雷莫司琼和托烷司琼预防术后镇痛患者恶心呕吐的疗效观察

目的比较雷莫司琼和托烷司琼预防术后镇痛患者恶心呕吐的预防作用。方法选择120例ASAⅠ～Ⅱ级择期子宫切除术患者,随机将患者分为3组,在开始缝皮前静脉注射雷莫司琼（R组,n=40）0．3mg、托烷司琼（T组,n=40）5mg、生理盐水（对照组,C组,n=40）5ml。观察术后48h内恶心呕吐发生情况并作比较。结果在术后24h内和48h内恶心呕吐的发生率R组（17．5％、32．5％）和T组（15．0％、30．0％）明显低于C组（40．0％、67．5％）,差异有统计学意义（P〈0．01）,R组和T组比较差异无统计学意义（P〉0．05）。结论雷莫司琼和托烷司琼均可显著减少术后恶心呕吐发生率,对于预防恶心呕吐两者疗效相当。     

盐酸雷莫司琼口腔崩解片预防恶性血液疾病联合化疗所致的胃肠反应

目的：观察盐酸雷莫司琼口腔崩解片预防恶性血液疾病患者联合化疗所致胃肠反应的疗效和安全性。方法：采用随机、对照方法，将入选病例随机分为治疗组（含服盐酸雷莫司琼口腔崩解片0．1mg）和对照组（静脉注射盐酸托烷司琼5mg）。结果：可评价疗效及安全性病例110例。两种药物对控制化疗所致食欲缺乏、恶心和呕吐的有效率相似。第1～7天盐酸雷莫司琼对食欲缺乏的完全控制率（52．7％～63．6％）、第4～7天对恶心的完全控制率（43．6％～56．4％）及第3、4、6天对呕吐的完全控制率（80．0％、87．3％和90．9％）明显优于盐酸托烷司琼注射剂，差异有显著性（P〈0．05）。盐酸雷莫司琼不良反应轻，主要为便秘、头痛、体热感和疲倦，为一过性，其发生率与盐酸托烷司琼注射剂相似。结论：盐酸雷莫司琼口腔崩解片能有效预防恶性血液病患者联合化疗所致的胃肠反应，适用于因各种原因不能吞服药片的患者。     

Ramosetron,a 5-HT3 receptor antagonist for the control of nausea and vomiting

Ramosetron is a selective serotonin 5-HT3 receptor antagonist with an affinity higher than that of the previously available drugs ondansetron, granisetron and tropisetron. Ramosetron was shown in pharmacological assays to inhibit activities mediated by 5-HT3 receptors, such as emesis caused by cisplatin. In clinical trials, ramostreon was at least as effective as the reference "setrons" against nausea and vomiting induced by chemotherapy or surgical interventions, but the efficacy was well maintained during a 48-h period, so that efficacy was significantly higher with ramosetron in terms of nausea and vomiting 6-48 h after treatment. Hence, ramosetron represents a good alternative over previously available drugs for the prophylaxis and treatment of chemotherapy-induced and postoperative nausea and vomiting. Data in children also support the efficacy of ramosetron, which is well tolerated by both child and adult patients.     

帕诺洛司琼与托烷司琼分别联合地塞米松预防含顺铂化疗所致恶心呕吐的临床对照研究

目的:观察和评价国产帕洛诺司琼联合地塞米松预防含高致吐性顺铂化疗引起的恶心、呕吐的有效性和安全性。方法:采用随机对照的试验方法,对使用含高致吐性顺铂（≥50mg/m2）化疗方案的患者,于化疗前半小时缓慢静脉推注帕洛诺司琼0.25mg (观察组)或静滴托烷司琼2mg (对照组),两组均于第1、2、3天化疗前分别静脉滴入地塞米松16mg、8mg、8mg,观察患者化疗引起的急性期（0-24h）、延迟期（24-120h及全期（0-120h）的呕吐的完全缓解率及无呕吐发作百分比,必要时给予解救性止吐治疗(托烷司琼或甲氧氯普胺)。结果:共入组72例患者,观察组35例,对照组37例,观察组对化疗引起的急性期、延迟期完全缓解率(CRR)与对照组相比无显著性差异(82.9%vs75.7%、65.7% vs43.2%,P＞0.05),但前者对化疗引起的全期CRR明显高于对照组(65.7% vs40.5%,P＜0.05）);观察组化疗后急性期无呕吐发作率与对照组相比无显著性差异（91.4%vs 83.8%, P＞0.05）,但在延迟期及全期则具有显著性差异（77.1% vs48.6%、74.3%vs43.2%, P＜0.05）。两组不良反应主要为头痛、便秘、眩晕、腹部不适等,均症状轻微,患者耐受性好。 结论:国产帕洛诺司琼联合地塞米松能有效地预防高致吐性化疗所致急性期、延迟期呕吐反应,对于延迟期呕吐反应其疗效优于托烷司琼,且安全性好。     

静脉注射托烷司琼治疗乳腺癌化疗所致恶心呕吐用药时机分析

目的探讨不同时间静脉注射托烷司琼治疗乳腺癌化学治疗(简称化疗)所致恶心呕吐的临床疗效。方法选取医院2016年8月至2018年10月收治的乳腺癌患者96例,按乱数表法分为研究组和对照组,各48例。两组患者化疗药物为顺铂(60 mg/m^2)+多柔比星(50 mg/m^2)+氟尿嘧啶(500 mg/m^2),研究组和对照组患者分别于化疗开始前和化疗结束后静脉注射枸橼酸托烷司琼注射液。结果研究组总有效率显著高于对照组,24 h内恶心、呕吐次数显著少于对照组,补液时长显著短于对照组,生活质量评分显著高于对照组(P<0.05);研究组与对照组患者不良反应发生率相当(8.33%比14.58%,χ^2=0.924,P=0.336>0.05)。结论乳腺癌患者化疗前预防性静脉注射托烷司琼能有效控制化疗所致恶心呕吐症状,提高患者生活质量。     

含服生姜片联合托烷司琼预防顺铂所致恶心呕吐的研究

目的：探讨含服生姜片联合托烷司琼预防顺铂所致的恶心呕吐的效果。方法将100例含顺铂标准化疗的患者随机分为观察组和对照组各50例,对照组使用托烷司琼静脉滴注预防恶心呕吐,观察组在对照组治疗的基础上联合采用生姜片含服,观察比较两组病人恶心呕吐情况。结果观察组化疗后恶心呕吐发生率显著低于对照组（P＜0．05）。结论含服生姜片联合托烷司琼能缓解顺铂化疗后引起的恶心呕吐,止吐效果显著。     

Current review of ramosetron in the prevention of postoperative nausea and vomiting

Postoperative nausea and vomiting (PONV) are distressing and frequent adverse events of anesthesia and surgery. Serotonin receptor antagonists (SRAs), including ondansetron, granisetron, tropisetron, dolasetron, and ramosetron, effectively decrease the incidence of PONV. Among these SRAs, ramosetron is the most effective antiemetic for the prophylaxis against PONV in terms of the inhibitory potency, binding rate, and stabilizing its pharmacological activity. This review article focused on the efficacy of ramosetron for preventing PONV in adults and postoperative vomiting (POV) in children. Because of young age of pediatric patients, nausea was not assessed a separate entity. MEDLINE (PubMED) and EMBASE (January 1990 - September 2010) were searched for randomized, double-blind, (placebo-controlled), studies (written in English) of ramosetron for preventing PONV in adults and POV in children. The incidence of PONV during 0-24 h after anesthesia was less in patients receiving ramosetron 0.3 mg than in those receiving placebo, in adults undergoing gynecologic surgery, dilatation and curettage, laparoscopic cholecystectomy, middle ear surgery, thyroidectomy, and total hip/knee replacement. The incidence of POV during 0-24 h after anesthesia was less in pediatric patients receiving ramosetron 6 mcg kg(-1) than in those receiving placebo, in children undergoing strabismus surgery and tonsillectomy. In adults, the most commonly reported adverse effect was headache (5-20%). In children, clinically serious adverse events, such as excessive sedation and extrapyramidal symptoms, were not observed. Prophylactic therapy with ramosetron is effective for preventing PONV in adults and POV in children without clinically serious adverse effects.     

氟哌利多与托烷司琼预防腹腔镜阑尾切除术后恶心呕吐的疗效观察

目的:观察氟哌利多、托烷司琼预防腹腔镜阑尾切除术后恶心呕吐的临床疗效。方法:选择60例择期行全凭静脉麻醉下腹腔镜阑尾切除术的患者,随机分为A、B、C组,每组20例,分别在开始缝合前静脉注射0.9%氯化钠10mL(A组)、氟哌利多1.25mg(B组)、托烷司琼5mg(C组)。术毕清醒后拔管,观察记录术后24h患者发生恶心呕吐的情况。结果:B、C组的术后恶心呕吐发生率明显低于A组(P<0.05);B、C组比较差异无统计学意义(P>0.05)。结论:氟哌利多和托烷司琼均可显著降低腹腔镜阑尾切除术后恶心呕吐的发生率,二者疗效相当。     

肿瘤患者化疗中托烷司琼与格拉司琼止吐作用的疗效观察

目的:采用托烷司琼和格拉司琼预防肿瘤化疗引起的恶心呕吐,并对其疗效进行观察.方法:将90例恶性肿瘤患者随机分为托烷司琼组和格拉司琼组,每组45例,两组患者均首次接受化疗,观察两组患者恶心、呕吐的程度及治疗效果.结果:托烷司琼组对预防恶性肿瘤化疗所致恶心、呕吐总有效率为75.5%,格拉司琼组总有效率为71.1%,两组疗效基本相似,P>0.05.结论:在肿瘤化疗中,托烷司琼与格拉司琼止吐作用的疗效基本相似,托烷司琼每日用药1次,更为方便.     

阿瑞匹坦对乳腺癌AC方案化疗后中重度呕吐患者的二级预防

目的 观察分析联合应用阿瑞匹坦、盐酸托烷司琼、地塞米松二级预防乳腺癌术后蒽环类药物联合环磷酰胺（AC方案）化疗所致恶心呕吐的疗效及不良反应。方法 选取2015年1月至2016年5月在山东省德州市市立医院肿瘤科住院治疗的乳腺癌术后AC方案首次化疗相关性恶心呕吐（chemotherapy-induced nausea and vomiting,CINV）为中重度的患者72例,随机分为观察组35例,对照组37例。继续化疗过程中,观察组使用阿瑞匹坦+盐酸托烷司琼+地塞米松三联止吐药物预防CINV,对照组使用盐酸托烷司琼+地塞米松预防CINV。观察两组患者化疗后急性期（0~24 h）及延迟期（24~120 h）预防恶心呕吐的效果及不良反应发生情况。结果 两组患者急性期呕吐的完全控制率比较,差异无统计学意义（P>0.05）,观察组急性期呕吐的有效控制率较对照组明显升高,差异有统计学意义（P<0.05）;观察组延迟期呕吐的完全控制率及有效控制率均高于对照组,差异均有统计学意义（P<0.05）。两组患者不良反应主要为便秘、疲乏、面色潮红、焦虑及头晕等,均症状轻微。结论 对乳腺癌AC方案化疗后中重度呕吐患者,化疗过程中给予阿瑞匹坦三联止吐治疗效果好,经济效益较高,且不良反应轻微,患者可耐受。     

国产盐酸托烷司琼治疗顺铂化疗所致恶心、呕吐的疗效与安全性评价

目的:比较国产与进口盐酸托烷司琼在治疗顺铂化疗所致恶心、呕吐的疗效和安全性。方法:采用多中心、双盲、随机对照方法,128例接受顺铂化疗的恶性肿瘤患者随机分为进口盐酸托烷司琼组和国产盐酸托烷司琼组,于化疗前1d应用盐酸托烷司琼,5mg/次,1次/d,连用6d,观察并记录用药1wk内患者食欲减退、恶心、呕吐及其他不良反应。结果:128例患者按研究要求完成观察,2组在治疗恶心、呕吐方面及发生其他不良反应方面均无显著性差异(P>0.05)。结论:国产盐酸托烷司琼在治疗顺铂化疗所致恶心、呕吐的疗效和安全性与进口盐酸托烷司琼相当。     

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。     

托烷司琼预防肺癌化疗所致恶心及呕吐的疗效

目的 :观察托烷司琼预防肺癌化疗所致恶心及呕吐的疗效。方法 :对 1 2 0例接受含顺铂的联合化疗方案的肺癌病人 ,采用随机分组法分为甲、乙2组 ,并采用自身对照法 ,分别观察了甲氧氯普胺(metoclopramide)和托烷司琼 (tropisetron) ,格拉司琼 (granisetron) 3mg和托烷司琼 5mg的疗效和不良反应。结果 :托烷司琼预防化疗所致恶心、呕吐明显优于甲氧氯普胺 ,甲氧氯普胺和托烷司琼对恶心和呕吐有效率分别为 2 7% ,2 3 %和 95 % ,93 % ;但格拉司琼和托烷司琼两者间无明显差异 ,有效率分别为 93 % ,95 %和 97% ,92 % ;副作用均较小。结论 :托烷司琼是肺癌化疗的良好止吐药之一 ,安全且价廉 ,可推广。     

托烷司琼与昂丹司琼预防单髋关节置换患者术后恶心呕吐的比较

目的:比较不同剂量托烷司琼和昂丹司琼在预防术后恶心呕吐(PONV)发生的效果,为临床应用提供参考。方法:选择单髋关节置换术患者178例,18~65岁,ASAⅠ或Ⅱ,随机分为4组。术毕均使用患者自控静脉镇痛(PCIA),PCIA药物配方为舒芬太尼2μg·kg-1+氟比洛芬酯4 mg·kg-1(最大至300 mg),加生理盐水至100 m L。其中,泵中止吐药方案,A组:托烷司琼10 mg,B组:托烷司琼15 mg,C组:昂丹司琼12 mg,D组:昂丹司琼16 mg。分别于6、12、24、48 h观察患者恶心、呕吐及相关并发症的发生情况。结果:术后6 h内,A组和B组呕吐发生率及呕吐程度明显低于C组;术后6~12 h内,A组恶心发生率明显低于C组和D组,A组呕吐发生率和呕吐程度明显低于C组(P<0.05)。结论:在单髋关节置换术后PCIA泵中持续输注托烷司琼10 mg可有效预防恶心呕吐。     

神经外科开颅术后患者呕吐及预防用药的临床回顾

目的：评价高选择性5-羟色胺（5-HT3）受体拮抗剂托烷司琼对神经外科术后患者出现的恶心、呕吐的预防作用。方法：回顾调查了我科过去6年收治的神经外科术后患者,按照应用药物的与否分为两组：未用药组（n=3 332）,托烷司琼组（n=3519）。分别统计入室后6、12、24 h的如下指标：（1）呕吐发生率,（2）其它不良反应发生情况。结果：与未应用呕吐药物组相比,托烷司琼组恶心呕吐的发生率均明显降低,差异有统计学意义（P〈0.01）。结论：本研究结果显示应用选择性5-HT3受体拮抗剂后,神经外科开颅术后患者术后呕吐的发生率明显降低。     

托烷司琼不同给药方式对老年患者硬膜外自控镇痛后恶心、呕吐的防治

目的探讨托烷司琼不同给药方式对老年患者硬膜外自控镇痛（PCEA）后恶心、呕吐的防治效果。方法将50例ASAI-Ⅲ级腰硬联合麻醉的老年手术患者,随机分为两组,A组麻醉前静脉注射托烷司琼5mg;B组术毕镇痛泵加托烷司琼5mg。术后观察并记录0、8、16、24、48h视觉模拟评分WAs）,恶心、呕吐发生程度及不良反应发生率。结果所有患者术后VAS评分均达到满意效果,各组比较差异无统计学意义（P〉0．05）。术后8hA组患者恶心、呕吐发生程度显著低于B组（P〈0．05）;术后A组患者恶心、呕吐发生率显著低于B组（P〈0．05）。结论托烷司琼能有效防止老年患者术后PCEA导致的恶心、呕吐,麻醉前应用效果较佳。     

托烷司琼复合氟哌利多、地塞米松对全麻子宫切除术后恶心呕吐的影响

目的观察托烷司琼复合氟哌利多、地塞米松对全身麻醉子宫切除术患者术后恶心呕吐(PONV)的预防作用。方法择期全身麻醉子宫切除术60例,随机双盲分成A、B两组,每组30例,A组术前给与托烷司琼5mg,B组术前给予托烷司琼2mg、氟哌利多1.25mg、地塞米松10mg。术后随访24h,记录患者术后的PONV的发生率和情况。结果与A组相比,B组术后6h内及6～24h的PONV发生率和程度降低(P<0.05)。结论托烷司琼复合氟哌利多、地塞米松对减少PONV的发生比单独应用托烷司琼效果更好。     

阿瑞匹坦联合托烷司琼预防顺铂化疗引起呕吐的临床观察

目的:观察阿瑞匹坦联合托烷司琼方案预防顺铂化疗引起呕吐的疗效及不良反应。方法:采用随机、自身交叉对照的方法,将60例接受两周期含顺铂联合化疗的患者,随机分为AB、BA组。AB组第1周期应用阿瑞匹坦联合托烷司琼,第2周期应用托烷司琼;BA组第1周期应用托烷司琼,第2周期应用阿瑞匹坦联合托烷司琼。结果:可评价疗效的59例患者中,阿瑞匹坦联合托烷司琼方案和托烷司琼方案对急性呕吐的完全缓解率分别为74.6%和57.6%,有效控制率分别为91.5%和81.4%(Z=-2.017,P=0.044);对延迟性呕吐的完全缓解率分别为69.5%和42.4%,有效控制率分别为86.4%和71.2%(Z=-3.112,P=0.002)。两种方案的主要不良反应为呃逆、便秘、头痛、头晕、口干等,不良反应发生率比较差异无统计学意义(P>0.05)。结论:阿瑞匹坦联合托烷司琼方案对顺铂化疗引起急性呕吐与延迟性呕吐均有很好的疗效,不良反应可以耐受。     

Tropisetron: an update of its use in the prevention of chemotherapy-induced nausea and vomiting

Tropisetron is a serotonin (5-hydroxytryptamine; 5-HT) antagonist that is primarily used in the prevention of chemotherapy-induced nausea and vomiting. Antagonism of 5-HT3 binding sites in the peripheral and central nervous system is the probable mechanism of prevention of acute nausea and vomiting. Effects on delayed nausea and vomiting are less well understood as these are probably not mediated solely by 5-HT3 receptors. Tropisetron monotherapy is effective for the control of acute, and to a lesser extent delayed, nausea and vomiting in patients receiving moderately to severely emetogenic chemotherapy. The combination of dexamethasone and tropisetron is more effective than monotherapy. Complete control of cisplatin-induced nausea and vomiting was obtained in 69 to 97% of patients receiving the combination compared with 46 to 80% receiving tropisetron monotherapy in randomised trials. There were generally no significant differences between the control of acute or delayed nausea and vomiting provided by tropisetron, ondansetron or granisetron in randomised, comparative trials. The antiemetic efficacy of tropisetron was maintained over multiple cycles of chemotherapy. Most comparative studies showed tropisetron monotherapy to be more effective than metoclopramide in controlling acute nausea and vomiting, with the exception of 1 study which showed similar efficacy. However, high dose metoclopramide plus dexamethasone provided similar control of delayed emesis to tropisetron plus dexamethasone. Tropisetron is also effective in children, including those who responded poorly to previous antiemetic treatment. Tropisetron and ondansetron generally have similar efficacies in this population. The drug enhanced patients' quality of life and was well tolerated by adults and children alike. The recommended oral and IV dosage of tropisetron is 5 mg once daily; there is no increase in efficacy with doses >5 mg. CONCLUSIONS: Tropisetron is similar to other 5-HT3 receptor antagonists for the prevention of chemotherapy-induced nausea and vomiting in both adults and children. It is suitable as first-line therapy (combined with a corticosteroid) for the prevention of acute nausea and vomiting in patients treated with moderately to severely emetogenic chemotherapeutic agents. This combination is also moderately effective in the prevention of delayed nausea and vomiting.     

帕洛诺司琼防治乳腺癌化疗相关性恶心呕吐的临床对照研究

目的 观察帕洛诺司琼防治乳腺癌化疗相关性恶心呕吐的疗效及安全性.方法 选择2010年1月-2013年6月沈阳军区总医院收治的乳腺癌77例,其中帕洛诺司琼组（A组）38例和托烷司琼组（B组）39例.两组患者均采用含表柔比星方案化疗,分别观察两组化疗后0~5 d内出现恶心、呕吐及食欲不振等消化道反应和便秘、头晕等不良反应.结果化疗后0~24 h两组恶心、呕吐及食欲不振控制率差异均无统计学意义（P＞0.05）,化疗后2~5 d A组对恶心、呕吐控制率明显优于B组（P＜0.05）,食欲不振控制率无差异（P＞0.05）.两组不良反应较轻,无明显差异（P＞0.05）.结论 在乳腺癌化疗中,帕洛诺司琼防治表柔比星引起迟发性恶心呕吐疗效显著,安全性高.