托烷司琼与格拉司琼预防妇科腹腔镜术后恶心呕吐的比较

目的：比较托烷司琼与格拉司琼预防妇科腹腔镜术后恶心呕吐的临床疗效.方法：选择90例ASAⅠ～Ⅱ级行妇科腹腔镜手术的患者随机均分为三组,在手术结束时分别静脉注射托烷司琼5 mg（T组,n=30）、格拉司琼3 mg（G组,n=30）、生理盐水5 mL（对照组,NS组,n=30）.结果：在术后8 h内和9～24 h恶心呕吐发生率T组（20.0%,10.0%）和G组（20.0%,33.3%）明显低于NS组（63.3%,60.0%）（P＜0.05）,T组在术后8 h内恶心呕吐发生率与G组比较无显著性差异（P＞0.05）,但在术后9～24 h内恶心呕吐发生率明显低于G组（10.0% vs 33.3%）（P＜0.05）.结论：托烷司琼与格拉司琼均可有效预防妇科腹腔镜术后恶心呕吐发生率,但托烷司琼的远期效果优于格拉司琼.     

帕洛诺司琼预防高致吐性化疗所致恶心呕吐临床研究

目的:通过帕洛诺司琼和格拉司琼分别联合地塞米松预防以大剂量顺铂为主方案化疗所致恶心呕吐,观察和评价帕洛诺司琼联合地塞米松预防高致吐性化疗方案的疗效和安全性.方法:56例非小细胞肺癌患者接受以大剂量顺铂为主化疗方案,随机分为两组:治疗组28例,对照组28例.治疗组:帕洛诺司琼0.25 mg,静脉推注;对照组:格拉司琼3 mg,静脉滴注;两组均联合地塞米松12 mg,静脉推注,均于化疗前30min给药.结果:治疗组和对照组预防急性呕吐的完全有效率分别为82.1%和78.6%,恶心的改善率分别为64.3%和60.7%,差异均无显著性(P>0.05);治疗组和对照组预防延迟性呕吐的完全有效率分别为60.7%和39.3%,差异有显著性(P<0.05).结论:帕洛诺司琼和格拉司琼分别联合地塞米松预防以大剂量顺铂为主方案化疗所致急性呕吐和恶心疗效相当,对于延迟性呕吐的完全有效率前者优于后者,不良反应轻,患者耐受性良好,推荐帕洛诺司琼联合地塞米松作为高致吐性化疗方案的常规药物.     

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。     

帕洛诺司琼对比托烷司琼在预防晚期肺癌恶性胸腔积液胸腔化疗所致恶心呕吐的疗效观察

目的评价帕洛诺司琼在预防晚期肺癌恶性胸腔积液胸腔化疗所致恶心止吐的疗效并与托烷司琼对比。方法46例晚期肺癌伴恶性胸腔积液需行顺铂胸腔化疗的患者随机分为实验组（帕洛诺司琼组,n=23）和对照组（托烷司琼组,n=23）,观察并比较两组病人预防恶心止吐的效果及不良反应。结果实验组和对照组的急性恶心有效控制率分别为87．0％和78．3％,急性呕吐有效控制率分别为73．9％和60．9％,两组相比无显著性差异（P〉0．05）;在迟发性恶心和呕吐有效控制率方面,帕洛诺司琼组分别为78．3％和69．6％,托烷司琼组分别为47．8％和34．8％,两者具有显著性差异（P〈0．05）。治疗期间有部分患者出现腹胀、便秘及头晕,两组相比无显著性差异（P〉0．05）。结论帕洛诺司琼与托烷司琼在预防晚期肺癌恶性胸腔积液患者行顺铂胸腔化疗所致急性恶心呕吐的疗效相当,但对于迟发性恶心呕吐帕洛诺司琼有更好的效果。     

格拉司琼防止顺铂化疗所致恶心呕吐的疗效观察

格拉司琼(枢星)是一种新型选择性5-HL受体拮抗剂。我院自2002年1月～2003年6月对38例以顺铂为主的联合化疗患者比较枢星与昂丹司琼(枢丹)对胃肠道反应的疗效。     

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。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.     

盐酸托烷司琼预防化疗所致恶心呕吐反应的疗效观察

目的：观察盐酸托烷司琼预防化疗时引起的恶心呕吐反应的疗效及其不良反应。方法；对47例接受顺铂或阿霉索或吡喃阿霉索化疗的癌症患者随机分为两组：A组23例和B组24例。A组采用国产盐酸托烷司琼预防性治疗．B组采用进口盐酸托烷司琼预防性治疗。观察并记录两组用药及用药后3d患者食欲减退及恶心呕吐情况。结果：A组有效率78．26％，B组有效率87．50％，两组比较，差异无统计学意义（P〉0．05）。结论：国产盐酸托烷司琼与进口盐酸托烷司琼预防癌症化疗时引起的恶心呕吐疗效相当，且无明显的不良反应。     

托烷司琼预防乳腺癌化疗中恶心呕吐的疗效观察

目的:观察托烷司琼在预防乳腺癌化疗所致恶心呕吐的临床疗效。方法:将46例接受环磷酰胺、吡柔比星、5氟脲嘧啶联合化疗的乳腺癌患者进行4~6个疗程的自身对照,随机分为托烷司琼组和恩丹西酮组,比较治疗效果。结果:托烷司琼组与恩丹西酮组止吐疗效比较有显著性差异(P<0.05)。两组的不良反应无明显差异。结论:托烷司琼能有效控制恶性肿瘤化疗所致的恶心呕吐,且不良反应少,可作为预防化疗引起的恶心呕吐的优选药物,值得临床应用。     

托烷司琼预防术后静脉自控镇痛致恶心呕吐疗效观察

目的观察托烷司琼抑制患者术后静脉自控镇痛（patient controlled intrarenous analgesia,PCIA）所致恶心呕吐的效果。方法选择择期手术需行全身麻醉ASAI-Ⅱ级患者120例,所有患者术前均无明显胃肠道功能异常和恶心呕吐症状,无心、肺、肝、肾功能不全;术前24h未给任何止吐药。术毕将120例患者随机分为3组：①Ⅰ组（生理盐水组,n=40）,术毕静脉注射生理盐水2mL,患者PCIA配方为芬太尼0.6～0.8mg,用生理盐水稀释至100mL。②Ⅱ组（托烷司琼组,n=40）,术毕静脉注射托烷司琼2mg;在Ⅰ组PCIA配方中加托烷司琼4mg。③Ⅲ组（氟哌利多组,n=40）术毕静脉注射氟哌利多2.5mg,在Ⅰ组PCIA配方中加氟哌利多2.5mg。术后连续观察48h,记录术后0、4、8、16、24、32、48h视觉模拟评分（VAS）、舒适评分（BCS）及恶心呕吐等不良反应。结果所有患者术后镇痛及舒适评分均达基本满意水平,各组相比,差异无统计学意义（P〉0.05）。防治恶心、呕吐效果,Ⅱ组效果最好,Ⅱ组、Ⅲ组与Ⅰ组相比差异均有显著性（均P〈0.05）;Ⅱ组与Ⅲ组相比差异无显著性（P〉0.05）。Ⅲ组出现了3例锥体外系症状及5例嗜睡症状,Ⅱ组有3例出现一过性轻微头痛。结论托烷司琼及氟哌利多均能抑制PCIA所致恶心、呕吐,但托烷司琼不良反应少且轻微。     

肿瘤患者发生化疗诱导性恶心呕吐的危险因素分析

目的探讨肿瘤患者发生化疗诱导性恶心呕吐的危险因素,以期为筛选高危患者和制定预防措施提供临床依据。方法2012年1月至2013年5月,采用便利抽样法选取龙游县人民医院恶性肿瘤患者345名为研究对象,采用一般资料调查量表、状态-特质焦虑量表(statetrait anxiety inventory,STAI)和症状困扰量表(the symptom distress scale,SDS),对其进行调查,并采用单因素和Logistic回归分析法分析。结果 345名患者中有240例发生恶心呕吐,发生率为60.57%。单因素分析显示,不同年龄、性别、化疗周期、有无恶心呕吐史、焦虑、疼痛和是否应用铂类化疗药的患者,其诱导性恶心呕吐发生率的差异均有统计学意义(均P0.05)。Logistic回归分析显示,年龄、女性、恶心呕吐史、焦虑、疼痛、应用铂类化疗药和化疗周期是恶心呕吐发生的危险因素。结论化疗诱导性恶心呕吐的发生与多种因素有关,化疗前采取一定的预防措施可降低其发生率,保证化疗的顺利进行并提高患者的生活质量。     

减量应用恩丹西酮防治化疗所致恶心呕吐反应的疗效观察

对1995年8月至1996年10月65例肿瘤内科应用同种化疗方案病人,随机分为正规组,减量组和胃复安组。分别采用不同剂量的恩丹西酮、胃复安及地塞米松进行止吐,并对其疗效进行了观察。结果显示:减量应用组与正规量应用组在止吐效果上无显著性差异(P>0.05),减量应用组止吐效果明显优于胃复安组(P<0.01).     

Prevention and Management of Postoperative Nausea and Vomiting in Adults

In early 2007, patients at our small community hospital's outpatient surgery center experienced postoperative nausea and postoperative nausea and vomiting (PONV) at a rate of 27% to 35%. Many record reviews and a written survey of nurses in the postanesthesia care unit and same day surgery center revealed that little or no risk assessment and no consistent prophylaxis or treatment were in use by nurses, physicians, or anesthesia care providers.After a review of the literature and discussions with anesthesia care providers, we developed and put into practice a risk assessment tool and perioperative care path. A formal evaluation to assess the effectiveness of the plan was performed one year after implementation. We found that the rates of PONV had decreased to 16%. AORN J 90 (September 2009) 391-413. © AORN, Inc, 2009.     

Effects of Ondansetron and Granisetron on Postoperative Nausea and Vomiting in Adult Patients Undergoing Laparoscopic Cholecystectomy: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

Background: Postoperative nausea and vomiting (PONV) are common and potentially distressing adverse events (AEs) associated with surgery and anesthesia. In patients undergoing laparoscopic cholecystectomy (LC) without antiemetic prophylaxis, the incidence of PONV can be as high as 72%.Objective: The aim of this study was to investigate the prophylactic antiemetic effects of ondansetron and granisetron in patients undergoing LC when these agents are administered before the end of surgery.Methods: Patients classified by the American Society of Anesthesiologist's physical status as I or II who were scheduled for elective LC were included in this randomized, double-blind, placebo-controlled study. Anesthesia was induced with thiopental 5 mg/kg and fentanyl 2 μg/kg, and was maintained with isoflurane 1% to 3% in 50% oxygen and 50% nitrous oxide and fentanyl as needed. Approximately 20 to 30 minutes before the end of the surgery, the patients randomly received either IV ondansetron 100 μg/kg (group O), IV granisetron 40 μg/kg (group G), or normal saline (group P). Plasma levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were determined preoperatively and 24 hours postoperatively. The patients were observed for 24 hours for PONV and other possible AEs. Postoperative pain intensity was determined using a 10-cm visual analogue scale. Four-point satisfaction scores were determined at 24 hours.Results: Ninety patients (69 women, 21 men) participated in the study. Demographic characteristics and operative data (duration of surgery and anesthesia and amount of intraoperative fentanyl) were similar in the 3 groups. The only AE reported by patients during the 24-hour observation period was nonsevere headache. The number of patients experiencing headache was similar in group P, group O, and group G (10 [33%] patients, 6 [20%], and 10 [33%], respectively). No significant changes were found in presurgical and postsurgical plasma levels of ALT and AST in any group. The mean (SD) satisfaction scores in group O and group G (3.0 [0.4] and 3.0 [0.6], respectively) were significantly higher than those in group P (2.5 [0.5]; both, P < 0.01). Immediately after surgery (period 0), significantly more patients in the placebo group (21 [70%]) experienced PONV compared with those in the ondansetron group (9 [30%]; P < 0.05) and the granisetron group (7 [23%]; P < 0.01). During the 24-hour observation period, a significantly greater number of patients in group P (18 [60%]) required a single dose of a rescue antiemetic drug compared with those in groups O and G (9 [30%] and 6 [20%], respectively; both, P < 0.01).Conclusions: Patients administered ondansetron 100 μg/kg or granisetron 40 μg/kg 20 to 30 minutes before the end of LC had significantly higher PONV control during the 24-hour postoperative observation period than patients receiving placebo. However, there were no significant differences between the active treatment groups in the incidence of PONV, patient satisfaction, or AEs.     

芳香疗法预防肿瘤患者化疗后恶心及呕吐的系统评价

目的评价芳香疗法对肿瘤患者化疗后恶心、呕吐的预防效果。方法检索数据库包括PubMed、WebofScience、Cochrane Library、Embase、CINAHL、知网、维普、万方和中国生物医学文献数据库,检索时限为从建库至2019年7月17日,收集芳香疗法预防肿瘤患者化疗后恶心、呕吐的随机对照试验,评价和提取信息后,采用RevMan5.3软件进行分析。结果共纳入10篇文献,共计1267例患者,按评估量表的种类分别进行Meta分析。在芳香疗法预防急性恶心的效果分析中,以视觉模拟评分量表(visual analogue scale,VAS)为结局指标的分析结果为[MD=-7.26,95%CI(-13.22,-1.31),P=0.02];以恶心、呕吐、干呕评分为结局指标的分析结果为[MD=-1.05,95%CI(-1.55,-0.55),P<0.0001];以急性恶心的发生率为结局指标的分析结果为[RR=0.69,95%CI(0.52,0.91),P=0.009]。芳香疗法预防急性干呕效果的分析结果为[MD=-0.59,95%CI(-0.97,-0.21),P=0.002],预防延迟性干呕效果的分析结果为[MD=-0.93,95%CI(-1.54,-0.31)=0.003]。结论芳香疗法对化疗后急性恶心、急性干呕及延迟性干呕的预防效果显著优于对照组,对其他时期恶心、呕吐的预防效果仍需要进一步验证。     

盐酸托烷司琼治疗顺铂引发恶心呕吐的疗效与安全性评价

【目的】比较国产盐酸托烷司琼和国产盐酸格拉司琼在治疗顺铂所引起的食欲减退、恶心、呕吐反应的疗效及安全性。【方法】采用随机、双盲、对照的方法将48例接受含顺铂化疗方案的恶性肿瘤患者分为两组进行研究,于化疗前1d开始给予盐酸托烷司琼(5mg/次,1次/d)或格拉司琼(3mg/次,1次/d),连用7d,同时观察患者食欲减退、恶心、呕吐等不良反应以及相关安全指标。【结果】国产盐酸托烷司琼和国产盐酸格拉司琼在治疗顺铂引起的食欲减退、恶心、呕吐反应方面以及安全性指标检测方面均无显著性差异(P>0.05)。【结论】国产盐酸托烷司琼治疗顺铂引起的食欲减退、恶心、呕吐反应的疗效和用药安全性与国产盐酸格拉司琼相当。