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     

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。     

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。     

Penetration-Enhancing Effect of Ethanolic Solution of Menthol on Transdermal Permeation of Ondansetron Hydrochloride Across Rat Epidermis

The aim of this investigation was to study the effect of an ethanol-water solvent system and ehtanolic solution of menthol on the permeation of ondansetron hydrochloride across the rat epidermis in order to select a suitable ethanol-water vehicle and optimal concentration of menthol for the development of a transdermal therapeutic system. The solubility of ondansetron hydrochloride in ethanol, water and selected concenetrtaion of ethanol-water vehicles (20:80 v/v, 40:60 v/v and 60:40 v/v) was determined. The effect of these solvent vehicles, containing 1.5% w/v of ondansetron hydrochloride, on the in vitro permeation of the drug was studied across the rat epidermis. The highest permeation was observed from 60% v/v of ethanol-water vehicle that showed highest solubilty. Hence, the hydroxypropyl cellulose (HPC) (2% w/w) gel formulations containing 1.5% w/w of ondansetron hydrochloride and selected concentrations of menthol (0, 2, 4, 8 and 10% w/w) were prepared using 60% v/v of ethanol-water vehicle, and subjected to in vitro permeation of the drug across rat epidermis. The transdermal permeation of ondansetron hydrochloride was enhanced markedly by the addition of menthol to HPC gel drug reservoir formulations. A maximum flux of ondansetron hydrochloride (77.85 ± 2.85 μ g/cm^2.h) was observed with a mean enhancement ratio of 13.06 when menthol was incorporated at a concentration of 8% w/w in HPC gels. However, there was no significant increase in the drug flux with 10% w/w menthol when compared to that obtained with 8% w/w of menthol in HPC gel formulations. The results suggest that 2% w/w HPC gel drug reservoir formulation, prepared with 60% v/v ethanol-water, containing 8% w/w of menthol provides an optimal transdermal permeation of ondansetron hydrochloride.     

Combining ondansetron and naltrexone effectively treats biologically predisposed alcoholics: from hypotheses to preliminary clinical evidence

BACKGROUND: Individuals considered to be early onset alcoholics (EOA) are characterized by an early onset age, a broad range of antisocial behaviors, high familial loading, and presumed biological disease predisposition. Ondansetron, a 5-HT3 antagonist, improves drinking outcomes and increases abstinence rates among EOA. Individuals with high familial loading for developing alcoholism have lower levels of beta-endorphin and demonstrate a more pronounced increase in beta-endorphin levels in response to alcohol administration compared with individuals who do not have alcoholic relatives. The propensity for naltrexone (a mu opioid antagonist) to reduce alcohol's rewarding effects and drinking in humans is greatest in individuals with high familial loading. Predicated on the added knowledge that 5-HT3 receptors may themselves mediate alcohol reward via activation of the endogenous opioid system, we hypothesized that the combination of ondansetron and naltrexone would act synergistically and would be an effective treatment in EOA. METHODS: We conducted an 8-week double-blind placebo controlled clinical trial in which 20 EOA were randomized to receive ondansetron (4 microg/kg twice a day) + naltrexone (25 mg twice a day) or placebo as an adjunct to weekly standardized group Cognitive Behavioral Therapy. RESULTS: At endpoint, subjects who received ondansetron + naltrexone (n = 10), compared with those who received placebo (n = 10), had fewer drinks/day (covariate adjusted mean 0.99 +/- 0.60 vs. 3.68 +/- 0.63; F1, 16 = 9.35,p = 0.008; effect size = 1.42), drinks/drinking day (covariate adjusted mean 3.14 +/- 0.87 vs. 6.76 +/- 0.71; F1, 13 = 10.45, p = 0.007; effect size = 1.71), and a trend toward increased percent days abstinent (covariate adjusted mean 69.76 +/- 8.64 vs. 48.24 +/- 9.12; F1, 16 = 3.58, p = 0.08; effect size = 0.88). CONCLUSIONS: Ondansetron plus naltrexone seems to synergistically improve the drinking outcomes of EOA. Larger scale studies that test these medications, both alone and together, among various alcoholic subtypes are needed to establish and extend these promising findings.     

曲马多联合昂丹司琼预防剖宫产麻醉后寒颤的效果观察

目的：观察曲马多联合昂丹司琼预防蛛网膜下腔麻醉后寒颤的临床效果。方法将120例行剖宫产的产妇随机分为观察组A、观察组B和对照组。麻醉开始前,观察组A缓慢静脉注射曲马多1mg／kg,观察组B缓慢静脉注射曲马多1mg／kg＋昂丹司琼4mg,对照组给予生理盐水4ml。观察麻醉开始至手术结束4h内产妇寒颤、恶心呕吐、眩晕、低血压、呼吸抑制等不良反应情况和新生儿Apgar评分情况。结果观察组A和观察组B产妇寒颤发生率均低于对照组,差异均有统计学意义（P＜0．05）,观察组A恶心呕吐发生率高于观察组B和对照组,差异均有统计学意义（P＜0．05）,观察组B与对照组恶心呕吐发生率差异无统计学意义（P＞0．05）。3组均未发生眩晕、呼吸抑制等,且术中低血压发生率3组间差异无统计学意义（P＞0．05）,3组新生儿Apgar评分组间差异无统计学意义（P＞0．05）。结论曲马多联合昂丹司琼能有效预防蛛网膜下腔麻醉后的寒颤反应,且恶心呕吐的发生率较低。     

昂丹司琼不同时间及不同剂量给药在预防妇科腹腔镜手术PONV的临床效果

目的探讨昂丹司琼不同时间及不同剂量给药预防妇科腹腔镜手术术后恶心呕吐的临床效果。方法选择全麻下行妇科腔镜手术的患者100例为研究对象,分为四组,每组25例。第一组在麻醉诱导前5rain昂丹司琼8mg静脉注射;第二组手术结束时昂丹司琼8mg静脉注射;第三组麻醉诱导前5min昂丹司琼4mg静脉注射;第四组整个麻醉期间未使用任何抗呕吐药物。比较四组术后24h内恶心呕吐的发生率及程度。结果第一组、第二组、第三组无效例数显著低于第四组,差异均有统计学意义（P〈0．05）。结论昂丹司琼能有效降低术后恶心呕吐的发生率,且临床效果与不同时间和不同剂量无明显关系。     

Potential employment of non-silica-based stationary phases in pharmaceutical analysis

The absolute majority of the HPLC applications use silica-based columns for the separation of active substance and its impurities. However, stationary phases based on metal oxides appear as an interesting alternative. The aim of our study was to investigate the potential utilization of metal oxide-based stationary phases in analytical evaluation of ondansetron and its five pharmacopoeial impurities. In our study commercially available ZrO₂-based columns (e.g. Zr-PBD, Zr-PS, Zr-C18) and TiO₂-based column were used. The effect of an organic modifier (type and ratio), a buffer (type, pH and concentration) and the influence of temperature was investigated. The separation of ondansetron and its five pharmacopoeial impurities was successfully accomplished on a Zirchrom^®-PBD column using a mobile phase consisting of acetonitrile-ammonium phosphate (25 mM, pH 7.0) (18:82, v/v). Detection was performed at 216 nm and the analysis was completed within 7.5 min. The paper proves metal oxide-based stationary phases as an alternative to classical silica-based stationary phases in pharmaceutical analysis.