Tortorice P V, O'Connell M B
College of Pharmacy, University of Minnesota, Minneapolis, MN 55455.
Pharmacotherapy. 1990;10(2):129-45.
Cancer chemotherapy is associated with numerous toxicities such as nausea and vomiting (emesis). The frequency, onset, and duration of emesis depend largely on the emetogenic potential of specific agents. An exact mechanism for chemotherapy-induced emesis (CIE) is not known but is thought to occur through several noxious actions and numerous neuronal pathways. The three types of CIE are acute, delayed, and anticipatory. Nonchemotherapy causes of emesis should be considered before diagnosing CIE. Once the diagnosis is established, antiemetic regimens should be recommended based on characteristics of the patients and the agents. Phenothiazines, butyrophenones, cannabinoids, metoclopramide, corticosteroids, and benzodiazepines have been successful in preventing and treating CIE. Combinations of these drugs have also been successful and are still being investigated for improved emetic protection with fewer adverse reactions. Investigational agents such as serotonin antagonists may prove to be effective with few toxic effects. Despite the minimal information available on delayed and anticipatory nausea and vomiting, attempts should be made to treat them. Suggested guidelines for the management of CIE have been developed.
癌症化疗伴随着多种毒性反应，如恶心和呕吐（呕吐）。呕吐的频率、发作时间和持续时间在很大程度上取决于特定药物的致吐潜力。化疗引起的呕吐（CIE）的确切机制尚不清楚，但被认为是通过几种有害作用和众多神经通路发生的。CIE的三种类型是急性、延迟性和预期性。在诊断CIE之前，应考虑非化疗引起的呕吐原因。一旦确诊，应根据患者和药物的特点推荐止吐方案。吩噻嗪类、丁酰苯类、大麻素类、甲氧氯普胺、皮质类固醇和苯二氮䓬类药物在预防和治疗CIE方面已取得成功。这些药物的联合使用也已取得成功，并且仍在进行研究，以在减少不良反应的情况下提高止吐保护作用。诸如5-羟色胺拮抗剂等研究性药物可能被证明有效且毒性作用极小。尽管关于延迟性和预期性恶心和呕吐的可用信息很少，但仍应尝试对其进行治疗。已经制定了CIE管理的建议指南。
