健脾和胃降逆止呕中药内服加穴位贴敷治疗妊娠恶阻脾胃虚弱证的临床研究

【目的】观察健脾和胃降逆止呕中药穴位贴敷治疗妊娠恶阻的临床疗效。【方法】将122例妊娠恶阻脾胃虚弱证患者随机分为观察组63例和对照组59例,对照组2例中途退出,最终纳入57例。对照组采用健脾和胃降逆止呕中药内服、静脉输液、饮食起居护理与情志调护,观察组在对照组治疗的基础上加用健脾和胃降逆止呕中药穴位贴敷。每日1次,4d为1个疗程,连续治疗2个疗程。观察2组妊娠恶阻临床症状的改善情况,比较2组临床疗效,并评价其安全性。【结果】（1）观察组总有效率为96.8%,显著优于对照组的71.9%（P＜0.01）;（2）观察组呕吐症状消失所需时间显著少于对照组（P＜0.01）;（3）治疗过程中,2组均无明显不良反应情况发生。【结论】健脾和胃降逆止呕中药穴位贴敷可显著提高妊娠恶阻的临床疗效,联合中药内服、静脉输液、饮食起居护理与情志调护可达最佳治疗效果。     

盐酸格拉司琼预防神经外科术后恶心呕吐的观察

目的观察盐酸格拉司琼术中静脉注射预防神经外科手术后恶心呕吐的效果。方法选择神经外科手术患者40例,随机分为两组,观察组(20例)静脉注射盐酸格拉司琼3mg,对照组(20例)静脉注射生理盐水5mL,观察术后24h内恶心呕吐发生率及副反应。结果格拉司琼组术后恶心呕吐发生率(15%)明显少于生理盐水组(55%)。结论术中静脉注射盐酸格拉司琼可提早预防神经外科手术后恶心呕吐的发生。     

揿针联合托烷司琼对腹腔镜全子宫切除术后恶心呕吐及炎性因子的影响

目的 观察揿针联合托烷司琼对腹腔镜全子宫切除术后恶心呕吐（PONV）及炎性因子的影响。

方法 选择择期全麻下行腹腔镜全子宫切除手术患者90例,年龄25～60岁,BMI 18～28 kg/m²,ASA Ⅰ或Ⅱ级。采用随机数字表法将患者随机分为三组：托烷司琼组（A组）、揿针组（B组）和揿针组联合托烷司琼（C组）,每组30例。A组麻醉前30 min静脉推注托烷司琼5 mg;B组麻醉前30 min应用揿针刺激患者中脘、双侧内关、足三里穴,留针48 h;C组麻醉前30 min静脉推注托烷司琼5 mg,并应用揿针刺激患者中脘、双侧内关、足三里穴,留针48 h。记录术后6、12、24 h恶心呕吐严重程度评分、术后首次肛门排气和排便时间。分别在术前30 min和术后24 h抽取静脉血检测TNF-α和IL-6的浓度。

结果 与C组比较,术后6、12、24 h A组和B组恶心呕吐严重程度评分明显升高,术后24 h TNF-α和IL-6浓度明显升高（P＜0.05）。与A组比较,B组和C组术后首次肛门排气、排便时间明显缩短（P＜0.05）。

结论 揿针联合托烷司琼能够有效预防PONV的发生,改善胃肠功能,缓解免疫抑制,减轻术后炎症反应。     

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.     

刺激内关穴和足三里穴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)是术后最常见的并发症之一,可引起刀口裂开、水电解质紊乱等并发症.大量的研究成果表明针刺对PONV具有很好的预防作用. 目的 概述PONV的发生机制和危险因素,以及针刺内关穴(PC6)和足三里穴(ST36)对PONV防治作用的临床应用进展. 内容 针刺PC6和ST36可以减少PONV的发生及严重程度,也可以减轻患者术后的疼痛. 趋向 针刺PC6和ST36对PONV具有很好的疗效,而且其生理干扰小、无创、安全,可以被很好地应用于PONV的防治.     

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。     

Recent advances,trends and economic considerations in the risk assessment,prevention and treatment of postoperative nausea and vomiting

During the last two decades there have been considerable achievements regarding the management of postoperative nausea and vomiting (PONV). Due to the importance of these symptoms in the aim to streamline clinical processes and to improve patient satisfaction, the debate on the best strategies and also research that focuses on PONV continues. This review summarises the recent developments with respect to the management of PONV. Following a brief review on what is already known on the risk assessment, prevention and treatment of PONV, newer trends in the pharmacological prevention (dexamethasone, neurokinin-1 antagonists, multimodal prevention) will be discussed as well as new insights regarding the value of algorithms for the prevention of PONV. Further, pharmacogenetically based algorithms (according to the metaboliser status) as well as new treatment strategies (dexamethasone, multimodal treatment) will be covered. No drug so far can achieve a reduction of PONV of more than one third. Furthermore, all clinical studies consistently demonstrated that a combination treatment has a simple additive effect without any relevant interaction between different drugs or classes of drugs. The relative reduction of ～ 30% can also be expected from dexamethasone and it is likely that the substances presently in development and in an early clinical use (e.g., neurokinin-1 antagonists) will not represent the new panacea. However, they will probably replenish the existing antiemetic portfolio to better cope with high risk patients. Stratified prevention using pharmacogenetic knowledge is still in the early stages. Algorithms need to be customised to the local settings in order to prove efficient. Treatment remains a most important pillar and there is evidence that the principles of combining antiemetics to prolong effects and improve protection can be similarly applied to treatment. Recent developments in the area of PONV are more related to implementing the already existing evidence than based on the introduction of new molecules. New molecules replenish the pharmacological antiemetic portfolio, which is needed due to the limited efficacy of any single agent available so far. The new neurokinin-1 receptor antagonist, aprepitant, and the long lasting 5-HT₃ receptor antagonist palonosetron are the latest developments in this context. Treatment is most important and can also be regarded as a secondary prevention. Due to limited efficacy of single treatment interventions, combination therapy may gain more widespread use in the future.     

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.