5-HT3受体拮抗剂的进展与临床应用评价

目的:对5-HL3受体拮抗剂的进展和临床应用进行进一步评价,以期为临床医师和药师提供参考.方法:通过对国内、外近期文献的收集整理.对5-HL受体拮抗荆进行分析与综述.结果与结论:5-HL受体拮抗剂的问世,使缓解由癌症化疗所致的呕吐已不再成为难题,但须遵循目前国内、外有关呕吐处理若干意见,达到治疗的规范化.     

Tachykinin NK1 receptor antagonists for the control of chemotherapy-induced nausea and vomiting

The treatment of neoplastic disease with chemotherapeutic cytotoxic drugs has long been associated with profound nausea and vomiting (emesis). This became the most feared side effect of this type of treatment and was so severe that some patients would withdraw from further treatment, thus jeopardising their clinical outcome and possibly life expectancy. The introduction of the 5-HT₃ receptor antagonists had a significant impact in this area, offering substantial reductions in emesis, largely through prophylactic treatment. Unfortunately, some forms of emesis were resistant to treatment with these drugs, so the search has continued to identify new chemical entities with a higher level of efficacy and a broader spectrum of activity. Data generated in animals has identified tachykinin NK₁ receptors as highly important in the emetic reflex and experimental evidence strongly supports NK₁ receptor antagonists as highly efficacious anti-emetic agents, with unparalleled broad spectrum activity. Several novel antagonists have recently entered clinical development and data are emerging to support their anti-emetic activity. This area continues to attract substantial medicinal chemical research effort. Most major pharmaceutical companies are seeking new matter through structural refinement of early leads or discovery of novel compounds from library screening. The scope of chemical lead matter has advanced from early piperidine and quinuclidines to a spectrum of templates that improve expectations for a well-tolerated therapeutic agent. Recent success in combining 5-HT₃ and NK₁ antagonists in emesis treatment is expected to greatly advance clinical outcomes with newer and safer agents.     

中西医结合治疗新生儿呕吐51例

目的:观察中西医结合治疗新生儿呕吐的临床疗效。方法:选择2012年4月—2014年4月本院收治的102例患儿,随机分为观察组与对照组,每组各51例。对照组行西医常规治疗,观察组在对照组的基础上服用生大黄水,比较两组患儿的临床疗效。结果:观察组有效率为90.20%,对照组有效率为60.78%,两组有效率比较,差异具有统计学意义(P0.05)。观察组患儿呕吐停止时间与鼻饲停止时间分别为(51.67±30.02)h、(63.32±31.30)h,均显著优于对照组患儿的(74.35±30.22)h、(85.32±31.28)h,差异均有统计学意义(P0.05)。结论:中西医结合治疗新生儿呕吐可明显提高临床疗效,缩短疗程。     

姜辣素对顺铂致大鼠异嗜模型行为的作用

目的研究姜辣素对顺铂所致大鼠异嗜高岭土模型的影响并观察外周和中枢c-fos蛋白的表达。方法大鼠随机分成正常对照组、模型组、昂丹司琼+地塞米松组、阿瑞吡坦+地塞米松组、姜辣素组及姜辣素+地塞米松组,24 h及72 h记录各组摄食量及食高岭土量。免疫组化方法观察脑和回肠中c-fos蛋白的表达。结果 24 h内,姜辣素组、姜辣素+地塞米松组摄食量增加,啃食高岭土量减少,姜辣素组与姜辣素+地塞米松组相比摄食量增加(P<0.05);48～72h内,姜辣素组食高岭土量减少(P<0.05)。姜辣素组、姜辣素+地塞米松组c-fos阳性表达颗粒的灰度值明显高于模型组(P<0.05)。结论姜辣素可促进摄食并可抑制顺铂所致的大鼠异嗜高岭土行为,地塞米松对姜辣素无辅助作用。     

美国妇产科医师学会“妊娠期恶心呕吐指南2015版”要点解读

正妊娠期恶心、呕吐是一种影响孕妇及其胎儿健康的常见疾病。早孕期轻度的恶心、呕吐是一种生理性反应;中度(和)或重度或病情迁延(和)或加重的妊娠期恶心、呕吐,会严重影响孕妇的生活质量,乃至危及母胎生命安全,需及时诊治。美国妇产科医师学会(ACOG)近年来针对妊娠期呕吐,颁布了一系列指南,并提出一些与妊娠期恶心、呕吐诊治有关的新观念及循证医学证据。本文对2015年颁布的第153号《妊娠期恶心     

Approach to the baby with bilious vomiting

Bilious vomiting in the term neonate is a cardinal feature of a critical condition – intestinal malrotation – and may herald an impending abdominal crisis. It may also be due to a number of other surgical and medical causes, and there is a significant healthcare burden in excluding malrotation in the neonatal population. Health professionals caring for neonates need a sound knowledge of the assessment, diagnosis, and management of the neonate presenting with bilious vomiting. This review discusses the approach and immediate management, discusses uncertainties in evidence and offers practical advice for healthcare professionals who are faced with a baby with bilious vomiting.     

耳穴贴压用于预防乳腺纤维瘤摘除术后呕吐疗效观察

目的评价耳穴贴压预防喉罩辅助通气全凭静脉麻醉下乳腺纤维瘤摘除术患者术后呕吐的效果。方法选择年龄40岁以下、ASA评分Ⅰ级、乳腺纤维瘤摘除术患者80例,随机分为A组和B组,每组40例。A组在麻醉复苏阶段患者唤醒后于耳廓相应穴位寻找敏感点,采用耳穴贴压治疗。B组不予任何处理。术后不同时间随访观察两组患者恶心、呕吐次数及BP、HR、SpO2等生命体征变化。结果两组患者术后4 h和24 h BP、HR、SpO2比较,差异均无统计学意义(P0.05);A组患者术后恶心、呕吐发生率低于B组,两组比较差异具有统计学意义(P0.01)。结论耳穴贴压具有良好的预防全凭静脉麻醉下乳腺纤维瘤摘除术患者术后恶心、呕吐的作用,且无明显不良反应。     

雷莫司琼预防急诊剖宫产术中恶心呕吐的临床效果

选择急诊剖宫产手术患者206例,随机分成2组:雷莫司琼组(钳夹脐带后静脉给予雷莫司琼0.3 mg,103例),对照组(钳夹脐带后静脉给予等容量生理盐水,103例),分别观察并记录剖宫产娩出胎儿后恶心、呕吐的发生率,术中追加呕吐药的几率,低血压发生率,疼痛评分及其他不良反应发生率.雷莫司琼组患者恶心、呕吐发生率为10.7％(11例),对照组患者发生率为28.2％(29例),差异有统计学意义(P＜0.01),两组术中低血压比较差异无统计学意义(P＞0.05).雷莫司琼能降低急诊剖宫产术中患者恶心呕吐发生率.