Comparison of the efficacy and side-effects of ondansetron and metoclopramide-diphenhydramine administered to control nausea and vomiting in children treated with antineoplastic chemotherapy: a prospective randomized study

Nausea and vomiting following antineoplastic therapy in patients receiving chemotherapy remains a problem. To prevent nausea and vomiting due to antineoplastic therapy, many types of drugs have been used. Ondansetron and the combination metoclopramide-diphenhydramine have been widely used in children. In this prospective randomized study these drugs were compared both for their efficacy and side-effects in children treated with antineoplastic chemotherapy (with and without cisplatin) the number of chemotherapy courses being equal in both groups. Ondansetron gave complete anti-emetic cover in five of nine courses in patients treated with cisplatin. Metoclopramide-diphenhydramine gave complete anti-emetic cover in one out of nine courses, and 17 out of 23 courses in patients treated without cisplatin. Metoclopramide-diphenhydramine produced side effects in nine courses whereas ondansetron produced side-effects in three courses. Conclusion Ondansetron appeared to be superior to metoclopramide-diphenhydramine in the control of emesis induced by chemotherapy regimens containing cisplatin. The results of the present prospective randomized study indicate that ondansetron is a useful anti-emetic in the treatment of chemotherapy-induced emesis. Received: 17 May 1996 / Accepted in revised form: 23 December 1997     

恩丹西酮（齐鲁）预防顺铂所致呕吐的：Ⅲ期临床研究

目的进一步确定恩丹西酮（齐鲁）的临床应用价值及改进的用药方案。方法多中心协作研究,观察单用恩丹西酮和恩丹西酮合并地塞米松对顺铂（每次３０ｍｇ～２００ｍｇ）所致呕吐的预防效果。结果３３０例接受恩丹西酮、４４３例接受恩丹西酮加地塞米松治疗。结果对急性恶心有效率分别为７３．３％和８０．８％,对急性呕吐有效率分别为８６．７％和９４．８％,第１天平均呕吐次数分别为０．９和０．５次,表明加用地塞米松可显著提高对急性恶心呕吐有效率。但对迟发性呕吐的疗效相似。此外,单用恩丹西酮８ｍｇ静脉注射也能取得疗效。结论该药对预防顺铂所致呕吐疗效突出,改进的方案用法简便,可减少用药次数,疗效好。     

昂丹司琼联合地塞米松对比昂丹司琼单药预防腹腔镜胆囊切除术后恶心呕吐的荟萃分析

目的:系统评价昂丹司琼联合地塞米松与昂丹司琼单药预防腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)术后恶心呕吐(postoperative nausea and vomiting,PONV)的疗效及安全性,以期为临床用药提供参考。方法:系统检索与筛选Cochrane Library、Pub Med、EMBASE、SCI、CNKI、维普、万方数据库中对比昂丹司琼单药与联合用药预防LC术后PONV的随机对照试验。使用Google学术、百度学术等搜索引擎进一步补充检索。按照纳入与排除标准纳入文献后,由两位作者独立进行质量评价、数据提取,交叉核对后,使用Rev Man 5.3软件统计分析,合并效应量中计数资料采用相对危险度(relative risk,RR)及95%可信区间(confidence interval,CI)描述。结果:纳入12项随机对照试验,共1 156例患者。Meta分析结果显示,相较昂丹司琼单药组,联合地塞米松用药组LC术后24 h内PONV发生率显著下降[RR=0.45,95%CI(0.35,0.57)]。依据药物用量行亚组分析时发现,4 mg、8 mg昂丹司琼联合用药组均可显著降低术后24 h PONV发生率,而在8 mg时较单药组可显著降低总的呕吐发生率[RR=0.40,95%CI(0.23,0.71)]。安全性方面,两组术后其他并发症发生率差异无统计学意义。结论:昂丹司琼联合地塞米松相较昂丹司琼单药能更好地预防LC术后的PONV,有效降低术后不适症状,同时临床应用时应注意昂丹司琼剂量的选择。     

地塞米松联合恩丹西酮对手术后病人自控镇痛相关恶心呕吐的影响

目的　观察地塞米松联合恩丹西酮对手术后病人自控镇痛 (PCA)所致恶心呕吐的防治效果。方法　随机将 2 0 0例在连续硬膜外麻醉下行下肢手术的患者分为四组 :对照 (C)组于手术切皮前 (T1)和手术结束时 (T2 )分别静脉注射生理盐水 2ml;地塞米松 (D)组于T1、T2 时分别注射地塞米松 10mg和生理盐水 2ml;恩丹西酮 (O)组于T1、T2 时分别注射生理盐水 2ml和恩丹西酮4mg ;地塞米松 +恩丹西酮 (D +O)组于T1、T2 时分别注射地塞米松 10mg和恩丹西酮 4mg。术毕均行病人自控静脉芬太尼镇痛 (PCIFA)。观察术后 2 4h内病人镇痛效果、镇静评分和恶心呕吐发生情况。结果　 5例患者因故退出此观察。组间镇痛效果、镇静评分无明显差异。C组恶心呕吐发生率为 5 2 1% ,明显高于D组 (33 3% )和O组 (32 7% ) ,P <0 0 5 ;D +O组恶心呕吐发生率为16 0 % ,与C组比较 ,P <0 0 1,与D组和O组比较 ,P <0 0 5 ;各处理组恶心程度均小于对照组 ,P <0 0 5 ;D +O组呕吐程度低于C组 ,P <0 0 5。结论　地塞米松与恩丹西酮单独应用均能有效地减少手术后PCIFA相关的恶心呕吐 ,减轻恶心程度 ;两药联合应用进一步降低患者的恶心呕吐发生率和呕吐的程度     

昂丹司琼不同给药方式对腹腔镜胆囊切除术后恶心、呕吐的预防

目的研究昂丹司琼不同给药方式对预防腹腔镜胆囊切除手术(LC)后恶心呕吐(PONV)的临床疗效。方法将200例美国麻醉医师协会分级(ASA)Ⅰ～Ⅱ级,择期行LC的患者随机分为4组:Ⅰ组术毕未使用昂丹司琼;Ⅱ组术毕静注昂丹司琼8 mg;Ⅲ组术毕镇痛泵内加昂丹司琼4 mg,静脉推注昂丹司琼4 mg;Ⅳ组术毕镇痛泵内加昂丹司琼8 mg。记录术后2、4、8、20、36和48 h患者的PONV情况。结果与Ⅰ组相比,Ⅱ组在术后2、4和8 h恶心、呕吐发生率显著降低(P<0.05),Ⅲ组在术后2、4、8、20、36和48 h恶心、呕吐发生率明显降低(P<0.05);Ⅰ组和Ⅳ组各时间点呕吐的发生率差异无统计学意义。与Ⅱ组相比,Ⅲ组在术后36、48 h呕吐发生率明显降低(P<0.05);与Ⅳ组相比较,Ⅱ组在术后2、4、8 h恶心、呕吐发生率明显降低(P<0.05),Ⅲ组在术后2、4、8、20、36和48 h呕吐发生率明显降低(P<0.05)。结论术毕单次注射昂丹司琼4mg,并通过术后镇痛泵(PCA)持续输注,可以在术后48 h内有效预防恶心、呕吐的发生。     

甲状腺癌根治术后恶心呕吐的预防

[目的]研究枢丹和格拉司琼在甲状腺癌根治术患者术后的抗呕吐作用 ,并比较两者对术后恶心呕吐(PONV)的预防效果。[方法]选择甲状腺癌根治术患者90例 ,随机分为枢丹组(4mg,n=30)、格拉司琼组(3mg,n=30)和安慰剂组(生理盐水 ,n=30) ,诱导前静推枢丹或格拉司琼或安慰剂 ,双盲法观察术后24小时恶心、呕吐的发生率。[结果]枢丹组恶心、呕吐的发生率(23 % ,17 %)与格拉司琼组(20 % ,13 %)无显著性差异(P>0 05) ,用药组恶心、呕吐的发生率明显低于安慰剂组(67 % ,57 %;P<0 01)。[结论]枢丹和格拉司琼均能有效地预防甲状腺癌根治术后的恶心、呕吐 ,两者对PONV的预防效果无明显差别。     

阿扎司琼和昂丹司琼预防妇科肿瘤术后恶心呕吐的疗效观察

目的 观察阿扎司琼和昂丹司琼预防妇科肿瘤术后恶心、呕吐的临床疗效。方法 选择90例ASAⅠ～Ⅱ级择期妇科手术患者,随机分为3组,每组30例,在全麻诱导前5min,分别缓慢静脉注射阿扎司琼10mg（A组）、昂丹司琼8mg（B组）、生理盐水5mL（对照组,C组）。观察静注前及静注后5min时的血压、心率,术后24h恶心呕吐的次数和程度。结果 在术后24h内恶心呕吐比较差异有统计学意义（P〈0．05）,A组优于B组,B组优于C组。结论 阿扎司琼和昂丹司琼均可显著减少妇科术后恶心呕吐发生率,阿扎司琼对恶心呕吐的预防作用优于昂丹司琼。     

Delivery of doxorubicin across the blood–brain barrier by ondansetron pretreatment: a study in vitro and in vivo

Doxorubicin (Dox) has got a limited efficacy in the treatment of central nervous system tumors because of its poor penetration through blood–brain barrier mediated by MDR efflux transporters. We investigated the possibility that ondansetron (Ond) enhances Dox cytotoxicity in cell lines interfering with P-glycoprotein and increases Dox concentration in rat brain tissues.     

昂丹司琼对肺癌化疗所致恶心呕吐的预防

目的：评价单剂昂丹司琼对肺癌化疗所致恶心、呕吐的预防作用。方法：选择35例肺癌化疗患者,采用自身交替对照的方法,观察单次静脉注射昂丹司琼8mg对化疗所致恶心、呕吐的预防作用。结果：单剂昂丹司琼对肺癌化疗所致恶心、呕吐的控制率分别为91．4％、94．3％;甲氧氯普胺的控制率分别为65．7％,74．3％,两者比较差异显著。结论：单剂昂丹司琼对肺癌化疗所致恶心、呕吐有明显的预防作用。