxis, 10% to 20% of patients experience PONV. With placebo, 65% to 86% of patients experience emetic symptoms after the first incident of PONV.² The prevention of PONV has been well studied; however, there is little knowledge available for the treatment of PONV. The main pharmacological classes of drugs used in the treatment of PONV as single agents or combination therapy include 5-HT3 receptor antagonists, glucocorticoids, antihistamines, cholinergic antagonists, butyrophenone, phenothiazines, and benzamides.³ In general, a drug possessing a different mechanism of action from the prophylactic regimen should be used for the treatment of PONV. As demonstrated by Kovac and colleagues, in patients who received ondansetron for the prevention of PONV, additional ondansetron for the treatment of PONV was ineffective.⁴ Furthermore, less is known about the treatment of refractory PONV, and it has yet to be studied. We present a case of fosaprepitant used in the treatment of refractory PONV.     

氟哌利多穴位注射对妇科腹腔镜手术后恶心呕吐的影响

目的：观察氟哌利多穴位注射对妇科腹腔镜手术后恶心呕吐的影响。方法：将60例妇科腹腔镜手术患者以随机数字表法分为A组（n＝30）和I组（n＝30）。 A组患者在诱导前10 min于双侧内关穴注射氟哌利多1 mg,I组患者在诱导前10 min静脉注射氟哌利多2 mg。记录患者术毕至拔气管导管时间、术毕至听从指令时间、术后24 h内恶心呕吐发生率及严重程度。结果：A组患者术后0～1、1～2、2～4、4～12 h的恶心呕吐评分（ NVS评分）低于I组,麻醉后监测治疗室内给予止吐药的病例数少于I组（P均＜0．05）。2组患者术后12～24 h的NVS评分、拔管时间、听从指令时间的差异无统计学意义（P＞0．05）。结论：氟哌利多穴位注射预防妇科腹腔镜手术后恶心呕吐的效果优于静脉注射氟哌利多,且不影响麻醉恢复。     

ApoE基因多态性对瑞舒伐他汀疗效的影响

目的：调查血脂异常人群中ApoE基因多态性的分布情况及其对瑞舒伐他汀调脂效果的影响。方法：选取本院2017年1月~2019年6月血脂异常的住院患者127例,采用PCR-荧光探针法测定其ApoE基因型,并分别测定患者服用瑞舒伐他汀钙12周前后的血脂水平进行统计分析。结果：在127例患者中,E3/3基因型比例最高,达62.20%;治疗前E4/4+E3/4基因型的患者TC、TG水平较高且显著高于E3/3基因型（P＜0.05）;瑞舒伐他汀治疗后各组TC、TG及LDL-C水平均有下降,HDL-C水平均有所提高,其中E3/3基因型的TG水平降低作用最强（P＜0.05）。结论：ApoE基因多态性不仅对血脂水平高低有一定的影响,还与瑞舒伐他汀的降脂疗效相关。     

Effects of Different Administrations of Ondansetron on Nausea and Vomiting During Postoperative Laparoscopic Cholaparoscopic

目的 研究昂丹司琼不同给药方式对预防腹腔镜胆囊切除手术(LC)后恶心呕吐(PONV)的临床疗效.方法 将200例美国麻醉医师协会分级(ASA)Ⅰ~Ⅱ级,择期行LC的患者随机分为4组:Ⅰ组术毕未使用昂丹司琼;Ⅱ组术毕静注昂丹司琼8mg;Ⅲ组术毕镇痛泵内加昂丹司琼4mg,静脉推注昂丹司琼4mg;Ⅳ组术毕镇痛泵内加昂丹司琼8mg.记录术后2、4、8、20、36和48h患者的PONV情况.结果 与Ⅰ组相比,Ⅱ组在术后2、4和 8h恶心、呕吐发生率显著降低(P<0.05),Ⅲ组在术后2、4、8、20、36和48h恶心、呕吐发生率明显降低(P＜0.05);Ⅰ组和Ⅳ组各时间点呕吐的发生率差异无统计学意义.与Ⅱ组相比,Ⅲ组在术后36、48h呕吐发生率明显降低(P<0.05);与Ⅳ组相比较,Ⅱ组在术后2、4、8h恶心、呕吐发生率明显降低(P＜0.05),Ⅲ组在术后2、4、8、20、36和48h呕吐发生率明显降低(P<0.05).结论 术毕单次注射昂丹司琼4 mg,并通过术后镇痛泵(PCA)持续输注,可以在术后48h内有效预防恶心、呕吐的发生.     

昂丹司琼不同给药方式对腹腔镜胆囊切除术后恶心、呕吐的预防

目的研究昂丹司琼不同给药方式对预防腹腔镜胆囊切除手术(LC)后恶心呕吐(PONV)的临床疗效。方法将200例美国麻醉医师协会分级(ASA)Ⅰ～Ⅱ级,择期行LC的患者随机分为4组:Ⅰ组术毕未使用昂丹司琼;Ⅱ组术毕静注昂丹司琼8 mg;Ⅲ组术毕镇痛泵内加昂丹司琼4 mg,静脉推注昂丹司琼4 mg;Ⅳ组术毕镇痛泵内加昂丹司琼8 mg。记录术后2、4、8、20、36和48 h患者的PONV情况。结果与Ⅰ组相比,Ⅱ组在术后2、4和8 h恶心、呕吐发生率显著降低(P<0.05),Ⅲ组在术后2、4、8、20、36和48 h恶心、呕吐发生率明显降低(P<0.05);Ⅰ组和Ⅳ组各时间点呕吐的发生率差异无统计学意义。与Ⅱ组相比,Ⅲ组在术后36、48 h呕吐发生率明显降低(P<0.05);与Ⅳ组相比较,Ⅱ组在术后2、4、8 h恶心、呕吐发生率明显降低(P<0.05),Ⅲ组在术后2、4、8、20、36和48 h呕吐发生率明显降低(P<0.05)。结论术毕单次注射昂丹司琼4mg,并通过术后镇痛泵(PCA)持续输注,可以在术后48 h内有效预防恶心、呕吐的发生。     

格拉司琼抗病人自控镇痛下术后恶心、呕吐作用的临床研究

目的 :研究病人自控镇痛 (PCA)条件下盐酸格拉司琼抗术后恶心、呕吐 (PONV )的临床效果及输注该注射液快、慢对术中循环的影响。方法 :90名择期手术患者随机分为3组 :A组 ,恩丹西酮8mg ;B组 ,托烷司琼3mg ;C组 ,格拉司琼3mg(50ml)。格拉司琼分别在术毕前20、30、40、50、60min输完 ,记录输注中循环指标变化及术后4、8、12、24h及2、3d时恶心、呕吐情况。结果 :扩容基础上输注格拉司琼时间>20min ,对血压、心率无明显影响 (P>0 05) ,且无头痛等并发症 ;PCA条件下B、C组的抗PONV效果与A组存在显著性差异 (BvsA ,P<0 01 ;CvsA ,P<0 001) ,且C组较B组PONV发生率更低 (P<0 05) ,C组的价格效益比较B组显著提高 (P<0 01)。结论 :PCA条件下格拉司琼抗PONV作用较恩丹西酮、托烷司琼明显 ,且其价格效益比高 ,术中输注格拉司琼时间>20min对循环无明显影响     

氟哌利多、格拉司琼预防腹腔镜胆囊切除术后恶心呕吐疗效观察

目的:比较氟哌利多、格拉司琼预防腹腔镜胆囊切除术后恶心呕吐的临床疗效.方法:选择 120例ASA Ⅰ一Ⅱ级择期腹腔镜胆囊切除术病人,按入院编号随机分为三组,各40例.A组诱导前 5 min 静注氟哌利多 2.5 mg,B组在开始缝皮前静注格拉司琼3 mg、C组(对照组)静注生理盐水10 mL.结果:术后24 h内恶心呕吐发生率A组17.5%、B组15%,明显低于C组50%(P＜0.05),A组与 B组比较差异无显著性(P＞0.05).结论:氟哌利多和格拉司琼均可显著降低腹腔镜胆囊切除术后恶心呕吐发生率.     

术后静脉自控镇痛的妇科患者发生恶心呕吐的相关因素分析

目的 分析影响使用静脉自控镇痛泵的妇科患者术后发生恶心呕吐的相关因素,为临床减少妇科患者术后恶心呕吐提供参考.方法 回顾2018年01月至2018年12月1400例使用静脉自控镇痛泵妇科患者的术后麻醉查房记录,记录患者术后24 h内是否出现恶心呕吐以及围术期相关信息.对影响患者术后发生恶心呕吐的相关因素进行统计学分析....     

A Double-Blind,Placebo-Controlled Evaluation of Intranasal Metoclopramide in the Prevention of Postoperative Nausea and Vomiting

Nausea and vomiting are common complaints in the postoperative period and contribute to patient distress and delay of discharge for outpatient surgical procedures. Laparoscopic procedures are associated with a high incidence of postoperative nausea and vomiting (PONV) episodes. Parenteral use of metoclopramide prevents and treats PONV. The intranasal route provides rapid and complete absorption of metoclopramide without many of the adverse effects observed with parenteral administration of the drug. We performed a prospective, double-blinded, randomized, placebo-controlled study to evaluate the safety and efficacy of metoclopramide 20 mg administered intranasally for emetic prophylaxis in laparoscopic surgery patients. The results from 109 patients enrolled in the study showed that this intranasal dose of metoclopramide may be ineffective in preventing the occurrence of PONV The poor performance of the intranasal metoclopramide formulation in this study cannot be attributed to patient-specific and perioperative factors. It may be due to an inadequate dose or slow absorption of the drug. The small sample size, however, may also have been a factor.