Ondansetron预防眼科全麻术后恶心、呕吐的临床观察

Ondansetron是一种新型的强效、具有高度选择性的5-HT3受体拮抗剂，已广泛用于癌症病人化疗所致的恶心、呕吐的预防和治疗。最近有研究表明Ondansetron对术后恶心、呕吐有预防和治疗效果。我院于2001年1～4月对眼科全麻手术病人用或不用Ondansetron的术后恶心、呕吐的发病情况进行了双盲法比较观察，以探讨Ondansetron预防和治疗术后恶心、呕吐的效果。……

专属性5—HT_3受体拮抗剂—Ondansetron的药理学与临床应用

Ondansetron(商品名:枢复宁,Zofran)的化学名为1、2、3、9,—四氢—9—甲基—3—〔(2—甲基—1H—眯唑基—1—)甲基〕—4H—咔唑酮,是第一个用于临床的专属性5—HT_3受体拮抗剂,是预防和治疗由化疗药物引起的恶心和呕吐的安全有效药物,该药由英国葛兰素药厂开发,并于1991年上市,我国已批准进口,但价格昂贵,为了减轻癌症患者的痛苦和降低治疗费用,国内齐鲁制药厂与中国医科院药物所共同研制和生产了Ondansetron,现已获得卫生部颁发的新药证书和试生产文号。

Postoperative Nausea and Vomiting Prophylaxis with Ondansetron in Diagnostic Gynecologic Laparoscopy: Preemptive versus Preventive Method

Background and Objective: Post-operative nausea and vomiting (PONV) is a common adverse effect of the anesthesia in laparoscopic surgery. Ondansetron has been used for prevention and treatment of the PONV. The purpose of the present study was to compare the effects of preemptive and preventive intravenous ondansetron on PONV in patients undergoing diagnostic gynecologic laparoscopy. Materials & Methods: In a randomized double-blind clinical trial, 80 women candidate of diagnostic laparoscopy, were enrolled to study in two preemptive or preventive groups (n = 40). Ondansetron 4 mg IV was administered 5 min before anesthesia induction or 5 min before extubation in preemptive or preventive groups, respectively. The frequency and severity of the PONV were compared at post-anesthetic care unit (PACU), 3th, 6th and 24th postoperatively in two groups. Also the first time of need for the antiemetic drug was studied. Results: Demographic data were similar but duration of anesthesia was shorter in preventive group. The PONV rate was similar in two groups [(37.5% and 32.5% in preemptive and preventive groups, respectively (P = 0.815)]. In preemptive group it was more intense at PACU and 24 hours after surgery (P-value <0.05) and rate of vomiting was high (11 vs. 3, P-value 0.037). The first request for antiemetic drug was earlier and the antiemetic consumption dose (P-value <0.05), recovery and hospital stay times were high in preemptive group (P-value = 0.001). Conclusion: Preventive ondansetron is more effective than preemptive form, in reducing the severity of PONV but not rate of the PONV in diagnostic gynecologic laparoscopy.

Ondansetron and Hypothermia Induced Cardiac Arrest in a 97-Year-Old Woman: A Case Report

Background:Ondansetron and hypothermia are both known to induce bradycardia or QT interval prolongation,thus placing affected patients at risk of cardiac arrest.Case Report:Herein,we report the case of a 97-year-old woman who initially presented with confusion and hypothermia,and experienced severe bradycardia and asystolic cardiac arrest after a 4 mg intravenous ondansetron bolus injection.Conclusion:Ondansetron is associated with bradycardia and QTc prolongation,both of which might be further exacerbated by hypothermia.Clinicians should be aware that administering ondansetron in patients with hypothermia might further increase the risk of adverse cardiac events and eventual cardiac arrest.

A Randomized Controlled Trial Comparing the Efficacy of P6 Acupuncture Plus Ondansetron versus Ondansetron or P6 Acupuncture in the Prevention of Nausea and Vomiting after Bupivacaine-Morphine Spinal Anesthesia

Objective: To compare P6 acupuncture plus ondansetron with either ondansetron or P6 acupuncture in the prevention of postoperative nausea and vomiting (PONV) in patients submitted to spinal anesthesia. Methods: A randomized controlled trial was performed with 90 patients undergoing orthopedic surgery under spinal anesthesia with bupivacaine, 15 to 17.5 mg, and morphine, 100 μg. They were assigned to one of the three groups: Group Ondansetron (n = 30), patients were given ondansetron, 8 mg intravenously, before spinal block was performed;Group P6 acupuncture (n = 30), patients were subjected to bilateral electrical stimulation of P6 acupoint for 30 minutes before anesthesia;and Group P6 acupuncture plus ondansetron (n = 30), the exact combination of the groups Ondansetron and P6 acupuncture. Results: In the post anesthesia care unit, the incidence of nausea and vomiting ranged from 13.3% to 26.7% and from 6.7% to 13.3%, respectively, with no significant differences among groups (p > 0.05). Ondansetron group had the highest incidence of nausea (73.3%) (p < 0.001) and vomiting (43.3%) (p < 0.001) at the ward from 0 to 24 hours, followed by P6 acupuncture (33.3% and 26.7%) and P6 acupuncture plus ondansetron groups (16.0% and 0%). Conclusion: Preoperative stimulation of P6 acupoint in combination with ondansetron has higher efficacy than either P6 acupoint stimulation or the administration of ondansetron on the prevention of PONV in patients submitted to bupivacaine-morphine spinal anesthesia.

Repeated generalized seizures shortly after single intramuscular dose is an additional reasonable cause to restrict the use of ondansetron: A case report

Background: Ondansetron, a 5-hydroxytryptamine (5-HT) receptor antagonist, is generally regarded as a safe and well tolerated antiemetic. Meanwhile, some reports mentioned that it is a probable cause of single generalized seizures after intravenous administration. Our report may be the first to indicate repeated generalized seizures after intramuscular therapeutic dose of ondansetron. Methods and Results: We report a 24-year-old female with nausea and vomiting related to gastritis that experienced repeated ondansetron-induced seizures shortly after a single intramuscular therapeutic dose. Two minutes after intramuscular injection of 4 mg ondansetron, our patient developed the first generalized seizure. Within the following two hours, seizures occurred two more times. In the emergency department, the patient developed a fourth, but weaker and shorter, generalized seizure. The patient was not hypoglycemic, but her blood hemoglobin and serum electrolytes were below normal. A few hours later, the patient was discharged. The dramatic onset of the seizures, as well as the complete recovery and absence of any neurological sequel in our patient, indicated that it was probably related to ondansetron. Conclusion: Patients should be informed about the potential side effects of ondansetron especially the life-threatening repeated generalized seizures, and clinicians should restrict its use to hospitalized patients.

Palonosetron versus Ondansetron as Prophylaxis against Postoperative Nausea and Vomiting (PONV) after Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Trial

Introduction: Postoperative nausea and vomiting (PONV) are prevalent symptoms after laparoscopic surgeries with an incidence rate of (54% - 79%) in bariatric procedures. Despite its popularity, limited studies assessed the effect of antiemetics for PONV prophylaxis after laparoscopic sleeve gastrectomy (LSG). The aim of this trail is to compare the effectiveness of a single pre-induction intravenous dose of Palonosetron versus Ondansetron for prophylaxis of PONV, 24 hours after LSG. Subjects and Methods: This prospective randomized controlled double-blind parallel-group study was conducted from May till December 2019. Recruited patients were consented and randomized using a closed envelop method into two groups with fifty patients each. The total number of nausea and vomiting attacks in the 24 hours postoperatively was considered as a primary end point. The secondary end points were the frequency of nausea, retching and vomiting attacks in the 24 hours post-surgery. The severity of nausea was evaluated using a 10 cm visual analogue scale (VAS). Results: This RCT included 100 patients divided into 2 groups of 50 patients each. Patients received either 75 mcg Palonosetron (Group I) or Ondansetron 4 mg (group II). Group I had statistically significant fewer episodes of nausea, retching and vomiting in the first 4 hours (P = 0.022) and from 4 to 12 hours (P = 0.024) but not after 12 hours post LSG. Total episodes of nausea, retching and vomiting in 24 hours postoperative were significantly less in group I (P = 0.021). Conclusion: A single dose of intravenous 75 mcg Palonosetron is superior to Ondansetron 4 mg in preventing PONV for patients after LSG.

ONDANSETRON对防治介入化疗引起恶心呕吐的作用

动脉插管灌注化疗治疗肿瘤中,化疗药物引起的毒副作用,虽比全身化疗轻,但不宜忽视,尤其是消化道反应(恶心、呕吐),可在治疗中或以后出现。一直是医生较大的困扰,而ondansetron(枢复宁)的应用,则对克服呕吐等带来了希望,就此笔者以84例动脉灌注化疗治疗肿瘤应用枢复宁的情况作一报道。

5HT_3受体拮抗剂的止吐作用:ICS205-930和Ondansetron的临床研究

恶心和呕吐是肿瘤化疗中最令人头痛的副作用,三十年前发现的氮芥类是细胞毒药物中一种最严重的致吐剂,顺铂、蒽环类抗生素和其它烷化剂,虽增强了肿瘤化疗效果,但也加剧了呕吐作用,有时化疗所致的恶心和呕吐严重到不得不推迟甚至拒绝治疗的程度。胃复安(Metoclopramide)是现用的有效止吐剂,但仅在大剂量时才能减轻呕吐,此时常导致锥体外副作用,如牙关紧闭、斜颈、面部痉挛、角弓反张、眼球盲动、坐立不安等。5HT_3受体拮抗剂能抑制细胞毒素和X射线所引起的呕吐,又不产生锥体外副作用,是一种很有希望的止吐药物。目前临床上至少有五种5HT_3受体拮抗剂,如ICS205-930、Granisetron(BRL43694)、Ondansetron(GR38032F)、Batanopride(BMY-25801)、Zacopride。

隔物灸辅助昂丹司琼预防淋巴瘤化疗相关恶心、呕吐的效果

目的 探讨隔物灸辅助昂丹司琼对淋巴瘤化疗相关恶心、呕吐的预防效果。方法 选取2019年1月至2022年7月在台州市中心医院(台州学院附属医院)治疗的淋巴瘤化疗患者共计112例,按照随机数字表法将其分成研究组和对照组,每组56例。对照组给予昂丹司琼治疗,研究组给予隔物灸辅助昂丹司琼治疗。比较两组化疗结束后7 d恶心、呕吐发生率、症状积分、生活质量。结果 研究组恶心、呕吐发生率低于对照组,差异有统计学意义(P<0.05)。研究组恶心、呕吐积分低于对照组,差异有统计学意义(P<0.05)。研究组躯体功能、认知功能、社会功能、情绪功能评分高于对照组,差异有统计学意义(P<0.05)。结论 隔物灸辅助昂丹司琼应用于淋巴瘤化疗患者中,可提高恶心、呕吐预防效果,缓解恶心、呕吐症状,提高生活质量。

昂丹司琼预防性用药对急性冠脉介入手术患者恶心呕吐发生和负性情绪的影响

目的:探讨昂丹司琼预防性用药对急性冠脉介入手术患者恶心呕吐发生和负性情绪的影响。方法:选取2018年1月—2021年5月急诊行经皮冠状动脉介入(PCI)术治疗的患者120例,将患者按照随机数字表法分为对照组与研究组,每组60例,两组患者均行PCI术治疗,研究组给予负荷剂量的阿司匹林和氯吡格雷双抗药物治疗之前经静脉注射昂丹司琼4 mg,对照组双抗药物治疗之前不给予止吐药物,观察患者术中及术后24 h内恶心呕吐发生情况,采用抑郁自评量表(SDS)和焦虑自评量表(SAS)对患者术前及术后48 h时负性情绪进行评价,调查患者对恶心呕吐干预的满意度。结果:研究组患者术中及术后24 h内恶心呕吐发生率分别为21.67%和33.33%,对照组分别为46.67%和61.67%,研究组术中及术后24 h恶心呕吐发生率低于对照组,比较差异均有统计学意义(P<0.05);研究组术中及术后24 h内恶心呕吐发生次数、持续时间及严重程度少于(低于)对照组,比较差异均有统计学意义(P<0.05)。两组患者术前SDS及SAS评分比较差异无统计学意义(P>0.05),术后评分与术前比较下降,且研究组评分低于对照组,比较差异均有统计学意义(P<0.05)。研究组患者满意度整体高于对照组,比较差异均有统计学意义(P<0.05)。结论:急性冠脉介入手术患者术前预防性应用昂丹司琼可有助于降低术前及术后24 h内恶心呕吐发生率、发生次数及严重程度,间接改善患者负性情绪。

穴位针刺疗法联合昂丹司琼治疗乳腺癌术后化疗相关性恶心呕吐的临床效果

目的穴位针刺疗法联合昂丹司琼治疗乳腺癌术后化疗相关性恶心呕吐(CINV)的效果。方法选取河南省肿瘤医院2019年9月至2021年9月收治的乳腺癌术后患者98例,采用随机数字表法分为对照组(n=52)和针刺组(n=46)。对照组接受昂丹司琼,针刺组在此基础上接受穴位针刺疗法。对比两组临床疗效,在急性期、迟发期和持续期的恶心视觉模拟评分(VAS)和呕吐次数、生活功能量表(FLIE)评分和卡氏功能状态(KPS)评分及血清5-羟色胺(5-HT)水平变化。结果经过治疗后,在急性期、迟发期和持续期针刺组治疗有效率较高(P<0.05);治疗后针刺组在急性期、迟发期和持续期恶心VAS评分和呕吐次数较对照组低(P<0.05);针刺组在急性期、迟发期和持续期FLIE评分和KPS评分较对照组高(P<0.05);针刺组在急性期、迟发期和持续期血清5-HT水平较对照组低(P<0.05)。结论采用穴位针刺疗法联合昂丹司琼治疗乳腺癌术后CINV具有较好的疗效,能够减少恶心呕吐次数,提高患者生活质量,值得在临床上推广应用。

美沙拉秦联合昂丹司琼对溃疡性结肠炎患者肠黏膜屏障功能及炎症因子水平的影响

目的探讨美沙拉秦联合昂丹司琼对溃疡性结肠炎(UC)患者肠黏膜屏障功能及炎症因子水平的影响。方法选取2019年4月至2022年4月在中国人民解放军联勤保障部队第九二四医院消化内科治疗的80例UC患者,按随机数字表法分为观察组和对照组,各40例。对照组给予美沙拉秦治疗;观察组在对照组基础上给予昂丹司琼治疗。比较2组治疗前后肠黏膜屏障功能指标[二胺氧化酶(DAO)、D-乳酸]、炎症因子[肿瘤坏死因子α(TNF-α)、白细胞介素17(IL-17)、IL-23]水平,治疗2、4、8周肠黏膜愈合率和临床疗效。结果治疗后,观察组DAO、D-乳酸、TNF-α、IL-17、IL-23水平均低于对照组(均P<0.05)。观察组治疗2、4、8周肠黏膜愈合率均高于对照组(均P<0.05)。观察组治疗总有效率高于对照组[95.0%(38/40)比67.5%(27/40)](P=0.002)。结论对UC患者采用美沙拉秦联合昂丹司琼进行治疗,可改善肠黏膜屏障功能,降低炎症因子水平,提高肠黏膜愈合率和治疗有效率。

术前应用昂丹司琼和地佐辛对无痛负压吸宫术舒适度的影响

目的:探讨术前应用昂丹司琼和地佐辛对无痛负压吸宫术受术者舒适度的影响。方法:2022年3月对200例ASA I~II级无痛负压吸宫术者进行术后舒适度调查(对照组),2022年4月入选200例ASA I~II级无痛负压吸宫术受术者(观察组),于术前5min给予地佐辛注射液5mg和昂丹司琼注射液4mg入壶。两组均静脉缓慢推注丙泊酚2mg/kg和瑞芬太尼2μg/kg进行全身麻醉的诱导和维持。比较两组消毒阴道时是否舒适、术后恶心呕吐和腹痛情况,及手术时间,手术结束至苏醒时间,离室时间。结果:观察组阴道消毒时不适感发生率由90%降至为0;术后中重度腹痛发生率由56.5%降至4.5%,VAS评分由(6.3±1.8)分降至(2.8±1.8)分;术后恶心呕吐发生率由36.5%降至5.5%;观察组苏醒时间和离室时间未发生延迟(P>0.05)。结论:无痛负压吸宫术前应用昂丹司琼和地佐辛可以提高受术者的舒适度。

姜辣素穴位敷贴对全麻患者术后恶心呕吐的作用及机制

目的探讨姜辣素穴位敷贴对全麻患者术后恶心呕吐(PONV)的作用及机制。方法67例全麻患者分为对照组(手术结束前静脉滴注昂丹司琼注射液4 mg)和观察组(全麻诱导前和术后24 h姜辣素穴位敷贴),收集2组患者一般资料信息,记录术后第1天、第2天及第3天PONV和不良反应的发生情况,采用视觉模拟(VAS)评分和Osoba量表评估PONV发生的严重程度和对患者生活质量的影响;抽取2组患者术前及术后第1天外周静脉血,采用酶联免疫吸附法检测血清5-羟色胺(5-HT)、胃动素(MTL)及胃泌素(GAS)水平。结果观察组患者术后第1天和第2天PONV发生率低于对照组(P<0.05),观察组患者术后第1天、第2天及第3天VAS评分明显低于对照组(P<0.001);观察组患者术后第1天和第2天CR、CC均高于对照组(P<0.05或P<0.01);2组患者术后第1天血清5-HT、MTL及GAS均高于术前,且观察组患者<对照组(P<0.05或P<0.01);观察组患者术后第1天和第2天Osoba评分低于对照组(P<0.05);2组患者术后3 d内不良反应检出率比较,差异无统计学意义(χ^(2)_(校正)=2.688,P=0.101)。结论姜辣素穴位敷贴可有效预防全麻患者术后PONV的发生,且可减轻PONV发生的严重程度,提高患者生活质量,可能与抑制5-HT、MTL及GAS的表达有关。

丁香柿蒂散加味穴位贴敷联合昂丹司琼治疗肺癌顺铂化疗后恶心呕吐的疗效观察

目的探讨丁香柿蒂散加味穴位贴敷联合昂丹司琼治疗肺癌顺铂化疗后恶心呕吐的临床疗效及安全性。方法选取2017年7月至2019年7月北京中医药大学房山医院肿瘤科住院并行顺铂联合方案化疗的的59例肺癌患者作为研究对象,采用随机数字表法分为对照组(n=29)与实验组(n=30)。对照组给予昂丹司琼注射液止吐,实验组在对照组基础上联合中药穴位敷贴止吐,比较两组临床疗效、卡氏功能状态(KPS)评分、安全性及生命质量评分。结果化疗第1、2天,两组恶心呕吐缓解总有效率比较差异无统计学意义;化疗第3~6天,实验组恶心呕吐缓解总有效率均明显高于对照组,差异有统计学意义(P<0.05)。治疗前,两组KPS评分比较差异无统计学意义;治疗后,两组KPS评分均低于治疗前,且实验组低于对照组,差异有统计学意义(P<0.05)。两组白细胞、血红蛋白、血小板、谷丙转氨酶、肌酐异常情况比较差异无统计学意义。治疗前,两组整体功能、特异症状评分比较差异无统计学意义;治疗后,两组整体功能评分均低于治疗前,特异症状评分均高于治疗前,但实验组整体功能评分高于对照组,特异症状评分低于对照组,差异有统计学意义(P<0.05)。结论丁香柿蒂散加味穴位贴敷联合昂丹司琼治疗肺癌顺铂化疗后恶心呕吐临床疗效显著,可改善患者恶心呕吐症状,提高其生命质量,且安全性较高,值得临床推广应用。

地佐辛联合昂丹司琼治疗肱骨近端骨折术后疼痛的临床疗效观察

目的观察地佐辛联合昂丹司琼治疗肱骨近端骨折(PHF)术后疼痛的临床疗效。方法选择2019年11月至2021年10月于宜春市中医院治疗的86例PHF患者,按随机数字表法将其分为两组,各43例。对照组采用舒芬太尼+昂丹司琼术后静脉自控镇痛(PCIA),观察组采用地佐辛+昂丹司琼术后PCIA。比较两组镇痛、镇静效果、PCIA按压次数、P物质(SP)、5-羟色胺(5-HT)及不良反应。结果观察组术后2 h、12 h时Ramsay评分[(2.91±0.60)分、(2.75±0.49)分]低于对照组,呼吸抑制发生率(4.65%)低于对照组(P<0.05);两组术后2 h、12 h时视觉模拟评分法(VAS)评分、PCIA按压次数及术后SP、5-HT、恶心、呕吐发生率比较,差异无统计学意义(P>0.05)。结论地佐辛联合昂丹司琼用于PHF患者术后镇痛、镇静效果确切,且呼吸抑制发生率低,临床应用安全性高,可为PHF患者术后镇痛管理提供指导。

一种新型呕吐动物模型——水貂

目的 用水貂建立一种新型呕吐动物模型。方法 将水貂随机分组 ,给予 3种经典致呕剂顺铂、阿朴吗啡、硫酸铜及X射线全身照射 ,测定致吐反应和抗呕吐药的抗呕吐反应 ,最后取水貂肠管进行 5 HT免疫组化检测。结果 顺铂 ( 7 5mg·kg- 1 ,ip)、阿朴吗啡 ( 1 6mg·kg- 1 ,sc)和硫酸铜 ( 40mg·kg- 1 ,ig) 3种致呕剂均使水貂发生恶心、干呕和呕吐 ,顺铂引起水貂呕吐的阈值剂量为 5mg·kg- 1 。昂丹司琼和甲氧氯普胺可抑制顺铂和阿朴吗啡所致的干呕、呕吐。 5 HT免疫组化结果提示 ,肠道EC细胞 5 HT释放参与呕吐的发生机制。结论 水貂可作为一种新型呕吐模型 。

托烷司琼治疗腹部手术后恶心、呕吐的多中心随机对照研究

目的:评价iv单剂量(2 mg)托烷司琼对全身麻醉下的腹部手术后病人出现的恶心和(或)呕吐症状的疗效。方法:采用前瞻、随机、对照、平行和多中心的实验设计,患者共64例,全麻术后神智清醒、出现中度以上的恶心症状和(或)呕吐,立即通过iv托烷司琼2 mg(试验组)或昂但司琼4 mg(对照组)观察用药后24 h内,呕吐和恶心程度的变化,比较两组之间的差别。结果:完成研究61例,淘汰3例,淘汰率为4.7％;托烷司琼和昂但司琼均能显著缓解全麻术后发生的呕吐和恶心症状,其呕吐和恶心平均停止时间、用药后24 h发生呕吐病例数和呕吐病人平均呕吐次数,两组比较结果相似,研究者和病人自身评价,两种药物的疗效相似(P>0.05)。结论:托烷司琼单剂量(2 mg)对全身麻醉外科腹部手术后病人发生的呕吐和(或)恶心症状有较好的疗效。

国产恩丹西酮预防化疗引起恶心呕吐80例临床观察

采用随机对照法观察了恩丹西酮对８０例顺铂及非顺铂类化疗药的止吐作用，化疗第１周期用思丹西酮或胃复安，第２周期交换。结果显示，恩丹西酮对控制急性呕吐的有效率为９１．３％，而胃复安仅为５８．８％（ｐ＜０．０１）；其对非顺铂类的止吐作用，前２天优于顺铂（Ｐ＜０．０５）；它对迟发性呕吐的疗效也优于胃复安。本研究认为，恩丹西酮控制顺铂及非顺铂类化疗引起的恶心呕吐均有良好的疗效，副作用少。