按摩及穴位埋针预防CT增强扫描时恶心呕吐的疗效观察

目的 探讨按摩及穴位埋针对预防CT增强扫描时恶心、呕吐的影响.方法 将300例CT增强扫描检查的患者按检查顺序分成观察组和对照组各150例.对照组在CT增强扫描前4～6 h禁食,观察组在常规禁食的基础上于检查前30 min再行按摩及穴位埋针.比较两组CT增强扫描时恶心、呕吐的情况及CT片的图像质量.结果 观察组恶心、呕吐发生率及CT片图像伪影发生率明显低于对照组(P＜0.01).结论 按摩及穴位埋针可预防CT增强扫描时恶心、呕吐症状,提高CT片图像质量,减轻患者痛苦.     

温胆汤防治化疗致恶心呕吐40例

[目的]观察温胆汤防治化疗所致恶心、呕吐消化道反应的疗效。[方法]患者随机分两组,治疗组40例用温胆汤联合化疗方案;对照组40例,用化疗方案的同时给予盐酸恩丹西酮注射液。[结果]治疗组比对照组在恶心、呕吐消化道反应明显少（P〈0.05）。[结论]温胆汤可减少肿瘤患者化疗的消化道反应。     

Combination of symptoms,syndrome and disease: Treatment of refractory diabetic gastroparesis

AIM: To assess effect of combination of symptoms, syndrome and disease on treatment of diabetic gastroparesis with severe nausea and vomiting.METHODS: Professor Tong Xiaolin’s clinical electronic medical records of patients who were treated between January 1, 2006 and October 1, 2012 were used as a database. Patients who met the inclusion criteria were enrolled. General information (name, sex and age), symptoms and blood glucose levels were obtained from the clinic electronic medical record, which was supplemented by a telephone interview. The patient-rated Gastroparesis Cardinal Symptom Index (GCSI) was used to evaluate the severity of the symptoms of gastroparesis. The effects of the treatment were assessed by the change in the severity of the symptoms of gastroparesis and the change in blood glucose between the baseline levels and the post-treatment levels at 1, 2, 4, 8 and 12 wk.RESULTS: Forty-five patients had a mean GCSI nausea and vomiting severity score of 4.21 ± 0.67 and a total GCSI score of 2.77 ± 0.63 before treatment. There was a significant improvement in the nausea and vomiting score at every return visit compared with the baseline score (1 wk: 3.02 ± 1.04 vs 4.18 ± 0.71, P < 0.001; 2 wk: 2.32 ± 1.25 vs 4.16 ± 0.73, P < 0.001; 4 wk: 2.12 ± 1.26 vs 4.12 ± 0.73, P < 0.001; 8 wk: 1.79 ± 1.09 vs 4.24 ± 0.77, P < 0.001; 12 wk: 0.69 ± 0.92 vs 4.25 ± 0.70, P < 0.001). Twenty-five of the 45 patients had complete resolution of vomiting during the observation period (mean time to resolution was 37.9 ± 27.3 d). The postprandial fullness and early satiety subscale, bloating subscale and total GCSI scores were also improved. Finally, the blood glucose levels improved after treatment, although the change was not significant.CONCLUSION: Use of the combination of symptoms, syndrome and disease to treat diabetic gastroparesis with refractory nausea and vomiting may be a new treatment option.     

神经外科麻醉后恢复期常见病症及处理

目的 观察进入神经外科麻醉后恢复室(NPACU)患者病症的发生率和治疗特点,确保患者麻醉后恢复期的安全.方法 统计我院收治神经外科术后患者412人次.患者入室后严密监测神志、血压、心率、血氧饱和度等生命体征,持续吸氧并进行改良Aldrete评分.在NPACU停留期间监测有无呼吸道梗阻、通气不足、恶心、呕吐、疼痛、寒颤等麻醉苏醒期病症的发生,并进行相应的治疗.改良Aldrete评分达到9分以上患者转出NPACU.结果 神经外科术后患者NPACU停留时间为2-3 h.63%患者在NPACU期间发生麻醉苏醒期相关病症.其中,疼痛发生率达21%,高血压、恶心、呕吐、躁动谵妄分别为13%、12%、9%、8%,呼吸道梗阻低氧血症、寒颤、心律失常发生率分别为5%、5%、4%,而低血压、苏醒延迟发生率很低.所有患者转出NPACU时改良Aldrete评分均在9～10分.结论 NPACU对于保证患者围术期的安全,及时处理麻醉后病症,有效避免相关病症造成的严重后果,提高神经外科患者麻醉苏醒质量具有重要意义.     

舒必利防治非顺铂化疗所致迟发性恶心呕吐的临床观察

目的：探讨舒必利预防／控制非顺铂化疗所致迟发性恶心呕吐的效果。方法：采用自身对照法，观察１０４例恶性肿瘤患者，对以非顺铂化疗患者于第１周期口服舒必利，第２周期肌肉注射胃复安，预防消化道迟发性恶心、呕吐、疗效对比观察。结果：第２、３天有效率舒必利为９５．２％、９４．２％，胃复安为７３．１％、７４％，二者之间有显著统计学差异（Ｐ〈０．０５）。椎体外系反应，舒必利１．９％，胃复安７．７％。结论：舒必利止     

大半夏汤防治化疗呕吐的胃肌电生理研究

目的观察大半夏汤对顺铂所致家鸽呕吐的止呕作用机制。方法采用家鸽腹腔注射顺铂造模,将受试家鸽随机分为空白对照组、DDP组、阳性胃复安对照组、高剂量组、中剂量组、低剂量组,造模成功后给药1周,用BL-410生物功能实验系统记录胃起搏区的慢波频率。结果高、中、低剂量组与DDP组相比,平均慢波频率及慢波异常节律指数均有统计学意义(P均<0.05)。结论大半夏汤止呕的机制与其纠正胃肌电慢波频率及节律有关。     

不同剂量氟哌利多预防术后PCA恶心、呕吐的临床观察

目的:比较不同剂量氟哌利多用于芬太尼静脉术后镇痛(PCA)中对恶心、呕吐的预防作用,并与万唯(阿扎丝琼)相比较。方法:150例择期行腹部手术患者,ASA-级,接受芬太尼术后自控镇痛,随机、双盲分为五组,PCA用药均为芬太尼(0.02mg/ml)。I组为对照组,、、组分别加入氟哌利多(0.0125mg/ml,0.025mg/ml,0.05mg/ml),V组加入万唯0.1mg/ml。观察记录各组患者镇痛后4、8、12、24h芬太尼用量、疼痛评分、恶心呕吐评分、镇静评分。结果:与对照组相比、、组病人恶心和呕吐发生率明显降低(P<0.05);组病人恶心和呕吐发生率虽然有所降低但与对照组相比无显著性差异(P>0.05);、组的恶心和呕吐发生率较组高,但无显著性差异(P>0.05)。组病人术后24h的镇静评分明显高于其它各组(P<0.05)。各组间疼痛、VAS评分及芬太尼用量无差异(P>0.05)。结论:中等剂量氟哌利多能有效地减少芬太尼术后PCA治疗中的恶心、呕吐,副作用少。     

盐酸恩丹西酮预防小儿斜视矫正术后恶心呕吐的临床研究

目的探讨应用高选择性5-HT3受体拮抗剂盐酸恩丹西酮(以下简称恩丹)预防小儿斜视矫正术后恶心呕吐的效果.方法选择3～10岁择期行斜视矫正术的患儿60例随机分为A组(对照组,n=30):手术结束前10 min静脉注射生理盐水5 ml;B组(恩丹组,n=30):手术结束前10 min静脉注射恩丹0.2 mg/kg.观察每组患儿术后8 h和24 h恶心呕吐发生率及严重程度.结果术后8 h和24 h内恩丹组恶心呕吐发生率及严重程度均显著低于对照组(P＜0.01).结论盐酸恩丹西酮能有效预防小儿斜视矫正术后恶心呕吐的发生.     

Clinical, psychiatric and manometric profile of cyclic vomiting syndrome in adults and response to tricyclic therapy.

Our goal was to investigate 31 adult patients (mean age 29 years, range 18-62 years) meeting Rome II criteria for cyclic vomiting syndrome (CVS). All subjects completed a clinical questionnaire, a Hamilton Rating Scale for Anxiety (HAM-A) and Zung Depression Inventory. Gastric emptying time was assessed in 30 subjects and electrogastrogram (EGG) in 11 between acute attacks. Twenty-seven patients treated with amitriptyline completed a follow-up questionnaire. The mean age of onset of the patients was 30 years (range 14-53 years) and cycles of nausea and vomiting were accompanied by often-severe epigastric and diffuse abdominal pain. A typical attack ranged from 1 to 14 days, with the majority being 4-6 days. The HAM-A revealed that 84% had an anxiety disorder, and based on Zung Depression Inventory 78% suffered from mild-to-severe depression. Only 4 (13%) patients reported migraine, but 14 had a family history of migraine. Gastric emptying time was rapid in 23 (77%), normal in 4 and delayed in 3. The EGG was abnormal in 7 of 11 patients, with 4 having tachygastria. Of 13 patients using marijuana, 7 had symptom relief, while 2 had resolution of CVS after stopping use. The overall treatment experience in the 24 patients receiving amitriptyline up to 1 mg kg(-1) day(-1) for at least 3 months indicated that 93% had decreased symptoms and 26% achieved full remission. Cyclic vomiting syndrome in adults has the following hallmarks: prominence of accompanying abdominal pain and increased prevalence of anxiety and depression, rapid gastric emptying and tachygastric EGG, and successful suppression of attacks by chronic amitriptyline therapy.