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     

格拉司琼与恩丹西酮防治食管癌术后化疗所致恶心呕吐的疗效对比

目的：比较格拉司琼与恩丹西酮防治食管癌术后患者化疗引起恶心、呕吐的作用及毒副反应。方法：回顾性研究439例食管癌术后化疗患者的临床资料，比较格拉司琼和恩丹西酮的治疗效果及毒副反应。结果：吻合VI位于颈部患者比位于胸内患者易发生恶心、呕吐。格拉司琼对化疗后急性（1d）恶心、呕吐有效率为81．6％，延迟性恶心呕吐（2—5d）的有效率分别为75．0％、64．2％、60．8％、56．1％。恩丹西酮对化疗后急性恶心、呕吐有效率为71．4％，延迟性恶心、呕吐的有效率分别为68．7％、57．7％、52．0％、47．1％，两组差异显著（P〈0．05），格拉司琼治疗效果优于恩丹西酮。两者不良反应基本相似。结论：格拉司琼对于防治食管癌术后患者化疗所致恶心、呕吐效果较好。     

格拉司琼与恩丹西酮防治食管癌术后化疗所致恶心呕吐的疗效对比

目的:比较格拉司琼与恩丹西酮防治食管癌术后患者化疗引起恶心、呕吐的作用及毒副反应。方法:回顾性研究439例食管癌术后化疗患者的临床资料,比较格拉司琼和恩丹西酮的治疗效果及毒副反应。结果:吻合口位于颈部患者比位于胸内患者易发生恶心、呕吐。格拉司琼对化疗后急性(1d)恶心、呕吐有效率为81.6%,延迟性恶心呕吐(2～5d)的有效率分别为75.0%、64.2%、60.8%、56.1%。恩丹西酮对化疗后急性恶心、呕吐有效率为71.4%,延迟性恶心、呕吐的有效率分别为68.7%、57.7%、52.0%、47.1%,两组差异显著(P<0.05),格拉司琼治疗效果优于恩丹西酮。两者不良反应基本相似。结论:格拉司琼对于防治食管癌术后患者化疗所致恶心、呕吐效果较好。     

阿扎司琼与恩丹西酮预防化疗性恶心呕吐的对照研究

目的 :比较阿扎司琼和恩丹西酮对预防恶性肿瘤化疗性呕吐的临床疗效。方法 :35例患者分为阿扎司琼组(A组 )和恩丹西酮组 (B组 )。阿扎司琼组 13例 ,化疗前静脉推注阿扎司琼 10mg ,隔日应用 1次 ;恩丹西酮组 2 2例 ,化疗前静脉推注恩丹西酮 8mg,每日 1次。结果 :阿扎司琼和恩丹西酮止吐的总有效率相近 (76 9%和 72 7% ) ,两组对比无明显差异 (P>0 0 5 ) ;但完全控制率分别为 5 3 8%和 4 0 9% ,两组比较差异有显著性 (P <0 0 5 )。对平均呕吐次数和初次呕吐时间也进行了比较 ,阿扎司琼和恩丹西酮有显著性差异 (P <0 0 5 )。结论 :阿扎司琼是一种预防化疗所致恶心呕吐的高效药物 ,不良反应很轻     

格拉司琼预防胃癌化疗引起恶心呕吐的临床研究

目的 :观察格拉司琼注射剂预防顺铂引起的急性及延迟性恶心呕吐的作用和毒副反应 ,并与恩丹西酮比较。方法 :采用随机自身对照方法 ,将 48例接受联合化疗 (含顺铂 )的胃癌患者随机分为A、B两组 ,均接受 2个周期相同方案的化疗。A组第 1周期用格拉司琼 ,第 2周期用恩丹西酮止吐 ;B组第 1周期用恩丹西酮 ,第 2周期用格拉司琼止吐。观察化疗后 2 4小时 (急性 )及 5日内 (延迟性 )恶心呕吐发生的情况。结果 :在化疗后 0h～ 6h ,格拉司琼对恶心的控制率与恩丹西酮相似 ,但第 1天、第 2天、第 3天格拉司琼对恶心的有效率 ( 62 5 %、47 9%、41 7% )优于恩丹西酮 ( 41 7%、2 7 1%、2 2 9% ,P <0 0 5 ) ,提示格拉司琼作用时间较恩丹西酮长。格拉司琼控制呕吐的效果及所致毒副作用与恩丹西酮相似。结论 :格拉司琼能有效控制胃癌化疗所致的恶心呕吐 ,作用时间较恩丹西酮长 ,它的不良反应轻 ,是良好的化疗止吐药     

国产盐酸格拉司琼注射液预防化疗所致消化道不良反应的研究

目的:研究盐酸格拉司琼注射液(华康格拉司琼)预防恶性肿瘤患者化疗所致消化道不良反应的有效性和安全性。方法:接受以顺铂为主或以蒽环类抗肿瘤药为主化疗的肿瘤患者,随机交叉采用该药和国产已上市的恩丹西酮预防化疗所致消化道不良反应。结果:接受顺铂为主化疗(顺铂组)14例及接受蒽环类药物化疗 (蒽环类组)29例肿瘤患者均先后采用华康格拉司琼和国产上市恩丹西酮预防消化道不良反应,二者对预防强致吐和中度致吐化疗药所致的急性和迟发性恶心与呕吐,疗效基本相同;不良反应基本相似,以便秘、疲倦及头痛为多见,但程度轻,不影响继续治疗。结论:国产新药华康盐酸格拉司琼预防肿瘤患者化疗所致的恶心与呕吐是安全有效的。     

国产盐酸格拉司琼注射液预防化疗所致消化道不良反应的研究

目的:研究盐酸格拉司琼注射液(华康格拉司琼)预防恶性肿瘤患者化疗所致消化道不良反应的有效性和安全性.方法:接受以顺铂为主或以蒽环类抗肿瘤药为主化疗的肿瘤患者,随机交叉采用该药和国产已上市的恩丹西酮预防化疗所致消化道不良反应.结果:接受顺铂为主化疗(顺铂组)14例及接受蒽环类药物化疗(蒽环类组)29例肿瘤患者均先后采用华康格拉司琼和国产上市恩丹西酮预防消化道不良反应,二者对预防强致吐和中度致吐化疗药所致的急性和迟发性恶心与呕吐,疗效基本相同;不良反应基本相似,以便秘、疲倦及头痛为多见,但程度轻,不影响继续治疗.结论:国产新药华康盐酸格拉司琼预防肿瘤患者化疗所致的恶心与呕吐是安全有效的.     

恩丹西酮治疗化疗后恶心呕吐的观察

顺铂等化疗药为高催吐性药物,引起的恶心呕吐往往使化疗难以进行。山东齐鲁制药厂生产的恩丹西酮为高选择性的５－ＨＴ３受体阻滞剂,是高效、低毒的新型止吐药。作者于１９９７年４月至１２月对６０例恶性肿瘤患者化疗同时应用恩丹西酮预防化疗所致恶心呕吐的观察,疗效...     

格拉司琼改进方案治疗化疗后恶心呕吐疗效观察

高选择性 5 - HT3受体拮抗剂格拉司琼是一种高效低毒的新型止吐药 ,我们自 1998年 10月— 1999年 9月对 96例恶性肿瘤病人化疗同时加用格拉司琼等药物止吐 ,取得较满意疗效。1　材料与方法1.1　临床资料　恶性肿瘤患者 96例。男 5 1例 ,女 45例 ,年龄 18岁～ 90岁 ,中位 5 6岁。肺癌 41例 ,乳腺癌 2 2例 ,胃癌收稿日期 :1999-11-17作者单位 :山东省临沂市肿瘤医院 ,山东　临沂　 2 760 0 214例 ,食管癌 12例 ,恶性黑色素瘤 2例 ,其他 5例。所有病人均经病理或脱落细胞学检查确诊。化疗前各项生化检查正常 ,功能状态 Karnofsky>6 0分 ,可以…     

格拉司琼动脉注射预防动脉化疗恶心呕吐的临床研究

目的探讨格拉司琼联合地塞米松动脉注射预防肿瘤动脉导管介入栓塞化疗恶心呕吐的疗效及不良反应。方法回顾性分析221例肝癌动脉介入栓塞化疗病例。观察组133例：动脉插管成功后注入格拉司琼3mg及地塞米松10mg;对照组88例：动脉注入胃复安30mg及地塞米松10mg。分别观察第1、2、3天内的恶心、呕吐发生率,治疗前后进行KPS评分。结果观察组第1天、第2天、第3天有效率分别为：86．5％、85．7％、95．5％;对照组分别为：55．7％、42．1％、84．1％．两组KPS评分下降率分别为：23．3％、47,7％。观察组优于对照组,相差均有显著性。观察组不良反应以便秘为主,无锥体外系反应,对照组锥体外系反应发生率14．8％。结论格拉司琼联合地塞米松动脉注射预防恶性肿瘤动脉介入栓塞化疗的恶心呕吐有效率高,不良反应轻。     

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。     

氟西汀减轻癌症化疗所致恶心呕吐的临床研究

[目的]探讨化疗所致恶心呕吐与抑郁症的关系及临床应用氟西汀进行干预的可行性.[方法]采用随机、前瞻性的自身对照研究,共52例患者入组,34例进行治疗组,接受氟西汀20mg/天,连用14天或以上;对照组18例,未予氟西汀治疗.[结果]化疗所致恶心呕吐的严重程度与抑郁密切相关(Rs=0.225,F=14.505,P=0.000);恶心呕吐情况,治疗组稳定和有效30例(88.2%),对照组11例(61.1%,X2=5.191,P=0.023).氟西汀的副作用少且可耐受.[结论]氟西汀能有效降低恶心呕吐的严重程度,值得临床进一步研究.     

Nausea and vomiting after ENT surgeries: A comparison between ondansetron, metoclopramide and small dose of propofol

Aims

To evaluate the antiemetic efficacy of ondansetron, metoclopramide or small dose of propofol following ear, nose and throat (ENT) surgery.

Materials and methods

A prospective randomized study involving 60 patients, both children and adults undergoing elective ENT surgery under standard general anesthesia. At the completion of surgery the patients received either 0.1 mg/kg of ondansetron or 0.2 mg/kg of metoclopramide or 0.5 mg/kg of propofol intravenously. The patients were observed for 24 hrs after operation for any occurrence of nausea and vomiting.

Results

The incidence of postoperative nausea and vomiting (PONV) during first 24 hrs was recorded in 20%, 70%, 50% of patients who had received ondansetron, metoclopr-amide or propofol respectively (p < 0.05). Fewer patients given ondansetron needed rescue antiemetic. The incidence of PONV was higher following middle year surgery.

Conclusion

It was concluded that ondansetron was most effective in preventing occurrence of PONV while metoclopramide was least effective. Propofol was effective only in 50% of patients, thus not recommended for routine use.     

大剂量顺铂所致恶心、呕吐的联合治疗

目的　观察联合止吐方案 (恩丹西酮 +地塞米松 +安定 +胃复安 +苯海拉明 )对大剂量顺铂化疗所致恶心、呕吐的治疗效果。方法　 5 0例接受大剂量顺铂化疗的恶性肿瘤患者 ,采用自身随机对照的方法 ,分别在第 1周期采用联合止吐方案 ,第 2周期采用常规止吐方案 (胃复安 +苯海拉明 ) ,或者在第 1周期采用常规止吐方案 ,第 2周期采用联合止吐方案 ,以观察联合止吐方案的止吐效果。结果　联合止吐方案 1、2、3天的止吐有效率分别为 90 %、86 %、92 % ,明显高于常规止吐方案 (P <0 0 1)。结论　联合止吐方案止吐效果好 ,减少了恩丹西酮的用量 ,节省了医疗费用 ,便于在临床推广使用。     

Practice Patterns for Prevention of Chemotherapy-Induced Nausea and Vomiting and Antiemetic Guideline Adherence Based on Real-World Prescribing Data

BackgroundGuideline‐recommended antiemetic prophylaxis improves nausea and vomiting control in most patients undergoing chemotherapy. Multinational Association of Supportive Care in Cancer/European Society for Medical Oncology (MASCC/ESMO) antiemetic guidelines recommend prophylaxis with a neurokinin‐1 receptor antagonist (NK₁RA), a 5‐hydroxytryptamine‐3 receptor antagonist (5‐HT₃RA), and dexamethasone for patients receiving highly emetogenic chemotherapy (HEC), including anthracycline‐cyclophosphamide (AC)‐ and carboplatin (considered moderately emetogenic chemotherapy)‐based chemotherapy. Here, we analyze the use of NK₁RA–5‐HT₃RA–dexamethasone for antiemetic prophylaxis associated with HEC and carboplatin.MethodsThe data source was the Global Oncology Monitor (Ipsos Healthcare). Geographically representative physicians from France, Germany, Italy, Spain, and the U.K. were screened for treatment involvement and number of patients treated per month. Patients’ data from January to December 2018 were collected from medical charts and extrapolated on the basis of the total number of physicians who prescribe chemotherapy. The emetic risk of chemotherapy was classified per MASCC/ESMO guidelines.ResultsData from 45,324 chemotherapy‐treated patients were collected, representing a total extrapolated prevalence of 1,394,848 chemotherapy treatments included in the analysis. NK₁RAs were used in 45%, 42%, and 19% of patients receiving cisplatin‐, AC‐, and carboplatin‐based chemotherapy, respectively; 18%, 24%, and 7% received the guideline‐recommended NK₁RA–5‐HT₃RA–dexamethasone combination; no antiemetics were prescribed for 12% of the treatments. Often, physicians’ perception of the emetic risk of chemotherapy did not follow MASCC/ESMO guideline classification.ConclusionLow adherence to antiemetic guidelines was revealed in clinical practice in five European countries, with 15% of all HEC‐/carboplatin‐based treatments receiving guideline‐recommended NK₁RA–5‐HT₃RA–dexamethasone prophylaxis and 12% of them receiving no antiemetics. New strategies for improving guideline adherence are urgently needed.Implications for PracticeDespite recent advances in antiemetic therapy, a substantial proportion of patients experience nausea and vomiting associated with chemotherapy in daily clinical practice. Antiemetic guidelines aim at prevention of chemotherapy‐induced nausea and vomiting (CINV), and guideline‐consistent antiemetic therapy can effectively prevent vomiting and, to a lesser extent, nausea in most patients with cancer. This study reports low adherence to antiemetic guidelines in the highly emetogenic chemotherapy setting in daily clinical practice across five European countries. Opportunity exists to increase adherence to antiemetic guideline recommendations. Implementation of strategies to facilitate guideline adherence can potentially improve CINV control.     

国产甲孕酮加强预防化疗消化道反应的效果比较

目的 :比较恩丹西酮、恩丹西酮 地塞米松、恩丹西酮 地塞米松 国产甲孕酮 (倍恩胶囊 )三种止吐方案预防化疗消化道反应的疗效。方法 :以中等剂量顺铂或阿霉素为主化疗的患者 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 ,单用恩丹西酮、恩丹西酮 地塞米松、恩丹西酮 地塞米松 倍恩胶囊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 6 3%、80 %、90 % ,差别具有显著性 (χ2 =6 .3,P <0 0 5 ) ;对于食欲不振 ,三个方案的有效率分别为 17%、5 3%、80 % ,有极显著差异 (χ2 =2 4 .2 7,P <0 0 0 5 )。结论 :单独使用恩丹西酮不足以完全预防化疗消化道反应 ,加用地塞米松后效果有所提高 ,但以恩丹西酮 地塞米松 倍恩胶囊最好 ,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 地塞米松     

Olanzapine for Preventing Nausea and Vomiting Induced by Moderately and Highly Emetogenic Chemotherapy

Nausea and vomiting are common adverse events in chemotherapy. In spite of the serious effects on thequality of life and further treatment, they remain overlooked by physicians, and no standard treatment has beendeveloped. Neurokinin-1 (NK-1) receptor antagonists and palonosetron are the major agents in the standardregimen for treating moderately and highly emetogenic chemotherapy-induced nausea and vomiting (CINV).However, NK-1 receptor antagonists first became commercially available at the end of 2013 and palonosetronhas not been extensively applied in China. Olanzapine was recommended as a therapy for moderate and severeCINV in antiemesis-clinical practice guidelines in oncology in 2014 for the first time. It is an atypical antipsychoticagent, which can block multiple receptors on neurotransmitters. During more than 10 years, olanzapine hasdemonstrated significant effects in preventing CINV and treating breakthrough and refractor CINV, which wasobserved in case reports, precise retrospective studies, and phase Ⅰ, Ⅱ and Ⅲ clinical trials, with no grade 3 to4 adverse events. In particular, it is superior to aprepitant and dexamethasone in delayed nausea and vomiting.Therefore, this compound is worthy of further investigation.