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.     

昂丹司琼与格拉司琼预防心脏手术后恶心呕吐的随机对照研究

目的探讨预防心脏手术后恶心呕吐（PONV）的方法,对比研究昂丹司琼和格拉司琼对心脏PONV的影响。方法选择气管内插管全身麻醉下行心脏手术的患者90例,随机分成三组,每组各30例。以双盲方式按下述方法给药：Ⅰ组麻醉诱导前静脉注射昂丹司琼4mg（溶于0．9％NaCl溶液20ml）;Ⅱ组麻醉诱导前静脉注射格拉司琼3mg（溶于0．9％NaCl溶液20m1）;Ⅲ组麻醉诱导前静脉注射0．9％NaCl溶液20m。术后12、24h观察记录患者的PONV程度并进行比较。结果Ⅰ组术后12hPONV发生率为20．0％（6／30）,术后24h发生率为26．7％（8,30）;Ⅱ组术后12hPONV发生率为20．0％（6／30）,术后24h发生率为23．3％（7,30）;Ⅲ组术后12hPONV发生率为72．4％（21／29）,术后24h发生率为79．3％（23／29）。Ⅰ、Ⅱ组术后12、24hPONV发生率显著低于Ⅲ组（P〈0．01）,Ⅰ组和Ⅱ组比较差异无统计学意义（P〉0．05）。结论昂丹司琼和格拉司琼对预防心脏PONV均有较好效果,均能有效地降低心脏PONV的发生率,利于患者恢复。     

温和灸在预防化疗消化道反应的疗效评价

目的比较恩丹西酮、恩丹西酮＋奥美拉唑、恩丹西酮＋温和灸三种止吐方案预防化疗消化道反应的疗效。方法以顺铂为主化疗的患者90例,随机分成三组,每组30例,分别使用上述止吐方案,观察其预防化疗消化道反应的效果。结果对于呕吐,单用思丹西酮、恩丹西酮＋奥美拉唑、恩丹西酮＋温和灸三个方案的有效率相近,分别为80％、87％、90％;对于恶心,三个方案的有效率分别为63％、80％,90％,差别具有统计学显著意义（X^2=6．3,P〈0．05）;对于食欲不振,三个方案的有效率分别为17％、53％、80％,有显著差异（x^2=24．27,P〈0．005）。结论单独使用恩丹西酮不足以完全预防化疗引起的消化道反应,加用奥美拉唑后效果有所提高,恩丹西酮＋温和灸效果最好,特别是预防化疗恶心和食欲不振明显优于单用恩丹西酮或恩丹西酮＋奥美拉唑。     

Gastric distension enhances CCK-induced Fos-like immunoreactivity in the dorsal hindbrain by activating 5-HT3 receptors

The combination of gastric distension and cholecystokinin (CCK) enhances both suppression of food intake and induction of c-Fos-like immunoreactivity (Fos-LI) in the dorsal vagal complex (DVC). Previously, we have shown that serotonin type-3 (5-HT3) receptor mediation of suppression of food intake by CCK requires gastric participation. Therefore, we hypothesized that 5-HT3 receptors mediate CCK-induced Fos-LI in the dorsal hindbrain through a mechanism that involves gastric distension. To test this hypothesis, we counted Fos-LI in the DVC of ondansetron (1 mg/kg; 5-HT3 receptor antagonist) and vehicle-treated rats following gastric balloon distension (5 ml), CCK (1 microg/kg) administration, or CCK combined with gastric distension. Ondansetron administration attenuated DVC Fos-LI by CCK administration. Likewise, ondansetron attenuated Fos-LI by gastric distension in the DVC, specifically within the nucleus of the solitary tract (NTS) and area postrema (AP) nuclei. The most pronounced attenuation of distension-induced Fos-LI by ondansetron occurred in the NTS, particularly in the medial and intermedial NTS. When combined, CCK and gastric distension enhanced Fos-LI in the DVC greater than each treatment alone. Furthermore, ondansetron administration attenuated the overall DVC enhanced Fos-LI induced by CCK + gastric distension, in particular at the NTS and AP nuclei. We found that, within the mid-to-caudal regions of the NTS and AP, 5-HT3 receptors most significantly mediate neuronal activation by CCK + distension. In conjunction with previous behavioral data, these results show that gastric distension enhances CCK-induced neuronal activation in the DVC by activating 5-HT3 receptors.     

Activation of the serotonin 5-HT3 receptor in the dorsal raphe nucleus suppresses REM sleep in the rat

The effects of the selective 5-HT₃ receptor agonist and antagonist m-chlorophenylbiguanide (m-CPBG) and ondansetron, respectively, were studied in adult male Wistar rats implanted for chronic sleep recordings. Microinjection of m-CPBG (2.0 and 4.0 mM) into the dorsal raphe nucleus (DRN) decreased rapid-eye-movement sleep (REMS) and the number of REM periods during the first, second, and third 2-h recording period. On the other hand, direct infusion of ondansetron (0.5–1.0 mM) into the DRN induced no significant changes in sleep variables over the 6 h of recording. Pretreatment with ondansetron (0.5 mM) antagonized the m-CPBG (2.0 mM)-induced reduction of REMS and of the number of REM periods. The data are consistent with the hypothesis that the 5-HT₃ receptor is involved in the effect of DRN serotonergic neurons on brainstem structures that act to promote and induce REMS.

It is suggested that the suppression of REMS after the microinjection of m-CPBG into the DRN is related, at least in part, to the stimulation of glutamatergic interneurons that express 5-HT₃ receptors. Activation of these receptors facilitates the release of glutamate, which, in turn, acts on postsynaptic N-methyl-d-aspartate and non-N-methyl-d-aspartate receptors expressed by serotonergic neurons of the DRN and increases the release of 5-HT at postsynaptic sites.     

Value of mink vomit model in study of anti-emetic drugs

AIM: To establish a new, reliable vomit model of minks. METHODS: Adult male minks were randomly divided into 8 groups (n=6): cisplatin (7.5 mg/kg) intraperitoneal injection (i.p.) group, copper sulfate (40 mg/kg) intragastric injection (i.g.) group, apomorphine (1.6 mg/kg) subcutaneous injection (s.c.) group, and 18 Gy whole-body X-irradiation group, ondansetron injection group (2 mg/kg i.p.) 30 min later followed by cisplatin (7.5 mg/kg) i.p., normal saline (NS) i.p. injection control group, metoclopramide injection group (4 mg/kg i.p.) 30 min later followed by apomorphine (1.6 mg/kg) s.c., NS i.g. control group. The frequency of retching and vomiting was calculated. After behavioral experiment, distribution of 5-HT in the ileum was detected by immunohistologic method. RESULTS: Cisplatin, apomorphine, copper sulfate and X-irradiation administered to minks evoked a profound emetic response in the animals. However, retching and vomiting were significantly inhibited by pretreatment with ondansetron and metoclopramide in cisplatin and copper sulfate groups (P=0.018). Immunohistologic result showed that 5-HT released from enterochromaffin cells (EC cells) was involved in vomiting mechanism. CONCLUSION: Mink vomit model has a great value in studying the vomiting mechanism and screening new antiemetic drugs.     

Toxic Epidermal Necrolysis in Pregnancy due to Ondansetron with a Favorable Outcome: A Case Report and Review of the Literature

Toxic epidermal necrolysis (TEN) is an uncommon, life-threatening hypersensitivity drug reaction with a high mortality rate that involves the skin and mucous membranes. Most reported cases involving pregnant patients were seen in those with human immunodeficiency virus. Here, we discuss a 21-year-old Iranian woman who presented at 18 weeks’ gestation with extensive TEN following the administration of ondansetron with no any other risk factors.