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。     

Incidence and Risk Factors of Postoperative Nausea and Vomiting in Patients with Fentanyl-Based Intravenous Patient-Controlled Analgesia and Single Antiemetic Prophylaxis

Purpose

We evaluated the incidence and risk factors of postoperative nausea and vomiting (PONV) in patients with fentanyl-based intravenous patient-controlled analgesia (IV-PCA) and single antiemetic prophylaxis of 5-hydroxytryptamine type 3 (5 HT₃)-receptor antagonist after the general anesthesia.

Materials and Methods

In this retrospective study, incidence and risk factors for PONV were evaluated with fentanyl IV-PCA during postoperative 48 hours after various surgeries.

Results

Four hundred-forty patients (23%) of 1878 had showed PONV. PCA was discontinued temporarily in 268 patients (14%), mostly due to PONV (88% of 268 patients). In multivariate analysis, female, non-smoker, history of motion sickness or PONV, long duration of anesthesia (>180 min), use of desflurane and intraoperative remifentanil infusion were independent risk factors for PONV. If one, two, three, four, five, or six of these risk factors were present, the incidences of PONV were 18%, 19%, 22%, 31%, 42%, or 50%. Laparoscopic surgery and higher dose of fentanyl were not risk factors for PONV.

Conclusion

Despite antiemetic prophylaxis with 5 HT₃-receptor antagonist, 23% of patients with fentanyl-based IV-PCA after general anesthesia showed PONV. Long duration of anesthesia and use of desflurane were identified as risk factors, in addition to risk factors of Apfel''s score (female, non-smoker, history of motion sickness or PONV). Also, intraoperative remifentanil infusion was risk factor independent of postoperative opioid use. As the incidence of PONV was up to 50% according to the number of risk factors, risk-adapted, multimodal or combination therapy should be applied.     

盐酸帕洛诺司琼预防硬膜外自控镇痛所致恶心呕吐的分析

【摘要】　目的 观察盐酸帕洛诺司琼预防术后硬膜外腔自控镇痛引起恶心呕吐副作用的效果。方法 选取择期硬膜外麻醉下开腹胆囊切除术后施行硬膜外腔自控镇痛(PCEA)的患者60例,PCEA采用吗啡6 mg+0.125%布比卡因混合液(100 mL)。将患者分为盐酸帕洛诺司琼组,氟哌啶组和对照组(每20例),在术前静脉给予盐酸帕洛诺司琼0.25 mg,氟哌啶2.5 mg和生理盐水100 mL。术后记录使用PCEA镇痛期间的恶心例数及其严重程度;呕吐例数及次数;出现呕吐后给予胃复安,非那根,地塞米松等药物止吐的控制率。结果 对照组13例出现Ⅰ~Ⅲ级恶心呕吐的不良反应,盐酸帕洛诺司琼组患者1例1级恶心呕吐的发生,与其他两组相比P<0.001;氟哌啶组出现5例Ⅰ~Ⅱ级恶心呕吐的,与对照组相比P=0.022。结论 术前预防性给予盐酸帕洛诺司琼可显著降低胆囊切除术后PCEA引起恶心呕吐副作用的发生。     

Postoperative nausea and vomiting prophylaxis: The efficacy of a novel antiemetic drug (palonosetron) combined with dexamethasone

BackgroundPalonosetron is a new, potent, and long-acting 5HT3-receptors antagonist that had been approved by the FDA for use in postoperative nausea and vomiting (PONV) prophylaxis. This study is designed to evaluate its efficacy combined with dexamethasone in PONV prophylaxis in highrisk patients scheduled for laparoscopic surgeries.MethodsIn this double-blind, active-controlled study, 150 patients aged 20–55 years, ASA I–II, and with Apfel’s PONV score 2–4 were equally randomized to receive dexamethasone 8 mg before anesthesia induction and saline 30 min before the end of surgery (group D + S), dexamethasone 8 mg before anesthesia induction and metoclopramide 25 mg 30 min before the end of surgery (group D + M), or dexamethasone 8 mg combined with palonosetron 0.075 mg before anesthesia induction and saline 30 min before the end of surgery (group D + P). Incidences of early and late PONV, complete response, adverse events from antiemetics used, and overall patients’ satisfaction were recorded.ResultsThe incidence of PONV was comparable in the three groups 0–6 h postoperatively. Palonosetron–dexamethasone and dexamethasone–metoclopramide combination therapies significantly reduced the incidence of PONV at 6–12 h postoperatively compared to dexamethasone monotherapy (12% and 16%, vs. 36%, respectively, with P < 0.05). Moreover, palonosetron–dexamethasone combination therapy significantly reduced the incidence of PONV at 12–24 h postoperatively compared to both dexamethasone monotherapy (16% vs. 48%, P < 0.01), and dexamethasone–metoclopramide combination therapy (16% vs. 40%, P < 0.05). The incidence of adverse drug effects was comparable in the three groups. The overall patients’ satisfaction was significantly higher in palonosetron–dexamethasone combination therapy compared to other groups.ConclusionPalonosetron–dexamethasone combination is effective and safe in PONV (early and late) prophylaxis in high-risk patients undergoing laparoscopic surgeries with known high-risk of PONV.     

防治术后恶心呕吐的研究进展

背景 术后恶心呕吐(postoperative nausea and vomiting,PONV)是麻醉手术后最常见的并发症之一,其发生率可高达30％.虽然国际上已公布了防治PONV共识和指南,但尚存在缺陷的PONV预测模型和复杂的防治策略成为临床防治PONV最大的障碍. 目的 探究在临床工作中防治PONV的主要障碍,为临床防治PONV工作提供更有效的途径. 内容 尚存在缺陷的PONV预测模型和复杂的防治策略是临床防治PONV最大的障碍,多模式防治PONV是一种简单、有效的预防PONV发生的方法. 趋向 多模式防治PONV更容易被临床麻醉医生接受和应用,新型的抗PONV药物和传统经典的抗呕吐药物为临床多模式防治提供了更大的选择空间.     

Review of evidence for the use of steroids in orthognathic surgery

Primarily, steroids are used routinely in orthognathic surgery to reduce swelling, but there is no nationally accepted regimen for the use of glucocorticoids in the UK. This article examines the evidence base for the use of steroids to reduce swelling, nausea, vomiting, and pain, and looks at evidence of the ratio of risks:benefits in orthognathic surgery and related publications. Evidence supports their use preoperatively, but the timing of this and their postoperative use may be contentious. The current regimens are associated with little morbidity and low cost. A well designed multi-centre study whose design would allow objective measures of swelling is required to resolve the areas of debate.     

Guideline for the Treatment of Breakthrough and the Prevention of Refractory Chemotherapy‐Induced Nausea and Vomiting in Children With Cancer

This clinical practice guideline provides an approach to the treatment of breakthrough chemotherapy‐induced nausea and vomiting (CINV) and the prevention of refractory CINV in children. It was developed by an international, interprofessional panel and is based on systematic literature reviews. Evidence‐based interventions for the treatment of breakthrough and prophylaxis of refractory CINV are recommended. Gaps in the evidence used to support the recommendations made in this clinical practice guideline were identified. The contribution of these recommendations to breakthrough and refractory CINV control in children requires prospective evaluation.