地塞米松联合昂丹司琼对胸腔镜术后病人静脉自控镇痛PONV的影响

目的:观察地塞米松联合昂丹司琼对胸腔镜术后病人自控静脉镇痛(PCIA)相关恶心呕吐的防治效果。方法:120例ASAⅠ~Ⅱ接受胸腔镜手术的患者,随机分为两组:地塞米松与昂丹司琼联合组(OD组)和昂丹司琼组(O组)。OD组患者在诱导时给予10 mg地塞米松,O组给予等量生理盐水,在手术结束前10分钟时,患者均给予静脉注射8 mg昂丹司琼,术后均行病人自控静脉镇痛(PCIA:生理盐水将2μg/kg舒芬太尼和8 mg昂丹司琼稀释到100 m L)。观察术后48小时内的恶心呕吐的发生率及严重程度。结果:在术后恶心呕吐整体发生率上OD组(53.3%)与O组(60%),差异无统计学意义(P0.05),但在重度PONV发生率上OD组(10%)要显著低于O组(26.7%),差异有统计学意义(P0.05)。结论:地塞米松联合昂丹司琼能有效地降低胸腔镜手术后以舒芬太尼为主的病人自控静脉镇痛所致严重恶心呕吐的发生率。     

托烷司琼与帕洛诺司琼用于小儿骨科术后镇痛预防恶心呕吐的效果研究

摘要 目的：比较托烷司琼与帕洛诺司琼用于小儿骨科术后镇痛时预防恶心呕吐的效果。方法：纳入2019年3月到2021年3月在我院进行骨科手术的儿童60例,根据术后镇痛泵中使用止吐药物的不同分为托烷司琼组和帕洛诺司琼组,每组30例,比较两组患儿术前、术后的心率（HR）、平均动脉压（MAP）,在术后48小时内,观察两组患儿恶心呕吐、头晕头痛、皮肤瘙痒以及呼吸抑制等术后并发症。视觉模拟评分法（VAS）评估患儿术后疼痛,Ramsay量表评估患儿术后镇静效果。结果：托烷司琼和帕洛诺司琼组患儿在术前和术后HR和MAP比较均无显著差异（P>0.05）;托烷司琼组和帕洛诺司琼组患儿术后VAS评分、Ramsay评分均随时间延长而降低,且同一时间点两组患儿VAS评分无显著差异（P>0.05）;帕洛诺司琼组术后PONV发生率（20.00 %）高于托烷司琼组（3.33 %）（P<0.05）。帕洛诺司琼组和托烷司琼组患儿出现头晕头痛、皮肤瘙痒以及呼吸抑制例数分别为3/2例、1/0例和1/0例。两组间术后并发症发生率比较无差异（P>0.05）。结论：托烷司琼与帕洛诺司琼对骨科手术后儿童血流动力学、疼痛和镇静效果并无差异,但在预防术后恶心呕吐方面托烷司琼效果优于帕洛诺司琼。     

Late chronotypes are associated with neoadjuvant chemotherapy-induced nausea and vomiting in women with breast cancer

Neoadjuvant chemotherapy, that is, the administration of chemotherapy before surgery, has been commonly used for locally advanced breast cancer to improve the surgical outcomes and increase the opportunity for breast-conserving therapy. Women with breast cancer often receive an anthracycline-based regimen as the neoadjuvant chemotherapy, which is associated with a high risk of emesis. Despite the development of novel antiemetics, chemotherapy-induced nausea and vomiting (CINV) has been commonly reported as a major adverse effect, affecting the quality of life of the patients. However, the factors predicting CINV in women with breast cancer undergoing neoadjuvant chemotherapy remain unclear. In this single-institution, prospective, observational study conducted at an outpatient cancer centre in the Republic of Korea from November 2013 to March 2016, we analysed women with breast cancer who planned to be treated with neoadjuvant chemotherapy before surgery. Candidate factors associated with CINV were assessed before neoadjuvant chemotherapy using the Munich Chronotype Questionnaire, Pittsburgh Sleep Quality Index and Hospital Anxiety and Depression Scale. CINV was assessed after chemotherapy by using the Multinational Association of Supportive Care in Cancer Antiemesis Tool. Of a total of 143 participants, 7 patients were lost to follow-up and 2 patients were excluded due to changes in their treatment plan; thus, 134 patients were finally included in the analyses. Overall, 48.5% of the participants experienced CINV, with delayed CINV prevalence (42.5%) being more common than acute (39.6%). In the univariate analyses, overall CINV was significantly associated with late chronotypes (odds ratio [OR], 3.49; 95% confidence interval [CI], 1.37–8.87; p = 0.009), a history of nausea/vomiting (OR, 2.19; 95% CI, 1.10–4.37; p = 0.026) and anxiety (OR, 2.25; 95% CI, 1.05–4.81; p = 0.036). In the multivariate analyses, late chronotypes (OR, 3.53; 95% CI, 1.27–9.79; p = 0.015) and a history of nausea/vomiting (OR, 2.83; 95% CI, 1.31–6.13; p = 0.008) remained significantly associated with CINV. In conclusion, in women with breast cancer undergoing neoadjuvant chemotherapy before surgery, late chronotypes were found to have an increased risk of CINV; these data suggest that clinicians need to assess and consider the chronotype in the management of CINV.     

The Binding of Palonosetron and Other Antiemetic Drugs to the Serotonin 5-HT3 Receptor

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灵芝多糖对顺铂引起的呕吐具抑制作用

以雄性昆明小鼠为实验材料,研究灵芝多糖对顺铂引起呕吐的抑制作用。实验分为5组,生理盐水+生理盐水组:腹腔注射0.9% NaCl两次,格拉司琼+顺铂组:腹腔注射格拉司琼和顺铂,生理盐水+顺铂组:腹腔注射0.9% NaCl和顺铂,灵芝多糖+生理盐水组:腹腔注射灵芝多糖和0.9% NaCl,灵芝多糖+顺铂组:腹腔注射灵芝多糖和顺铂,两种成分的注射间隔为30min。上述处理每天1次,连续5d,比较各组小鼠对高岭土的摄取量和脑内Fos蛋白表达水平。结果显示:顺铂可增加小鼠高岭土摄取量和脑内Fos蛋白表达水平,而格拉司琼和灵芝多糖可减少小鼠对高岭土的摄取量并降低脑内Fos蛋白表达水平。因此认为灵芝多糖可有效抑制顺铂引起的恶心呕吐。     

地塞米松预防乳癌患者术后恶心呕吐的有效性和安全性的临床研究

目的：分析地塞米松对接受乳癌根治术的患者术后恶心呕吐、血糖、皮质醇、出血和感染的影响,明确其临床使用的有效性和安全性。方法：将160 例择期全麻下行单侧乳癌改良根治术的女性患者随机分为实验组（地塞米松组,n=80）和对照组（生理盐水组,n=80）。检测两组患者术后第1 天和第3 天血糖和血清皮质醇水平,记录术后1～3天恶心呕吐次数和抗呕吐药物的使用量,比较两组术后1 周内出血和感染的发生情况。结果：实验组患者术后第1 天的恶心发生率显著低于对照组,术后1～2 天的呕吐发生率均显著低于对照组,术后第1 天血清皮质醇较对照组显著降低（P〈0.05）。两组患者术后血糖水平比较无统计学差异（P〉0.05）。术后1 周内,两组患者出血和感染的发生情况比较均无显著性差异（P〉0.05）。结论：地塞米松可有效地预防乳癌改良根治术患者术后恶心呕吐,短暂抑制术后内源性皮质醇水平,不增加患者术后高血糖、出血和感染的风险。     

经皮穴位电刺激辅助全身麻醉减少镇痛药及其副作用的随机对照研究

目的:1.为了明确经皮穴位电刺激是否可以减少择期乳腺癌根治术麻醉药的用量,产生针刺镇痛效应,并且缩短患者苏醒和拔管时间;2.经皮穴位电刺激是否可以明显的减少术后恶心呕吐、眩晕及皮肤瘙痒等麻醉相关并发症的发生;3.探讨电针镇痛效应是否与患者体内β-内啡肽、游离皮质醇有关。方法:选择60例进行择期乳腺癌根治术的患者,随机分为对照组(CON组)、经皮穴位电刺激组(TEAS组),每组30人。入手术室后TEAS组选择双侧合谷穴(LI4),内关穴(PC6)和足三里(ST36)作为穴位刺激30分钟,刺激频率为疏密波2/30 Hz,强度以患者所能承受为限(6-8 m A),对照组患者则仅将电极贴片贴于穴位,不给予电刺激。术中行Narcotrend脑电监测仪监测麻醉深度,记录术中血流动力学参数,采集外周静脉血行皮质醇和β-内啡肽检测。首要观察指标是术中瑞芬太尼用量,次要观察指标是麻醉苏醒质量和麻醉相关副作用。结果:TEAS组瑞芬太尼用量(0.063±0.026μg·kg-1·min-1)相比对照组(0.091±0.032μg·kg-1·min-1)减少了30%。两组间术中血流动力学和血浆β-内啡肽、皮质醇水平无显著差异(P0.05)。然而,拔管和苏醒时间在对照组分别为17(5)和14(8)min显著长于TEAS组(P0.05),TEAS组术后24小时眩晕和皮肤瘙痒发生率显著低于对照组(P0.05)。结论:经皮穴位电刺激确实产生了针刺镇痛效应,大大减少了全麻术中瑞芬太尼用量并降低术后麻醉相关并发症的发生率,是一种值得推广的辅助麻醉方法。     

Medications used to treat nausea and vomiting of pregnancy and the risk of selected birth defects

BACKGROUND Nausea and vomiting of pregnancy (NVP) occurs in up to 80% of pregnant women, but its association with birth outcomes is not clear. Several medications are used for the treatment of NVP; however, data are limited on their possible associations with birth defects. METHODS Using data from the National Birth Defects Prevention Study (NBDPS)—a multi‐site, population‐based, case‐control study—we examined whether NVP or its treatment was associated with the most common noncardiac defects in the NBDPS (nonsyndromic cleft lip with or without cleft palate [CL/P], cleft palate alone [CP], neural tube defects, and hypospadias) compared with randomly selected nonmalformed live births. RESULTS Among the 4524 cases and 5859 controls included in this study, 67.1% reported first‐trimester NVP, and 15.4% of them reported using at least one agent for NVP. Nausea and vomiting of pregnancy was not associated with CP or neural tube defects, but modest risk reductions were observed for CL/P (adjusted odds ratio [aOR] = 0.87; 95% confidence interval [CI], 0.77–0.98) and hypospadias (aOR = 0.84; 95% CI, 0.72–0.98). Regarding treatments for NVP in the first trimester, the following adjusted associations were observed with an increased risk: proton pump inhibitors and hypospadias (aOR = 4.36; 95% CI, 1.21–15.81), steroids and hypospadias (aOR = 2.87; 95% CI, 1.03–7.97), and ondansetron and CP (aOR = 2.37; 95% CI, 1.18–4.76), whereas antacids were associated with a reduced risk for CL/P (aOR = 0.58; 95% CI, 0.38–0.89). CONCLUSIONS NVP was not observed to be associated with an increased risk of birth defects; however, possible risks related to three treatments (i.e., proton pump inhibitors, steroids and ondansetron), which could be chance findings, warrant further investigation. Birth Defects Research (Part A) 2012. © 2011 Wiley Periodicals, Inc.     

异氟烷对化疗性大鼠异食癖恶心呕吐模型神经功能及呕吐相关神经递质的影响

摘要 目的：研究异氟烷预处理对化疗性大鼠异食癖恶心呕吐模型神经功能及呕吐相关神经递质的影响。方法：选用SD大鼠作为研究对象,腹腔注射顺铂以建立化疗性大鼠异食癖恶心呕吐模型（Model组）,腹腔注射等量生理研究作为对照组（Control）,在腹腔注射顺铂前1 h和12 h吸入异氟烷预处理作为异氟烷治疗组（Isoflurane）。记录腹腔注射顺铂0~12 h和12~24 h内各组大鼠摄入高岭土量;在腹腔注射顺铂0 h、12 h和24 h后,通过神经功能缺损评分法对各组大鼠神经功能进行评分;并在腹腔注射顺铂24 h后处死大鼠,收集大鼠回肠和延髓组织以检测5-羟色胺(5-Hydroxytryptamine,5-HT)、5-羟基-吲哚乙酸（5-hydroxy-indole acetic acid,5-HIAA）、色氨酸羟化酶（Tryptophan hydroxylase,TPH）以及单胺氧化酶（Monoamine oxidase,MAOA）含量。结果：与Control组相比,Model组和Isoflurane组大鼠在腹腔注射顺铂0~12 h,12~24 h以及0~24 h内摄入的高岭土量均显著升高（P<0.05）,并且Isoflurane组大鼠均显著Model组。三组大鼠在腹腔注射顺铂0 h、12 h和24 h后,神经功能评分均无显著差异（P>0.05）。与Control组大鼠相比,Model组和Isoflurane组大鼠在腹腔注射顺铂24 h后回肠/延髓组织内5-HT和TPH含量均显著升高,并且Isoflurane组大鼠显著低于Model组大鼠（P<0.05）;与Control组相比,Model组大鼠回肠和延髓组织中5-HIAA/5-HIT比值和MAOA含量均显著降低（P<0.05）;与Model组大鼠相比,Isoflurane组大鼠回肠5-HIAA含量、回肠/延髓5-HIAA/5-HT比值和MAOA含量均显著升高（P<0.05）。结论：异氟烷预处理可用于预防腹腔注射顺铂诱导的恶性呕吐,其机制可能与下降THP含量和提高MAOA含量,抑制5-HT合成以及促进5-HT代谢有关。     

洗胃后配合间歇胃肠减压治疗新生儿顽固性呕吐的疗效及安全性评价

目的：探讨洗胃后配合间歇胃肠减压治疗新生儿顽固性呕吐的临床疗效及安全性。方法：将2009年1月～2012年6月我院儿科收治124例顽固性呕吐的新生患儿随机分为两组,每组各62例。所有患儿均给予病因治疗、体位治疗、维持水电解质及酸碱平衡等常规综合治疗。在此基础上,对照组给予温盐水洗胃治疗,治疗组给予洗胃后配合间歇胃肠减压治疗。观察和比较两组患儿的临床疗效、体重和胃肠功能变化及不良反应。结果：治疗后,治疗组患儿总有效率为90.3%,显著高于对照组总有效率为75.8%（P〈0.05）;与对照组比较,治疗组患儿顽固性呕吐症状的缓解时间、胃肠功能完全恢复时间明显缩短,体重减轻程度较轻（P〈0.05）;两组患儿均未见坏死性肠炎、新生儿窒息等严重不良反应。结论：洗胃后配合间歇胃肠减压可提高临床疗效及促进胃肠功能恢复,简单安全,可作为新生儿顽固性呕吐理想的治疗方法。     

麻醉诱导时血压下降对术后恶心呕吐的影响

目的：观察麻醉诱导时血压下降与术后恶心呕吐的关系.方法：选择ASAⅠ-Ⅱ级的经腹胆囊切除术患者40例,按麻醉诱导时血压比基础值下降的程度分为2组,每组20例.A组：SBP比基础血压下降〉30%;B组：SBP比基础血压下降〈30%.术后随访病人48小时,记录病人恶心呕吐的发生情况.结果：麻醉诱导时血压下降对术后恶心呕吐有明显影响.结论：麻醉期间维持血流动力学稳定能降低PONV的发生.     

麻醉诱导时血压下降对术后恶心呕吐的影响

目的观察麻醉诱导时血压下降与术后恶心呕吐的关系。方法选择ASAⅠ-Ⅱ级的经腹胆囊切除术患者40例,按麻醉诱导时血压比基础值下降的程度分为2组,每组20例。A组SBP比基础血压下降>30%;B组SBP比基础血压下降<30%。术后随访病人48小时,记录病人恶心呕吐的发生情况。结果麻醉诱导时血压下降对术后恶心呕吐有明显影响。结论麻醉期间维持血流动力学稳定能降低PONV的发生。     

The emetic reflex in African walking catfish develops with age

This opportunistic observational study showed that following feeding, subadult catfish, Clorias gariepinus (>3 months old; n=37) were sensitive to the disturbance caused by removing two fish for weighing. This initiated intense and prolonged vomiting (oral expulsion of upper gut contents). The main emetic response occurred within a few minutes after fish removal, although commercial grade food pellets were still being vomited 50 to 100 min later. The magnitude of the vomiting response was relatively greater after consumption of larger meals, however, nothan 44% of a meal was ever vomited. Juvenile catfish (<3 months; n=8) were also sensitive to disturbance as indicated by vomiting. The emetic response in these younger fish wasas pronounced as that of the subadults even when given meals of similar relative size (approx. 2.4% wet body weight). No emesis was observed in post-hatching catfish (<3 weeksd; n=7) after feeding and following a similar disturbance. This suggests the emetic reflex may not operate in post-hatching catfish in reaction to a stimulus that in subadults and juveniles produced a graded, weight-dependent vomiting response. This raises the question of whether this difference represents neuronal pathway development or learning of the reflex.     

脑室和静脉注射吗啡对狗移行性综合肌电的影响

用10只狗作慢性实验,沿胃窦、小肠缝植8对银-氯化银双极电极,观察脑室和静脉注射吗啡对移行性综合肌电(migrating myoelectric complex,MMC)的影响。结果:(1)在十二指肠MMC周期时程的43％以后,静脉注射吗啡能诱发MMCⅢ相活动提前发生;在42％以内则无效应。(2)静脉注射3,000μg吗啡后,MMC周期延长,胃窦慢波频率减少;静脉注射300μg吗啡,对MMC周期时程和胃窦慢波频率无影响。(3 )脑室注射吗啡后,胃、小肠慢波首先发生自下而上的逆行性抑制,随之各部位峰电活动增多,十二指肠还发生痉挛性收缩的峰电活动,动物伴有呕吐的前驱症状和呕吐,MMC周期延长,胃窦慢波频率减少。(4)切断双侧膈上迷走神经后,脑室注射吗啡对胃和小肠肌电活动影响消失,但呕吐及其前驱症状仍然发生。     

格拉司琼联合隔药灸治疗肝癌介入术后恶心呕吐临床观察

目的:观察格拉司琼联合隔药灸治疗肝癌介入术后恶心呕吐临床疗效。方法:将符合纳入标准的肝癌介入术后恶心呕吐患者72例,分为治疗组与对照组,每组36例,对照组给予注射用盐酸格拉司琼静脉滴注治疗,治疗组在对照组的基础上给予隔药灸治疗。观察两组患者恶心、呕吐症状、胃液引流量及胃管留置时间,统计临床疗效。结果:治疗后治疗组在恶心、呕吐症状评分、胃液引流量、胃管留置时间方面明显均低于对照组(均P0.05)。治疗组、对照组临床疗效总有效率分别为91.67%、72.22%,比较有统计学意义(P0.05)。结论:格拉司琼联合隔药灸可以明显改善肝癌介入术后恶心呕吐症状,缩短胃管留置时间,临床疗效显著。     

Methylnaltrexone prevents morphine-induced kaolin intake in the rat

Opioids are frequently used analgesics, and emesis is a common opioid-induced adverse effect. Methylnaltrexone, a peripheral opioid antagonist, has the potential to block the undesired effects of opioids that are mediated by peripheral receptors while sparing the analgesic effect. We used a rat model of simulated emesis or pica to study if methylnaltrexone decreases morphine induced-kaolin consumption. We observed that after morphine administration, kaolin intake increased significantly compared to intake in the vehicle group, and the increase could be attenuated by ondansetron administration. Methylnaltrexone dose-dependently reduced kaolin ingestion induced by morphine. Morphine and methylnaltrexone did not significantly affect food intake and body weight in the experimental animals. Our data suggest that methylnaltrexone has therapeutic value in treating opioid-induced nausea and vomiting.     

Association study in eating disorders: TPH2 associates with anorexia nervosa and self‐induced vomiting

Twin studies suggest that genetic factors play a substantial role in anorexia nervosa (AN) and self‐induced vomiting (SV), a key symptom that is shared among different types of eating disorders (EDs). We investigated the association of 25 single nucleotide polymorphisms (SNPs), capturing 71–91% of the common variance in candidate genes, stathmin (STMN1), serotonin receptor 1D (HTR1D), tryptophan hydroxylase 2 (TPH2) and brain‐derived neurotrophic factor (BDNF), with AN and EDs characterized by regular SV. The first allele frequencies of all the SNPs were compared between a Dutch case group (182 AN, 149 EDs characterized by SV) and 607 controls. Associations rendering P‐values < 0.05 from this initial study were then tested for replication in a meta‐analysis with two additional independent ED case–control samples, together providing 887 AN cases, 306 cases with an ED characterized by SV and 1914 controls. A significant effect for the minor C‐allele of tryptophan hydroxylase 2 rs1473473 was observed for both AN [odds ratio (OR) = 1.30, 95% CI 1.08–1.57, P < 0.003] and EDs characterized by SV (OR = 1.52, 95% CI 1.28–2.04, P < 0.006). In the combined case group, a dominant effect was observed for rs1473473 (OR = 1.38, 95% CI 1.16–1.64, P < 0.0003). The meta‐analysis revealed that the tryptophan hydroxylase 2 polymorphism rs1473473 was associated with a higher risk for AN, EDs characterized by SV and for the combined group.     

非阿片类镇痛复合静脉全麻在鼾症手术患者中的疗效

目的:观察三重措施预防为基础,联合非阿片镇痛药复合静脉全麻在行鼾症手术患者术后恶心呕吐的应用效果。方法:选择择期行鼾症手术男性病人80例,随机分为两组:吸入麻醉组(inhalation group, IHLA组)和静脉麻醉组(intravenous group, TIVA组),每组40例,两组均采用三重措施预防恶心呕吐,IHLA组采用以舒芬太尼为基础复合七氟烷吸入麻醉,TIVA组以氯胺酮和右美托咪定镇痛基础上丙泊酚全凭静脉麻醉。评估两组病人恶心呕吐危险系数,采用李克特量表(Likert scale),记录并分析两组患者术后6~8 h在麻醉后监测治疗室(post anesthesia care unit, PACU)及病房24 h恶心呕吐发生情况及补救用药用量。结果:两组患者一般临床资料、恶心呕吐风险评分、手术时间、术后恢复期补救用药量人数无显著差异(P>0.05);IHLA组在PACU恶心呕吐发生率为39.5%,TIVA组发生率为18.9%,两者相比有显著性差异(P<0.05);IHLA组病房24 h恶心呕吐严重程度高于TIVA组,两组术后需要补救应用抗呕吐药物用量无显著差异(P>0.05)。结论:以三重措施预防为基础,与吸入麻醉相比,非阿片类镇痛药复合静脉麻醉可以减少肥胖病人鼾症手术术后恶心呕吐发生率和严重程度,降低围术期风险,有利于患者早期恢复。