Tropisetron versus metoclopramide for the treatment of nausea and vomiting in the emergency department: A randomized,double‐blinded,clinical trial

Aim: We aimed to compare the relative efficacy of tropisetron and metoclopramide in treating nausea/vomiting in undifferentiated ED patients. Methods: We undertook a randomized, double‐blinded, clinical trial. Adult patients requiring treatment for nausea/vomiting were randomly assigned to either tropisetron (5 mg) or metoclopramide (10 mg), by i.v. bolus. The primary end‐point was incidence of vomiting. Secondary end‐points were decrease in nausea score from baseline (0–100 VAS), the requirement of ‘rescue’ anti‐emetics, ongoing nausea over 48 h and side‐effects. Results: Fifty patients were enrolled in each group. The demographic variables, presenting complaints and nausea scores at baseline did not differ (P > 0.05). By 180 min, two (4.0%) and nine (18.0%) patients had vomited in the tropisetron and metoclopramide groups respectively (difference 14.0%, 95% CI 0.1–28.0, P= 0.05). Also, there were two and 20 episodes of vomiting respectively. Vomiting rates were 0.02 and 0.16 episodes/person‐hour (difference 0.14 episodes/person‐hour, 95% CI 0.07–0.21, P < 0.001) respectively. By 60 min and thereafter, the decrease in nausea score from baseline was greater (although not significantly so) in the tropisetron group. At 180 min, the decreases were 47.9 mm and 37.0 mm respectively (difference 10.9 mm, 95% CI ?0.7–22.6). Five (10.0%) and 13 (26.0%) patients required a rescue anti‐emetic respectively (difference 16.0%, 95% CI ?0.7–32.7, P= 0.07). Of patients followed up, 13/47 (27.7%) and 20/49 (40.8%) had ongoing nausea respectively (difference 13.2%, 95% CI ?7.7–34.0, P= 0.25). The tropisetron group had less akathisia. Conclusions: Tropisetron was associated with a significantly lower vomiting rate and shows promise as an alternative anti‐emetic in the ED.     

格拉司琼与恩丹西酮防治食管癌术后化疗所致恶心呕吐的疗效对比

目的：比较格拉司琼与恩丹西酮防治食管癌术后患者化疗引起恶心、呕吐的作用及毒副反应。方法：回顾性研究439例食管癌术后化疗患者的临床资料，比较格拉司琼和恩丹西酮的治疗效果及毒副反应。结果：吻合VI位于颈部患者比位于胸内患者易发生恶心、呕吐。格拉司琼对化疗后急性（1d）恶心、呕吐有效率为81．6％，延迟性恶心呕吐（2—5d）的有效率分别为75．0％、64．2％、60．8％、56．1％。恩丹西酮对化疗后急性恶心、呕吐有效率为71．4％，延迟性恶心、呕吐的有效率分别为68．7％、57．7％、52．0％、47．1％，两组差异显著（P〈0．05），格拉司琼治疗效果优于恩丹西酮。两者不良反应基本相似。结论：格拉司琼对于防治食管癌术后患者化疗所致恶心、呕吐效果较好。     

枢星防治曲马多术后镇痛患者恶心呕吐的研究

目的观察枢星(格拉司琼)不同给药模式对曲马多经静脉自控术后镇痛(PCIA)时恶心呕吐及血浆胃动素水平的影响。方法54例择期子宫切除术患者,术后行曲马多PCIA。按枢星给药模式不同分成3组,Ⅰ组为枢星3 mg加入曲马多镇痛泵中;Ⅱ组为枢星3 mg在给曲马多负荷量前5 min缓慢静注;Ⅲ组为单次静注枢星3 mg,并在镇痛泵中加枢星3 mg。分别测定入室、术毕、术后6、24、42 h血浆胃动素水平,并观察恶心、呕吐程度及发生率。结果Ⅰ组有8例发生Ⅱ~Ⅳ级恶心、呕吐,发生率为44.4%,Ⅱ组为3例,Ⅲ组为2例,分别为16.7%和11.1%。从入室到术毕胃动素浓度增高,Ⅰ组术后仍维持较高水平,Ⅱ、Ⅲ组术后6 h低于术毕水平(P<0.05);同时Ⅱ、Ⅲ组在术后6 h2、4 h时低于Ⅰ组(P<0.05)。结论应用枢星防治曲马多所致恶心呕吐时,须使用负荷量,且其作用与抑制血浆胃动素的合成及分泌有关。     

异丙酚在妇科腹腔镜手术中预防恶心呕吐的疗效观察

目的评价异丙酚预防妇科腹腔镜手术术后恶心呕吐的效果。本研究通过对70例择期腹腔镜下妇科手术患者的观察,了解其对术后恶心呕吐的预防作用。方法70例ASAI~II级择期腹腔镜下妇科手术患者,随机分为实验组和对照组,实验组在麻醉苏醒后静脉注入异丙酚0.4mg/kg,对照组使用生理盐水2ml。观察麻醉苏醒后24h内两组患者恶心呕吐的发生率。结果实验组在麻醉清醒后24h内恶心呕吐发生率(54.3%)明显低于对照组(74.3%),P<0.05。结论亚催眠量的异丙酚用于预防术后恶心呕吐有一定的疗效。     

盐酸伊立替康的不良反应及其预防处理

伊立替康(irinotecan,CPT-11)是喜树碱的半合成衍生物,是选择性拓扑异构酶Ⅰ抑制剂,本品及其体内代谢物SN-38可诱导单链DNA损伤,从而阻断DNA复制,产生细胞毒作用。CPT-11于1998年获FDA批准用于标准化疗方案治疗后转移性结肠直肠癌复发和恶化的二线治疗;于2000年3月获FDA批准联合氟尿嘧啶(5-FU)和亚叶酸钙(CF)用于转移性结肠直肠癌的一线治疗。本品单药有效率在18%左右,联合5-FU和CF的有效率约为50%。CPT-11主要不良反应有迟发性腹泻、恶心、呕吐、中性粒细胞减少症、急性胆碱能综合征等,现就其不良反应的表现类型及预防处理方法进行概述。     

呕必宁对顺铂所致脑组织5-HT含量变化的影响

目的：探讨中药复方呕必宁防治化疗药诱发呕吐的中枢机制。方法：应用行为学与分子生物学的方法，比较对照组、NS组、中药组实验动物静脉注射DDP前后，动物呕吐反应，血、脑脊液中DDP浓度，脑脊液、脑组织中的5-HT、5-HIAA含量变化。结果：注射DDP后与NS组比较，中药组猫的呕吐率下降；与此同时脑脊液中DDP浓度明显低于NS组、脑脊液及脑组织中5-HT和5-HIAA浓度较NS组显著降低。结论：呕必宁对DDP所致呕吐反应具有防治作用，其机制可能与降低猫脑脊液中DDP的浓度，降低脑脊液、脑组织中5-HT、5-HIAA含量有关。     

吐法源流与应用研究

探讨中医吐法理论源流及其形成发展历程,归纳了古今吐法临床应用的适应病证,认为病变部位在中脘以上,以胸脘为主,下至胃腑上至头面,诸凡痰涎、宿食、酒积、瘀血、热毒等有形实邪留滞人体上部,形成实证,均可考虑用吐法治疗。同时指出临床运用吐法时,应注意因人而宜、急缓分用、中病即止、不可尽剂、吐后调摄、医患配合,方可取得理想的治疗效果。     

Comparison of cyclizine and ondansetron for the prevention of postoperative nausea and vomiting in laparoscopic day-case gynaecological surgery

Seventy-four patients undergoing laparoscopic gynaecological surgery were randomly allocated to two groups receiving cyclizine 50 mg or ondansetron 4 mg at induction of anaesthesia. Anaesthetic and postoperative analgesia regimens were standardised. Approximately half of the patients in each group experienced some degree of postoperative nausea and vomiting (cyclizine, 56%; ondansetron, 54%). There was no difference between groups in respect of pre- and postdischarge incidence. Mean (SD) time to eye opening was significantly prolonged in the cyclizine group [10 (4) min vs. 8 (2) min; p < 0.001], but this had no influence on discharge times. Cyclizine and ondansetron appear equally effective in preventing postoperative nausea and vomiting but the 10-fold price differential favours cyclizine.     

The value of risks scores for predicting postoperative nausea and vomiting when used to compare patient group in a randomised controlled trial

Whilst conducting a randomised controlled trial into the effects of combination anti-emetics, we endeavoured to confirm that our patient groups were matched using the predictive scoring systems for postoperative nausea and vomiting (PONV) and postoperative vomiting (POV) reported in the literature. One hundred and seventy-seven female patients attending for day case gynaecological surgery were studied and their individual risks of PONV and POV were calculated using four predictive models for PONV and two predictive models for POV. The scoring systems were then evaluated to see if agreement existed between them using the method described by Bland and Altman. Bias and 95% limits of agreement were calculated for each combination. Agreement between scoring systems was poor. As the scoring systems gave widely divergent predictions, we concluded that the predictive risk for PONV or POV would be dependent upon the scoring system chosen, thus limiting their usefulness in this role.