文档介绍：临床止吐指南
第1页，此课件共41页哦
临床治疗止吐指南
2008-03
第2页，此课件共41页哦
恶心呕吐的发生机制
恶心呕吐起因于脑控制的多级式反射途径的刺激，来自化学感受器触发区(CTZ)、喉咽部和胃肠道(GIand moderate emetic risk last for at least 4 days. Patients need to be
protected throughout the full period of risk.
Oral and IV antiemetic formulations have equivalent effectiveness.
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癌症病人呕吐控制原则
use the lowest fully efficacious dose of the antiemetic(s) prior to chemotherapy or radiation therapy.
Consider the toxicity of the specific antiemetic(s) .
Choice of antiemetic(s) used should be based on the emetic risk of the therapy as well as patient factors.
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癌症病人呕吐控制原则
There are other potential causes of emesis in cancer may include:
Partial or complete bowel obstruction
estibular dysfunction
Brain metastases
Electrolyte imbalance: hypercalcemia, hyperglycemia, hyponatremia
Anxiety
Anticipatory nausea and vomiting
第13页，此课件共41页哦
癌症病人呕吐控制原则
Concomitant drug treatments including opiates
Gastroparesis, tumor or chemotherapy (vincristine etc) induced.
Psychophysiologic:
⊳ Anxiety
⊳ Anticipatory nausea and vomiting
Anxiety
Anticipatory nausea and vomiting
第14页，此课件共41页哦
预防由高致吐风险抗肿瘤药物所致呕吐的用药方案
Start before chemotherapy
Aprepitant 125 mg PO day 1, 80 mg PO daily days 2-3
Or
Fosaprepitant dimeglumine 115mg iv day1 ,80 mg PO daily days 2-3
and
Dexamethasone 12 mg PO or IV day 1, 8 mg PO or IV daily days 2-4
and
5-HT3 antagonist:
Ondansetron 16-24 mg PO or 8-12 mg (maximum32 mg) IV day1
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预防由高致吐风险抗肿瘤药物所致呕吐的用药方案
Granisetron 2 mg PO or 1 mg PO bid or mg/kg (maximum 1 mg) IV day 1
or
Dolasetron 100 mg PO or mg/kg IV or 100 mg IV day 1
or
Palonosetron mg IV day 1
And
± Lorazepam -2 mg PO or IV or sublingual q4~ 6 h days 1-4
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预防由中致吐风险抗肿瘤药物所致呕吐的用药方案
Day1 Start before chemotherapy
Aprepitant 125 mg PO day 1, in select patients
Or
Fosaprepitant dimeglumine 115mg iv day1
and
Dexamethasone 12 mg PO