耳穴磁疗联合止吐药多模式治疗甲状腺切除术患者术后恶心呕吐的疗效分析

目的:探讨耳穴磁疗对甲状腺切除术患者术后恶心、呕吐(postoperative nausea and vomiting,PONV)及伤口疼痛的治疗效果。方法:46例接受甲状腺手术的患者随机分为多模式组(M组)和单一模式组(S组),各23例。M组给予耳穴磁疗联合格拉司琼和地塞米松以预防PONV,S组仅给予格拉司琼和地塞米松。比较两组术后0~2h、2~6h、6~24h、0~24h的PONV发生率和术后视觉模拟疼痛评分(visual analogue scale,VAS)。结果:M组完成随访23例,S组完成随访20例,纳入研究。两组患者的一般资料、手术时间和麻醉时间差异均无统计学意义。两组患者既往PONV史、晕动病史及吸烟史差异无统计学意义。两组患者术中舒芬太尼使用量差异无统计学意义。M组术后0~2h、2~6h、6~24h、0~24h恶心发生率均低于S组(P0.05);M组术后0~2h和0~24h呕吐发生率低于S组(P0.05)。M组术后PONV管理满意度高于S组(P=0.004)。两组患者术后止吐药物使用率差异无统计学意义。M组术后2h和6hVAS评分均低于S组(P0.05);两组患者术后24hVAS评分差异无统计学意义。两组术后拔管时间、对指令有反应时间和24h恢复质量评分差异均无统计学意义。结论:与单一用药模式相比,耳穴磁疗联合止吐药的多模式治疗能显著降低甲状腺切除术患者PONV发生率,同时可减轻患者术后早期伤口疼痛。     

右美托咪定联合格拉司琼预防妇科腹腔镜手术术后恶心呕吐的临床观察

目的探讨右美托咪定联合格拉司琼预防妇科腹腔镜手术术后恶心呕吐的效果。方法60例腹腔镜手术患者随机分成诱导组（I组）、术毕组（EOS组）和格拉司琼组（G组）各20例。Ⅰ组于诱导前10min静脉泵注右美托咪定,EOS组于手术结束前30min静脉泵注相同剂量右美托咪定,所有患者手术结束前30min均静脉注射格拉司琼3mg。记录术毕至拔气管导管、听从指令时间,麻醉恢复期内患者呼吸抑制、躁动等不良反应发生情况,术后24h内恶心呕吐发生率及严重程度。结果Ⅰ组拔管时间、听从指令时间,术后0-1h、1-2h恶心呕吐评分,在麻醉后恢复室内止吐药给药人次数均小于EOS组和G组。EOS组术后0～1h、-2h恶心呕吐评分和在麻醉后恢复室内止吐药给药人次数均小于G组（P〈0．05）。EOS组和G组拔管时间、听从指令时间无明显差异（P〉0．05）。术后2-4h、4-12h、12-24h各组间恶心呕吐评分无明显差异（P〉0．05）。所有患者均未见麻醉恢复期内呼吸抑制、躁动等不良反应。结论右美托咪定联合格拉司琼预防妇科腹腔镜手术术后恶心呕吐效果较单用格拉司琼更好,诱导前10min使用为佳。     

洗胃后配合间歇胃肠减压治疗新生儿顽固性呕吐的疗效及安全性分析

目的：探讨洗胃后配合间歇胃肠减压对新生儿顽固性呕吐的治疗效果和安全性。方法：选取2008年9月-2012年12月本院确诊治疗的顽固性呕吐新生患儿136例,依据随机分配原则分为减压组和对照组各68例,对照组患儿给予常规综合治疗和温盐水洗胃治疗,减压组在此基础上给予间歇胃肠减压治疗,对比分析两组患儿的临床治疗效果、胃肠功能恢复和复发情况。结果：减压组患儿呕吐次数、胃肠功能恢复时间均明显低于对照组,体重恢复程度明显高于对照组,差异有统计学意义（P〈0.05）;减压组患儿总有效率明显高于对照组,差异有统计学意义（P〈0.05）;减压组患儿呕吐复发率低于对照组,差异有统计学意义（P〈0.05）;两组患儿均未出现慢性肠炎、坏死性肠炎等严重胃肠不良反应。结论：洗胃后配合间歇胃肠减压治疗可有效缓解新生儿顽固性呕吐症状,加快胃肠功能恢复,有助于新生患儿体重的恢复,降低呕吐复发的发生,且具有较高的安全性,值得临床进一步推广。     

诱导睡眠护理干预减轻顺铂化疗致呕吐的效果

目的观察诱导睡眠的护理干预对减轻癌症患者大剂量顺铂化疗致呕吐的效果。方法将118例癌症化疗患者随机分为观察组(60例)与对照组(58例),对照组接受常规化疗护理,观察组在常规化疗护理的基础上实施诱导睡眠的护理干预。结果观察组患者化疗期间呕吐程度显著轻于对照组(P<0.05)。结论诱导睡眠的护理干预可有效预防及减轻顺铂化疗所致呕吐程度,提高患者化疗期间的生活质量。     

盐酸帕洛诺司琼预防上腹部手术后硬膜外吗啡镇痛所致的恶心呕吐

目的 观察和评价帕洛诺司琼对上腹部手术后硬膜外吗啡镇痛引起的恶心呕吐的预防效果和安全性.方法 择期行上腹部手术并术后接受硬膜外吗啡镇痛患者60例,随机分为帕洛诺司琼组（P组）和托烷司琼组（T组）.手术结束前30 min,P组患者缓慢静注帕洛诺司琼0.25 mg,T组患者缓慢静注托烷司琼6 mg.观察记录两组患者术后24 h、48 h VAS及Ramsay评分、恶心呕吐的程度,计算恶心呕吐有效控制率.同时记录患者腹胀、头痛、椎体外系症状等不良反应.结果 两组患者术后24 h及48 h的VAS及Ramsay评分差异无统计学意义.P组患者术后24 h的恶心及呕吐有效控制率分别为80.0%和73.3%,T组分别为63.3%和60.0%;P组患者术后48 h的恶心及呕吐有效控制率分别为90.0%和93.3%,T组分别为66.6%和63.3%.两组患者术后24 h恶心、呕吐有效控制率差异无统计学意义.P组患者术后48 h恶心、呕吐有效控制率明显优于T组患者（P 〈 0.05）.帕洛诺司琼的不良反应主要为头痛.结论 腹部手术后24 h内,帕洛诺司琼预防吗啡硬膜外镇痛所致的恶心呕吐的效果与托烷司琼相当,但术后48 h预防恶心呕吐的效果优于托烷司琼,且不良反应发生率低,程度较轻,安全性好.     

Olanzapine for the Prevention of Chemotherapy-Induced Nausea and Vomiting in Patients Receiving Highly or Moderately Emetogenic Chemotherapy: A Randomized,Double-Blind,Placebo-Controlled Study

ContextChemotherapy-induced nausea and vomiting (CINV) can severely impair patients' quality of life (QOL). Psychotropics, especially olanzapine, have a strong antiemetic effect.ObjectivesTo determine whether olanzapine could reduce the frequency of CINV and improve patients' QOL during chemotherapy.MethodsThis was a randomized, double-blind, placebo-controlled trial. Forty-four patients scheduled to receive highly or moderately emetogenic chemotherapy were enrolled. All patients received a 5-hydroxytryptamine₃ receptor antagonist, steroid, and neurokinin-1 receptor antagonist. Patients were randomly assigned to take 5 mg/day of oral olanzapine (OL group, n = 22) or placebo (control group, n = 22) daily from the day before chemotherapy (Day 0) to Day 5. The primary endpoint was the rate of patients who achieved total control (no vomiting, no use of rescue medications, and maximum nausea of <5/100 mm on a visual analogue scale). The secondary endpoint was Functional Living Index-Emesis questionnaire score on Days 0 and 6.ResultsThe rate of patients achieving total control was significantly higher in the OL group (86% and 64% in acute and delayed phases, respectively) than in the control group (55% and 23%, P = 0.045, P = 0.014, respectively). Furthermore, the OL group experienced a better QOL than the control group, as reported on the Functional Living Index-Emesis questionnaire (P = 0.0004).ConclusionThe addition of 5 mg/day of oral olanzapine to standard therapy can reduce the frequency of CINV and improve QOL of patients receiving highly or moderately emetogenic chemotherapy.     

不同时机针刺经穴对直肠癌根治术患者术后恶心呕吐发生的影响:血浆胃泌素浓度的测定

目的 评价不同时机针刺经穴对直肠癌根治术患者术后恶心呕吐(PONV)发生的影响.方法 择期拟行直肠癌根治术患者130例,年龄40～59岁,性别不限,BMI 20 ～ 25 kg/m2,ASA分级Ⅰ～Ⅲ级,采用随机数字表法,将患者随机分为5组(n=25):空白对照组(Ⅰ组)、常规药物治疗组(Ⅱ组)、术前针刺组(Ⅲ组)、术中针刺组(Ⅳ组)、术后针刺组(V组).Ⅰ组不予任何PONV干预;Ⅱ组于手术结束前静脉注射格拉司琼3 mg;Ⅲ组于麻醉诱导前30 min针刺经穴;Ⅳ组于切皮时针刺经穴;Ⅴ组于术毕时针刺经穴.选取双侧内关穴、合谷穴、支沟穴、曲池穴,针刺时间均为30 min.于入室(T0)、切皮后1 h(T1)、术毕(T2)、术后24 h(T3)时采集外周静脉血样,测定血浆胃泌素浓度,记录术后2h内、2～6h、6～12h、12～24 h及24 h内PONV的发生情况.结果 与Ⅰ组比较,Ⅱ组和Ⅲ组术后2 h内及24 h内PONV发生率及T3时血浆胃泌素浓度降低(P＜0.05),Ⅳ组和Ⅴ组上述指标差异无统计学意义(P＞0.05).与Ⅱ组比较,Ⅲ组T3时血浆胃泌素浓度降低(P＜0.05),PONV的发生率差异无统计学意义(P＞0.05),Ⅳ组和Ⅴ组术后2h内及24h内PONV的发生率升高(P＜0.05).与Ⅲ组比较,Ⅳ组和Ⅴ组术后2h内及24h内PONY的发生率及T3时血浆胃泌素浓度升高(P＜0.05).Ⅳ组和Ⅴ组间各指标差异无统计学意义(P＞0.05).结论 术前针刺经穴可降低直肠癌根治术患者PONV的发生,且与常规药物防治效果近似,其机制与降低术后血浆胃泌素浓度有关.     

Effect of ketamine on intraoperative nausea and vomiting during elective caesarean section under spinal anaesthesia: A placebo-controlled prospective randomized double blinded study

PurposeThe well documented maternal and fetal safety following spinal anaesthesia in caesarean section (CS) makes it the preferred anaesthetic technique. Intraoperative nausea and vomiting in parturients subjected to CS under spinal anaesthesia is a major drawback of the technique. Post-spinal hypotension, the sympathetic blockade and associated relative vagal hyperactivity in addition to intraoperative visceral pain are the most important underlying factors behind the high rate of IONV during spinal anaesthesia. Ketamine has a unique sympathomimetic and vagolytic criteria that may help in reducing the incidence of IONV secondary to spinal-induced hypotension. This study was an attempt to evaluate the effect of ketamine on the IONV in parturients subjected to elective CS under spinal anaesthesia.Patients and methodsTwo hundred twenty-nine patients were randomly allocated into two equal groups: the ketamine group; in which 0.5 mg/kg was infused intravenously in 20 min and the placebo group; in which normal saline was infused. The two groups were given subarachnoid block with local anaesthetic hyperbaric 0.5% bupivacaine and intrathecal fentanyl.ResultsIV infusion of ketamine was associated with significant reduction in the incidence of intraoperative nausea and hypotensive episodes.ConclusionThis study demonstrated a beneficial effect of IV infusion of ketamine on IONV in parturients subjected to elective CS under spinal anaesthesia.