摘要目的回顾性分析接受中高度致呕性化疗方案的恶性肿瘤患者出现爆发性呕吐后使用甲氧氯普胺联合奥氮平解救处理的疗效。方法本院2013年8月至2014年3月接受含铂类、蒽环类药物等中高度致呕性化疗方案的恶性肿瘤患者，化疗前常规止呕处理后出现爆发性呕吐的患者68例。其中46例接受高度致呕性化疗方案，常规止呕处理为化疗前30 min接受帕诺洛司琼0．25 mg静脉注射d1，联合地塞米松10 mg静脉注射d1～3；22例接受中度致呕性化疗方案，常规止呕处理为化疗前30 min接受昂丹司琼8 mg静脉注射d1～2，联合地塞米松10 m g静脉注射d1～3。化疗后确认出现爆发性呕吐后，予以甲氧氯普胺20 m g肌注、奥氮平10 m g口服，每天一次，使用3 d解救，监测解救用药后0～72 h的恶心、呕吐缓解状况以及其它不良反应发生情况。结果68例分别接受高度和中度致呕性化疗方案患者，解救治疗后其呕吐、恶心完全缓解率分别为80．9％（55／68）、75．0％（51／68）；不良反应主要为嗜睡13．2％（9／68）、疲劳10．3％（7／68）、头晕7．4％（5／68）等，未见明显的3～4级毒性反应。结论甲氧氯普胺联合奥氮平解救中高度致呕性化疗方案导致的爆发性呕吐有较好的疗效，无明显毒副作用，值得临床进一步推广。
Abstract：[Objective] To retrospectively analyze the efficacy of olanzapine combined with metoclopramide to treat explosive chemotherapy‐induced nausea and vomiting in patients with malignant tumor cancer receiving moderately and highly emetogenic chemotherapy .[Methods] Patients with malignant cancer receiving moder‐ately and highly emetogenic chemotherapy(platinum and anthracyclines) were chosen .Among 68 patients with explosive nausea and vomiting after conventional anti‐vomiting treatment before chemotherapy ,46 patients with highly emetogenic chemotherapy were treated with conventional anti‐vomiting therapy i .e .palonosetron 0 .25mg intravenously at d1 and dexamethasone 10mg intravenously once daily at d1~3 30min after chemothera‐py ,and 22 patients with moderately emetogenic chemotherapy were treated with conventional anti‐vomiting therapy i .e .ondansetron 8mg intravenously at d1~2 and dexamethasone10mg intravenously at d1~3 .When ex‐plosive nausea and vomiting appeared , all patients were given metoclopramide 20mg intramuscularly and olanzapine 10mg orally once daily for 3 days .The remission of nausea and vomiting and other adverse events at 0~24h after mediation were observed .[Results] A total of 68 patients with explosive nausea and vomiting af‐ter chemotherapy were treated .The efficacy was assessed .The complete remission(CR) rate of explosive vomiting and nausea were 80 .9% (55/68) and 75 .0% (51/68) ,respectively .The main side effects were drowsiness(13 .2% ,9/68) ,fatigue(10 .3% ,7/68) and dizziness(7 .4% ,5/68) and so on .No obvious grade 3~4 toxic reaction was found .[Conclusion]Metoclopramide combined with olanzapine for treating explosive nausea and vomiting induced by moderately and highly emetogenic chemotherapy had good efficacy without ob‐vious toxic and side reaction .Therefore ,it is worthy of clinical promotion .
引用本文:
周春香%陈立章%马进安. 奥氮平联合甲氧氯普胺解救化疗所致爆发性呕吐的临床研究[J]. 医学临床研究, 2015, 32(1): 90-92,96.
ZHOU Chun-xiang%CHEN Li-zhang%MA Jin-an. Clinical Study of Olanzapine Combined with Metoclopramide to Treat Explosive Chemotherapy-induced Nausea and Vomiting. JOURNAL OF CLINICAL RESEARCH, 2015, 32(1): 90-92,96.
2015, Vol. 32 
