目的:观察格拉司琼治疗急性酒精中毒所致呕吐患者临床治疗效果。方法:纳入急性酒精中毒伴呕吐患者369例,随机为对照组和格拉司琼组,对照组185例,在常规治疗的基础上给予甲氧氯普胺(10 mg,肌注);格拉司琼组184例,在常规治疗的基础上给予格拉司琼(3 mg,静滴)止吐。观察记录用药后恶心、呕吐完全缓解、部分缓解、总有效人数及不良反应情况。结果:格拉司琼组止吐总有效人数173例,有效率94.02%;对照组止吐总有效人数154例,有效率为83.24%,格拉司琼组有效率显著高于对照组,差异有统计学意义(χ 2 = 10.62, P < 0.01)。格拉司琼组不良反应17例,不良反应发生率为9.24%;对照不良反应41例,不良反应发生率为22.16%,格拉司琼组不良反应发生率显著低于对照组,差别有统计学意义(χ 2 = 11.63, P < 0.01)。结论:格拉司琼治疗急性酒精中毒伴呕吐疗效显著且安全性高。 Objective: To observe the antiemetic effect of Granisetron in the treatment of vomiting patients with acute alcoholism. Methods: The number of 369 patients with nausea and vomiting after diagnosed with acute alcoholism was randomly divided into two groups: the control group and Granisetron group. At the basis of conventional treatment, 185 patients in control group were treated by Metoclopramide (10 mg, intramuscular injection) or 184 patients Granisetron group treated by Granisetron (3 mg, intravenous drip). The number of complete remissions, partial remission, total effective rate and adverse reactions was observed and recorded. Results: The effective rate of antiemetic in Granisetron group (94.02%) was significantly higher than that in control group (83.24%) (χ 2 = 10.62, P < 0.05). The incidence of adverse reactions in Granisetron group (9.24%) was significantly lower than that in control group (22.16%) (χ 2 = 11.63, P < 0.01). Conclusion: Granisetron is effective and safe in the treatment of acute alcoholism with vomiting.
目的:观察格拉司琼治疗急性酒精中毒所致呕吐患者临床治疗效果。方法:纳入急性酒精中毒伴呕吐患者369例,随机为对照组和格拉司琼组,对照组185例,在常规治疗的基础上给予甲氧氯普胺(10 mg,肌注);格拉司琼组184例,在常规治疗的基础上给予格拉司琼(3 mg,静滴)止吐。观察记录用药后恶心、呕吐完全缓解、部分缓解、总有效人数及不良反应情况。结果:格拉司琼组止吐总有效人数173例,有效率94.02%;对照组止吐总有效人数154例,有效率为83.24%,格拉司琼组有效率显著高于对照组,差异有统计学意义(χ2 = 10.62, P < 0.01)。格拉司琼组不良反应17例,不良反应发生率为9.24%;对照不良反应41例,不良反应发生率为22.16%,格拉司琼组不良反应发生率显著低于对照组,差别有统计学意义(χ2 = 11.63, P < 0.01)。结论:格拉司琼治疗急性酒精中毒伴呕吐疗效显著且安全性高。
急性酒精中毒,呕吐,格拉司琼
Nan Zhang
Emergency Department of Nantong Hospital of Traditional Chinese Medicine, Nantong Jiangsu
Received: Sep. 5th, 2020; accepted: Sep. 20th, 2020; published: Sep. 27th, 2020
Objective: To observe the antiemetic effect of Granisetron in the treatment of vomiting patients with acute alcoholism. Methods: The number of 369 patients with nausea and vomiting after diagnosed with acute alcoholism was randomly divided into two groups: the control group and Granisetron group. At the basis of conventional treatment, 185 patients in control group were treated by Metoclopramide (10 mg, intramuscular injection) or 184 patients Granisetron group treated by Granisetron (3 mg, intravenous drip). The number of complete remissions, partial remission, total effective rate and adverse reactions was observed and recorded. Results: The effective rate of antiemetic in Granisetron group (94.02%) was significantly higher than that in control group (83.24%) (χ2 = 10.62, P < 0.05). The incidence of adverse reactions in Granisetron group (9.24%) was significantly lower than that in control group (22.16%) (χ2 = 11.63, P < 0.01). Conclusion: Granisetron is effective and safe in the treatment of acute alcoholism with vomiting.
Keywords:Acute Alcoholism, Vomiting, Granisetron
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急性酒精中毒是患者在短时间内摄入大量酒精或含酒精饮料后出现的中枢神经系统功能紊乱状态,严重者损伤脏器功能,导致呼吸循环衰竭,进而危及生命 [
所有纳入本研究的急性酒精中毒患者需符合以下纳入排除标准:1) 参照内科学 [
2018年1月至2019年12月期间我院急诊科收治的符合纳入排除标准的急性酒精中毒伴呕吐患者369例,随机分成2组,对照组和格拉司琼组,对照组185例,格拉司琼组184例。对照组中对照组男女比例为144:41,年龄18岁~67岁,平均(36.4 ± 11.4)岁;饮酒量150~600 ml,平均(303.0 ± 93.3) ml;格拉司琼组男女比例146:38,年龄18岁~66岁,平均(36.9 ± 11.0)岁;饮酒量150~650 ml,平均(304.1 ± 94.7) ml。
参照急性酒精中毒诊治共识 [
参照文献 [
数据用STATA 12.0软件进行处理,计量资料采用“均数 ± 标准差”表示,两组间对比采用成组t检验;计数资料比较采用χ2检验,以P < 0.05表示差异具有统计学意义。
两组患者性别、年龄、饮酒量等基线资料差异无统计学意义(P > 0.05),具有可比性,见表1。
男/女 | 平均年龄 | 平均饮酒量 | |
---|---|---|---|
对照组 | 144/41 | 36.4 ± 11.4 | 303.0 ± 93.3 |
格拉司琼组 | 146/38 | 36.9 ± 11.0 | 304.1 ± 94.7 |
Χ2 = 0.125 P = 0.724 | F = 0.15 P = 0.6946 | F = 0.01 P = 0.9103 |
表1. 两组患者基本资料
格拉司琼组患者呕吐症状完全缓解112例(60.87%),部分缓解61例(33.15%),总有效例数为173例,止吐有效率为94.02%。对照组患者呕吐完全缓解89例(48.11%),部分缓解65例(35.14%),总有效例数为154例,止吐有效率为75.68%。格拉司琼组止吐有效率显著高于对照组,差别有差异具有统计学意义(χ2 = 9.85, P < 0.01),见表2。
例数 | 完全缓解(%) | 部分缓解(%) | 无效(%) | 总有效率(%) | |
---|---|---|---|---|---|
对照组 | 185 | 89(47.92) | 65(35.14) | 31(16.76) | 154(83.24) |
格拉司琼组 | 184 | 112(60.87) | 61(33.15) | 11(5.98) | 173(94.02) |
Χ2 | 10.62 | ||||
P | 0.001 |
表2. 两组患者恶心呕吐的临床疗效比较
格拉司琼和甲氧氯普胺的常见的不良反应为头痛、头昏嗜睡、发热、便秘等,甲氧氯普胺还可引起肢体震颤、共济失调等不良反应。格拉司琼组患者发生头痛8例(4.35%),头晕嗜睡5例(2.72%),便秘4例(2.17%),总不良反应17例,发生率为9.24%;对照组患者出现头痛15例(8.11%),头晕嗜睡8例(4.32%),便秘6例(3.24%),肢体震颤12例(6.49%),总不良反应41例,发生率为22.16%。格拉司琼组不良反应发生率显著低于对照组,差异具有统计学意义(χ2 = 11.63, P = 0.001)。以上症状经对症处理后均得到缓解。
急性酒精中毒是急诊科的常见急症,其发病率逐年增加,主要与生活水平提高、社交活动增加及中国的酒文化有关。与其他研究相似,本研究中急性酒精中毒男性患者显著多于女性患者 [
急性酒精中毒时上消化道黏膜受到刺激后释放多种神经递质(如5-羟色胺、多巴胺等),兴奋延髓呕吐中枢,引起恶心、呕吐等症状 [
研究显示,5-羟色胺(5-HT3)受体拮抗药、甲氧氯普胺是目前临床常用的止吐剂 [
格拉司琼也是一种高选择性非竞争性的5-TH3受体阻滞剂,其抑制恶心呕吐的机理是通过拮抗中枢化学感受区及外周迷走神经末梢的5-HT3受体,从而抑制恶心、呕吐的发生。格拉司琼在预防和治疗术后恶心呕吐方面具有良好效果 [
张 楠. 格拉司琼治疗急性酒精中毒所致呕吐的临床疗效观察Clinical Observation of Vomiting Patients with Acute Alcoholism Treated by Granisetron[J]. 临床医学进展, 2020, 10(09): 2193-2197. https://doi.org/10.12677/ACM.2020.109332