课件：化疗所致的恶心呕吐文档资料.ppt

国外建议：爆发性恶心呕吐 国外建议：多日，高剂量，爆发性呕吐 2016 MASCC／ESMO 总 结 1、综述最新的2014版中国指南,2016版MASCC／ESMO指南,2017版NCCN指南推荐： 对于高度致吐风险的药物，止吐方案：NK-1、5HT-3联合地塞米松，爆发性呕吐应用奥氮平； 对于中度致吐风险的药物：止吐方案：5HT-3联合地塞米松，或加用NK-1。 2、对于2代的5HT-3受体拮抗剂——帕洛诺司琼（注射液\胶囊）是唯一获准用于预防迟发性CINV 的5-HT3 受体拮抗剂, 谢谢！ THANK YOU SUCCESS * * 可编辑 * * * 止吐药被认为是通过竞争性阻断位于CTZ和胃肠道内的神经递质（如5-羟色胺、多巴胺、乙酰胆碱和其他）受体，从而控制恶心和呕吐。通过阻断这些神经递质的释放，止吐药可阻止CTZ的激活，以及呕吐中枢的激活 例如，多巴胺拮抗剂（吩噻嗪类，苯甲酰胺类和丁酰苯类）主要作用于CTZ。5-羟色胺拮抗剂被认为是作用于CTZ和内脏传入神经（胃肠道）。抗胆碱类和抗组胺类被认为是 作用于呕吐中枢本身。NK-1受体拮抗剂作用于CTZ和呕吐中枢。 References: Tortorice PV, O’Connell MB. Management of chemotherapy-induced nausea and vomiting. Pharmacotherapy. 1990;10:129-145. Navari RM. Pathogenesis-based treatment of chemotherapy-induced nausea and vomiting – two new agents. J Support Oncol. 2003;1:89-103. * * * CINV的类型 急性呕吐： 用药后数分钟到数小时内出现，一般用药后5-6小时最高峰，24小时内缓解。 迟发性呕吐: 用药后24小时后出现，例如：DDP引起的迟发性呕吐常于给药后48-72 小时达最高峰，可持续6-7天。 预期性呕吐: 属条件反射，在前一次化疗中出现恶心/呕吐的病人，在下一次化疗开始前就出现恶心/呕吐。发生率18%-57%，常以恶心为主，年轻人发生率高于老年人。 突破（暴发性）呕吐: 指在给予预防性止吐治疗后仍出现的且需解救治疗的呕吐。 难治性呕吐：指预防性和解救性止吐治疗均失败的呕吐。 Chemotherapy-induced nausea and vomiting (CINV) falls into 3 distinct phases. Familiarity with these is useful for planning prophylactic treatment. Acute CINV is defined as nausea and/or vomiting that occurs within 24 hours of the administration of cancer chemotherapy. Delayed CINV is defined as nausea and vomiting that occurs after the first 24 hours. It may last for as long as 120 hours after administration of cancer chemotherapy. Anticipatory CINV is nausea and vomiting that occurs as a learned response or conditioning. It generally occurs during subsequent cycles of chemotherapeutic treatment when CINV has been poorly managed following previous cycles of chemotherapy. Anticipatory CINV occurs before, during, or after chemotherapy, but usually earlier than an episode of acute CINV would be expected to occur. Anticipatory CINV does not respond to antiemetic agents or other pharmacologic interventions, but has been shown to