Randomised comparison of ondansetron plus dexamethasone with dexamethasone alone for the control of delayed cisplatin-induced emesis

The role of 5-hydroxytryptamine₃ (HT₃) antagonists in the treatment of delayed emesis is still controversial. To evaluate whether 5-HT₃ antagonists can add to the efficacy of corticosteroids in controlling delayed emesis, we performed a randomised, prospective, open study comparing ondansetron plus dexamethasone with dexamethasone alone in cisplatin-treated patients. 149 cisplatin-naïve patients with lung cancer received at least 60 mg/m² of cisplatin and were treated with dexamethasone 32 mg intravenously (i.v.) and granisetron 3 mg i.v. on day 1. Patients were randomly assigned to receive either dexamethasone 16 mg i.v. alone (arm A) or dexamethasone plus ondansetron 8 mg daily (arm B) on days 2–4. None of the efficacy variables related to control of delayed emesis differed significantly between the two arms. In conclusion, there does not appear to be sufficient evidence to support the prolonged use of 5-HT₃ receptor antagonists after 24 h of cisplatin-containing chemotherapy.     

恩丹西酮不同时机用药对曲马多静脉术后自控镇痛恶心、呕吐的影响

目的探讨恩丹两酮不同时机用药对曲马多静脉术后自控镇痛恶心、呕吐的预防作用。方法 将90例ASAⅠ～Ⅱ级、住连续硬膜外麻醉下行下肢手术的病人随机均分为三组：Ⅰ组（不用恩丹西酮）、Ⅱ组（先用恩丹西酮再用曲马多）、Ⅲ组（先用曲马多冉用恩丹西酮）。术毕接PCIA。观察病人术后48h恶心、呕吐情况。结果Ⅱ组恶心、呕吐发生率显著低于Ⅰ组、Ⅲ组（P〈0．05）,Ⅰ组、Ⅲ组两者相比差异无统计学意义（P〉0．05）。结论曲马多负荷剂量前先应用恩丹曲酮可有效顶防曲马多静脉术后镇痛恶心、呕吐,而曲马多负荷剂量后应用恩丹西酮效果不明显。     

昂丹司琼的合成工艺改进

目的改进昂丹司琼的合成工艺。方法以1,2,3,9四氢4H咔唑4酮经N甲基化、Mannich反应和缩合得止吐药昂丹司琼。结果取得较佳的工艺条件,总收率为43.9%。结论该方法易于工业化生产。     

昂丹司琼和甲氧氯普胺预防食管癌术后恶心呕吐的疗效观察

目的探讨昂丹司琼联合甲氧氯普胺预防食管癌术后恶心呕吐（postoperative nausea and vomiting，PONV）的疗效。方法选择64例食管癌术后恶心呕吐患者，随机分成两组，A组应用甲氧氯普胺，B组在使用甲氧氯普胺的基础上加用昂丹司琼。结果两组效果B组优于A组，差异有统计学意义（P〈0.01）。结论昂丹司琼联合甲氧氯普胺对食管癌术后恶心呕吐的预防作用优于单用甲氧路普安。     

恩丹西酮联合针刺对化疗所致恶心与呕吐的疗效分析

目的：观察恩丹西酮联合针刺防治化疗所致恶心与呕吐的疗效。方法：80例血液系统恶性疾病化疗患者随机分为观察组和对照组。每天化疗前30分钟，观察组静注恩丹西酮8mg，配合针刺内关、足三里穴；对照组单纯静注恩丹西酮8mg。比较两组化疗24、96小时后的止恶心与止吐疗效及头痛、头晕、便秘和锥体外系症状等恩丹西酮毒副作用发生率。结果：观察组控制恶心与呕吐有效率均显著高于对照组（P＜0．01）；观察组恩丹西酮毒副作用发生率也明显低于对照组（P＜0．01）。结论：恩丹西酮配合针刺治疗，对化疗所致恶心与呕吐有防治具有协同作用。     

Oral olanzapine versus oral ondansetron for prevention of post-operative nausea and vomiting. A randomized,controlled study

BackgroundThis study was designed to mainly evaluate the efficacy and safety of olanzapine compared with placebo and ondansetron for prevention of postoperative nausea and vomiting in patients undergoing breast surgeries.MethodsEighty two female patients scheduled for breast surgeries were randomly assigned to four test groups received placebo or single oral dose of olanzapine 5 mg (OL5) or 10 mg (OL10) or ondansetron 16 mg (ON16) before induction of anesthesia by 4 h for olanzapine and 1 h for ondansetron. All patients were monitored for 24 h. Emetic episodes and nausea occurrence were the primary outcome in this study. Secondary endpoint was the complete response (CR) (without nausea and vomiting, no rescue therapy) for the acute (0–2 h) and late (2–24 h) periods.ResultsNeed for rescue antiemetics showed significant reduction (P < 0.05) for all groups in comparison with placebo. Number needed to be treated (NNT) improved on increasing dose of olanzapine from 5 mg to 10 mg for prevention of both nausea (48%) and vomiting (36%) in comparison to placebo.In the 0–2 h postoperative time interval, complete response (CR) rates were insignificant (P = 0.48, P = 0.11) for olanzapine 5 mg and 10 mg when compared to placebo; and significant for ondansetron 16 mg (P = 0.04). For the 2–24 h interval after surgery, CR rates were significant for OL5, OL10, and ON16 (P = 0.02, P = 0.005, P = 0.007) when compared to placebo. On comparing both olanzapine doses with ondansetron 16 mg during 0–2 h and 2–24 h study periods, there were no significant differences.ConclusionOlanzapine can be used safely and effectively for prophylaxis against PONV especially for late postoperative periods.     

氟比洛芬酯超前镇痛在妇科腹腔镜手术中的应用

目的观察氟比洛芬酯超前镇痛在妇科腹腔镜手术中的应用效果。方法择期腹腔镜下行妇科手术患者52例,ASA I~II,按照随机数字表法分为A组与B组各26例。A组在麻醉诱导前静脉注射氟比洛芬酯50 mg复合地塞米松10mg和昂丹司琼4 mg;B组在麻醉诱导前静脉注射相同容量的生理盐水。观察两组苏醒时间以及拔管后即刻、拔管后1、2、3、8h的收缩压(SBP)、心率(HR)、镇痛评分(视觉模拟评分法,VAS)、镇静评分(Ramsay评分法)和不良反应,记录两组患者术后24 h内追加镇痛药的情况。结果 A组拔管后各时点的VAS评分明显低于B组(P<0.05),恶心呕吐的发生率及术后24 h内追加镇痛药的患者明显少于B组(P<0.05)。两组Ramsay评分、苏醒时间、SBP、HR的变化和不良反应比较差异无统计学意义(P>0.05)。结论氟比洛芬酯超前用于妇科腹腔镜手术,具有良好的镇痛效果,不良反应发生率低,不影响全麻苏醒时间,安全性高。     

三种方法预防术后恶心呕吐效果的比较

目的：观察三种方法预防术后恶心呕吐（PONV）的效果。方法：选择80例美国麻醉医师协会（ASA）体检标准分类I－Ⅱ级上腹部以下手术患，随机分为三组，硬膜外麻醉，静脉给药：一组40例，给予枢丹8mg;二组20例，给予胃复安10mg；三组20例，给予氟哌利多5mg。观察三组PONV的发生率。结果：PONV发生率一组为3例（7．5％），二组7例（35％），三组7例（30％），一组与二、三组比较差异有显性（P＜0．05）。结论：枢丹较之胃复安及氟哌利多更能有效的预防术后恶心、呕吐的发生。     

雷莫司琼预防肺癌顺铂化疗所致恶心呕吐效果的随机对照临床研究

背景与目的顺铂对各种恶性肿瘤都有明显疗效,是肺癌联合化疗的常用药物。但它所引起的严重的恶心、呕吐成为临床应用顺铂的一个剂量限制因素。新一代止吐药物5-HT3受体拮抗剂雷莫司琼可以减轻顺铂化疗引起的恶心呕吐。为了观察雷莫司琼注射剂预防顺铂化疗所致恶心呕吐的临床疗效,我们进行了临床观察,并与恩丹西酮进行对照。方法采用随机平行对照方法,100例患者随机分为雷莫司琼组50例和恩丹西酮组50例。雷莫司琼0.3mg化疗前30min静脉冲入,恩丹西酮8mg化疗前15min和化疗结束时静脉冲入。结果雷莫司琼对顺铂所致恶心的控制率在第1~3天分别为82%、72%、84%,恩丹西酮分别为84%、70%、76%,两药疗效相似。雷莫司琼对呕吐控制的有效率在第1~3天分别为88%、86%、90%,恩丹西酮分别为80%、76%、86%,雷莫司琼对呕吐的有效率高于恩丹西酮,但无统计学上差异。两药不良反应的发生率相似。结论雷莫司琼能有效预防顺铂化疗引起的恶心呕吐,其疗效略优于恩丹西酮。