经皮穴位电刺激对无痛胃肠镜检查后恶心呕吐的影响

目的 观察经皮穴位电刺激(TEAS)双侧足三里穴(ST36)、脾俞穴(BL20)及大陵穴(PC7)对预防无痛胃肠镜检查后恶心呕吐的影响。方法 选择行无痛胃肠镜检查患者159例,男72例,女87例,年龄25～64岁,BMI 18～28 kg/m²,ASAⅠ或Ⅱ级。采用随机数字表法将患者分为两组：TEAS组(T组,n=80)和对照组(C组,n=79)。麻醉诱导前T组给予TEAS双侧ST36、BL20及PC7 20 min; C组仅在相应穴位予电极片贴敷不行电刺激。两组麻醉诱导均采用丙泊酚1.5 mg/kg复合舒芬太尼0.1μg/kg,并根据检查中患者情况追加丙泊酚0.5 mg/kg。记录患者苏醒后30 min头晕、恶心呕吐发生情况。记录检查中最低HR、SBP、DBP和苏醒后30 min的SBP、DBP。记录患者、麻醉科医师满意情况及患者留观时间。结果 与C组比较,T组检查后恶心呕吐发生率明显降低(P<0.05),检查中最低SBP明显升高(P<0.05),患者和麻醉科医师满意度明显升高(P<0.05),留观时间明显缩短(P<0.05)。结论 经皮...     

术中胃减压对神经内镜经鼻颅底手术后恶心呕吐的影响

目的探讨术中胃减压对行神经内镜经鼻颅底手术患者手术后恶心呕吐(PONV)的影响。方法回顾性分析2019年1—8月在复旦大学附属华山医院神经外科接受神经内镜经鼻颅底手术的357例患者的临床资料。根据术中是否进行胃减压,分为胃减压组(146例)和对照组(211例)。比较两组的临床特征和术后24 h内PONV发生率的差异。对于包括胃减压在内的各因素对行神经内镜经鼻颅底手术患者PONV发生的影响,采用单因素和多因素logistic回归分析法探讨。结果所有患者术后24 h内的PONV发生率为11.8%(42/357)。胃减压组的女性比例[58.2%(85/146)对比46.4%(98/211),P=0.029]和Apfel评分为2~3分的比例[64.4%(94/146)对比50.2%(106/211),P=0.008]均高于对照组,而胃减压组PONV的发生率低于对照组[7.5%(11/146)对比14.7%(31/211),P=0.039]。单因素logistic回归分析结果提示,术中采用脂肪填塞修补脑脊液漏、术中采用黏膜瓣修补脑脊液漏、术中胃减压和术中失血量是神经内镜经鼻颅底手术患者PONV发生的影响因素(均P<0.05)。多因素logistic回归分析结果提示,术中胃减压(OR=0.397,95%CI:0.185~0.852,P=0.018)和术中失血量(OR=1.133,95%CI:1.026~1.250,P=0.013)为神经内镜经鼻颅底手术患者PONV发生的独立影响因素。结论实施术中胃减压可降低神经内镜经鼻颅底手术患者PONV的发生率。     

奥氮平联合昂丹司琼预防非小细胞肺癌化疗所致恶心呕吐的疗效观察

目的比较奥氮平联合昂丹司琼与单用昂丹司琼预防非小细胞肺癌（NSCLC）化疗所致恶心呕吐（CINV）的效果。方法84例NSCLC患者随机分为研究组（42例）及对照组（42例）,研究组和对照组均在化疗前30min给予静脉滴注昂丹司琼8mg,研究组自化疗第1天早晨开始I：1服奥氮平10mg,连用8d,评价化疗第1周期的止吐效果。结果研究组和对照组急性呕吐的发生率分别为33．33％（14／42）和54．76％（23／42）,差异有统计学意义,P〈0．05;迟发性呕吐的发生率分别为16．67％（7／42）和47．62％（20／42）,差异有统计学意义,P〈0．01。结论奥氮平联合昂丹司琼与单用昂丹司琼相比,奥氮平联合昂丹司琼对于预防NSCLC化疗所致恶心呕吐有更好的效果,尤其是对迟发型恶心呕吐效果更为显著。     

The benefit of bilateral inferior alveolar nerve block in managing postoperative nausea and vomiting (PONV) after mandibular osteotomy

IntroductionThe purpose of our study was to evaluate the benefit of bilateral inferior alveolar nerve block (BIANB) in managing postoperative pain, nausea and vomiting and opioid and antiemetic consumption in mandibular osteotomy.Material and methods51 patients operated for bilateral sagittal split osteotomy (BSSO) were included in this prospective randomized controlled, double-blind, superiority trial.In the first group (n = 25), standard protocol was applied (general anesthesia and postoperative multimodal analgesia). The second group (n = 26) received bilateral inferior alveolar nerve block anesthesia at the start of surgery in addition to routine protocol. Postoperative monitoring was conducted every 4 h over the first 24 h and targeted the following criteria: postoperative nausea and vomiting (PONV), the visual analog scale (VAS) for pain, consumption of morphine (cumulative dose) and antiemetic agents, need for removal of guiding elastics.ResultsPONV was significantly lower in the BIANB group (15.4 % VS 40 %, p = 0.049), as were mean VAS scores for pain (1 VS 1.57, p = 0.045) and medians of morphine bolus (8 [6–16] VS 5.5 [1–8], p = 0.033). We found no significant difference in incidence of guiding elastic removal, and antiemetic consumption.DiscussionThe use of BIANB in BSSO improved postoperative patient comfort in terms of PONV and pain. Furthermore, it led to a decrease in opioid consumption. In conclusion, it is an additional therapeutic means of improving patients' postoperative comfort.     

The efficacy and safety of palonosetron compared with granisetron in preventing highly emetogenic chemotherapy-induced vomiting in the Chinese cancer patients: a phase II, multicenter, randomized, double-blind, parallel, comparative clinical trial

PURPOSE: This clinical trial was conducted to evaluate the efficacy and safety of Palonosetron in preventing chemotherapy-induced vomiting (CIV) among the Chinese cancer patients. PATIENTS AND METHODS: Two hundred and forty patients were scheduled to be enrolled and randomized to receive a single intravenous dose of palonosetron 0.25 mg, or granisetron 3 mg, 30 min before receiving highly emetogenic chemotherapy. The primary efficacy endpoint was the complete response (CR) rate for acute CIV (during the 0-24-h interval after chemotherapy). Secondary endpoints included the CR rates for delayed CIV (more than 24 h after chemotherapy). RESULTS: Two hundred and eight patients were accrued and received study medication. CR rates for acute CIV were 82.69% for palonosetron and 72.12% for granisetron, which demonstrated that palonosetron was not inferior to granisetron in preventing acute CIV. Comparisons of CR rates for delayed CIV yielded no statistical difference between palonosetron and granisetron groups and did not reveal non-inferiority of palonosetron to granisetron. Adverse events were mostly mild to moderate, with quite low rates among the two groups. CONCLUSIONS: A single dose (0.25 mg) of palonosetron is not inferior to a single dose (3 mg) of granisetron in preventing CIV and possesses an acceptable safety profile in the Chinese population.     

托烷司琼不同时间给药预防术后恶心呕吐的临床观察

目的观察托烷司琼不同时间给药预防术后恶心呕吐的效果。方法将120例择期在全凭静脉麻醉下行腹腔镜胆囊切除术(LC)的病人随机分为3组,每组40例。A组病人麻醉诱导前静脉注射托烷司琼5mg;B组病人手术结束后静脉注射托烷司琼5mg;C组为不给托烷司琼及其他抗呕吐药物的对照组。观察并记录病人术后24h恶心呕吐的发生情况。结果A、B组术后恶心呕吐的发生率明显低于C组(P<0.05),其中A组发生率比B组更低(P<0.05)。结论托烷司琼术前和术后不同时间给药,均能有效减少病人术后恶心呕吐的发生,术前预防性用药效果更佳。     

芳香疗法缓解麻醉术后恶心呕吐的Meta分析

目的评价芳香疗法缓解麻醉术后恶心呕吐的效果,为临床护理提供参考。方法检索国内外相关数据库从建库至2017年12月纳入的麻醉术后采用芳香疗法的随机对照试验文献9篇,共计851例患者(芳香疗法组431例,对照组420例)。采用Cochrane协作网Revman5.1软件进行Meta分析。结果术后恶心呕吐VAS评分、术后恶心呕吐发生率,两组合并效应量比较,差异有统计学意义(均P<0.01)。结论芳香疗法缓解麻醉术后恶心呕吐具有良好的效果,推荐临床护理中应用。     

术后恶心呕吐相关基因多态性的研究现状

背景 术后恶心呕吐(postoperative nausea and vomiting,PONV)是临床上常见的并发症,受多种因素的影响.尽管有多种类型的止吐药物用于控制PONV的发生,但效果并不理想,且患者对药物的反应存在很大的差异性. 目的 探讨基因多态性对PONV发生的影响,为预防PONV提供预警作用. 内容 多种基因多态性与PONV的发生具有关联性,其中涉及对止吐药物疗效的影响. 趋向 目前已发现多个PONV的易感基因,期待根据基因分型进行个体化治疗以优化PONV的药物防治效果.     

托烷司琼联合长托宁预防吗啡硬膜外镇痛恶心、呕吐的临床研究

目的:观察托烷司琼术后经患者硬膜外自控镇痛(PECA)泵持续输注结合长托宁术前肌注对直肠癌术后吗啡PECA所致的恶心呕吐的影响。方法:选择硬膜外麻醉下行直肠癌手术患者120例随机均分为A、B、C三组,A组术前抗胆碱药采用阿托品,B、C组采用长托宁,术后PECA均采用吗啡,术毕A组不用止呕药,B组托烷司琼5mg于术毕单次静注,C组托烷司琼5mg加入PECA泵中持续泵入。镇痛方法采用连续输注,连续量为2 mL/h,自控量为0.5 mL/15min,PCEA药液为吗啡5mg+托烷司琼5 mg+布比卡因150 mg+生理盐水至100 mL。于连接PECA泵即刻,观察各组术后2,12,24和48 h镇痛评分(VAS);Ramsay镇静评分(RSS);恶心、呕吐例数;因严重恶心、呕吐而要求终止PCA的例数。结果:(1)术后各时间点的VAS评分无明显差异,(2)A组各时点RSS明显低于B、C组(P<0.01)。(3)术后恶心、呕吐例数及要求终止PCA的例数A组明显多于B组、C组(P<0.05,P<0.01),恶心、呕吐例数B组亦明显多于C组(P<0.05)。结论:托烷司琼术后经患者PECA泵持续输注结合长托宁术前肌注能明显减少直肠癌术后吗啡PECA所致的恶心、呕吐,且有较好的术后镇静效果。