Objective To investigate the patient’s psychological anticipation and occurrence of chemotherapy-induced nausea and vomiting (CINV), and to assess the influence of CINV on quality of life, so as to provide evidence for clinical doctors to recognize and pay attention to CINV. Methods The patients in the Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science and Technology who took either moderately emetogenic chemotherapy (MEC) or highly emetogenic chemotherapy (HEC) were randomly sampled with a questionnaire for two circles. Patients were asked to record the following indexes before chemotherapy, on the second day and the sixth day of chemotherapy: acute and delayed nausea and vomiting, independently taking antiemetics, and functional living index-emesis (FLIE). Then, descriptive analysis and multiple linear regression analysis were adopted for the outcomes of investigation. Results A total of 344 patients were investigated, of which 303 fulfilled the questionnaire finally. For the single-day chemotherapy, the acute nausea and vomiting, delayed nausea vomiting and overall complete remission in the MEC group were 86.1%, 76.6%, and 71.5%, respectively; while those of the HEC group were 84.1%, 71.0%, and 66.7%, respectively. For the multi-day chemotherapy, the acute nausea and vomiting, delayed nausea vomiting and overall complete remission were 93.8%, 64.9%, and 64.9%, respectively. Patients’ expectation of nausea and anticipatory anxiety was closely related to the delayed nausea in their prior circle of chemotherapy. Based on the FLIE assessment, about 30% of all patients reported reduced daily living function. Conclusion CINV remains a significant problem among patients in China, especially in controlling the reaction during delayed phase and nausea as well. It requires that more attention should be paid to CINV and more effective prophylaxis should be adopted in clinical practice.
Objective?To evaluate the efficacy and safety of 5 HT-3 receptor inhibitor tropisetron injected in the postoperative nausea and vomiting (PONV) after general anesthesia. Methods?We searched the PubMed, EBSCO, Springer, Ovid, and CNKI to identify randomized controlled trials (RCTs) about tropisetron in preventing PONV after general anesthesia from January 1995 to September 2009. We also consulted references of the included studies for omission. The methodological quality of the included RCTs was assessed and data were extracted according to the standard of the Cochrane Handbook 5.0.1. The meta-analyses were performed by RevMan 4.2.10 software. Results?A total of 17 RCTs involving 4 678 patients were included. The results of meta-analyses showed that: (1) Efficacy: tropisetron injected could decrease the incidence of PONV after general anesthesia (RR=0.41, 95%CI 0.29 to 0.60), and decrease the incidence of PONV after general anesthesia with opioid drugs in patient controlled analgesia (RR=0.30, 95%CI 0.15 to 0.60); tropistron injected once or more could decrease the incidence of PONV in combination of PCA with tramadol (RR=0.41, 95%CI 0.29 to 0.56; RR=0.10, 95%CI 0.06 to 0.19); and tropisetron combined with dexamethasome could also lessen the incidence of PONV (RR=0.27, 95%CI 0.13 to 0.57). (2) Safety: Tropisetron injected could lessen the incidence of postoperative headache and dizziness (RR=0.35, 95%CI 0.16 to 0.75), but could not significantly decrease the pruritus and somnolence. Conclusion?Tropisetron injected can significantly decrease the incidence of PONV after general anesthesia, and it will not increase the adverse effect and the incidence of postoperative complications. Furthermore, it has also the advantage of decreasing postoperative headache and dizziness.
目的 探讨针刺治疗在防治术后恶心呕吐（PONV）中的作用与疗效。 方法 通过对2012年6月收治的1例全身麻醉下行小脑血肿清除术后出现持续性恶心呕吐症状，后辅以针刺治疗好转的病例报道，就针刺治疗对PONV的穴位选择，刺激方式，介入时间等相关研究进行复习和总结。 结果 患者恶心呕吐症状在选取中脘、足三里（双）、内关（双）穴针刺治疗3次后（30 min/次）明显减少，自诉恶心程度较前缓解，连续针灸6次后呕吐现象得到有效控制。 结论 目前有关针刺治疗PONV的研究越来越多，但尚无统一的治疗标准。
【摘要】 目的 观察曲马多超前镇痛对经腹子宫切除术患者术后疼痛和恶心呕吐的影响。 方法 2008年11月-2009年5月，40例全身麻醉下行经腹子宫切除术的患者，分为超前镇痛组和对照组（n=20）。超前镇痛组和对照组于麻醉诱导前30 min分别静脉注射曲马多（3 mg/kg）和生理盐水。术后12、24 h，观察Bolus次数和芬太尼的用量，患者疼痛评分及术后恶心呕吐的发生率。 结果 术后12、24 h，曲马多超前镇痛组Bolus次数和芬太尼的用量均小于对照组（Plt;0.05），术后恶心呕吐的发生率差异无统计学意义（Pgt;0.05）。 结论 经腹子宫切除术手术前给予曲马多超前镇痛能够减少术后镇痛药的需要量，且不增加术后恶心呕吐的发生率。【Abstract】 Objective To observe the effects of tramadonl preemptive analgesia on postoperative pain and postoperative nausea and vomiting (PONV) in patients with hysterectomy. Methods Form November 2008 to May 2009, fourty patients who had undergone hysterectomy were divided into preemptive analgesia (PA) group and control group, 20 patients in each. The PA and control group were intravenously injected with tramadol (3 mg/kg) and normal saline respectively. Twelve and 24 hours after hysterectomy, the Bolus times, consumption of fentanil, pain score and incidence of PONV were observed. Results Twelve and 24 hours after hysterectomy, the Bolus times and consumption of fentanil were both lower than those in control group(Plt;0.05), the difference of PONV incidences between two groups was not statistically significant (Pgt;0.05). Conclusion Intravenously injected with tramadol before hysterectomy can recduce the dosage of analgesic, and don′t increase the incidence of PONV.
目的 探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）中不同CO2气腹压力对患者肝功能、动脉血气及对颈、肩痛的影响。方法 选择行择期LC术患者120例，采用随机数字表法，按住院先后顺序对应入组，随机均分为气腹压力10mmHg （1 mm Hg=0.133kPa）组、12mmHg组及14mmHg组3组；对比分析3组患者手术后肝功能、血气指标以及术后当天、第1和第2天恶心、呕吐及颈肩部疼痛的发生率。结果 3组患者术前各参数组间比较差异均无统计学意义（P＞0.05）。术后肝功能及血气分析指标的改变3组间的差异有统计学意义（P＜0.05），气腹压力越大，其术后AST、ALT及TBIL水平升高越明显，而pH及PO2的下降越明显，PCO2的升高也越明显；术后患者颈、肩痛及恶心呕吐发生率3组间比较差异也有统计学意义（P＜0.05），气腹压力越大，术后颈、肩痛及恶心呕吐发生率越高。结论 CO2气腹压力对术后肝功能及动脉血气指标的改变以及术后颈、肩痛和恶心呕吐发生率有明显影响。
ObjectiveTo systematically review the effect of dexamethasone in preventing post-operative nausea and vomiting (PONV) associated with epidural opioids for post-cesarean section analgesia. MethodsWe searched PubMed, EMbase, CNKI, WanFang Data and CBM databases from inception to Dec. 31th 2015, to collect randomized controlled trials (RCTs) comparing dexamethasone with placebo/blank for the prevention of PONV associated with epidural opioids for postcesarean section analgesia. Two reviewer independently screened literature, extracted data, and assess the risk of bias of included studies. Then, meta-analysis was conducted by using RevMan 5.3 software. ResultsA total of 11 RCTs from 10 papers involving 1 011 patients were included. The results of meta-analysis showed that, compared with the placebo/ blank group, the dexamethasone group had lower incidence rates of post-operative nausea (RR=0.50, 95% CI 0.39 to 0.65, P < 0.000 01), postoperative vomiting (RR=0.39, 95% CI 0.29 to 0.52, P < 0.000 01), PONV (RR=0.37, 95% CI 0.30 to 0.46, P < 0.000 01), and rescue antiemetic (RR=0.34, 95% CI 0.19 to 0.62, P=0.000 5). ConclusionsCurrent evidence indicates that dexamethasone is effective for preventing PONV after epidural opioids for post-cesarean section analgesia. Due to the limited quantity and quality of the included studies, the above conclusion needs to be further verified by more high quality studies.
Objective To systematically evaluate the efficacy and safety of palonosetron hydrochloride injection for the prevention of chemotherapy-induced nausea and vomiting (CINV) associated with moderately or highly emetogenic chemotherapy. Methods Searched PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Biological Medical Database, Wanfang Database and VIP Chinese Science and Technology Journal Database to find domestic and abroad published literatures of palonosetron used to control CINV associated with moderately or highly emetogenic chemotherapy. Two reviewers independently selected literatures, extracted data and assessed quality of the included studies by the Cochrane handbook 5.1. Meta-analysis was performed using RevMan 5.3 software. Results Twenty trials involving 4 919 patients were included. The results of meta-analysis showed statistically significant differences between palonosetron and first-generation 5-hydroxytryptamine3 receptor antagonists (5-HT3RAS) in prevention of acute〔RR=1.09, 95%CI (1.40, 1.14),P=0.000 4〕, delayed 〔RR=1.26, 95%CI (1.15, 1.37),P＜0.000 01〕, and overall phase of CINV 〔RR=1.19, 95%CI (1.10, 1.30),P＜0.000 1〕. Subgroup analyses indicated that there were no statistical significances between palonosetron and granisetron (P=0.09) or ondansetron (P=0.08) in prevention of acute CINV, as well as between palonosetron and first-generation 5-HT3RAS in prophylaxis of moderately CINV (P=0.18), while there was statistical significance in favor of palonosetron in prophylaxis of delayed and overall phase of CINV. Compared with first-generation 5-HT3RAS, there were different in prophylaxis of highly chemotherapy-induced acute〔RR=1.10, 95%CI (1.02, 1.18),P=0.01〕, delayed〔RR=1.20, 95%CI (1.06, 1.36),P=0.005〕, and overall phase〔RR=1.18, 95%CI (1.04,1.33),P=0.008〕of CINV. In terms of safety, such as headache, constipation, diarrhea and dizziness, there were no statistical differences between two groups. Conclusions Palonosetron hydrochloride injection showed efficacy in prophylaxis of moderately or highly CINV, and didn't increase adverse events. Palonosetron hydrochloride injection is more better than first-generation 5-HT3RAS, especially in prevention of highly CINV, and can significantly improve the control rate of acute, delayed, and overall phase of CINV.