Heuser Fabian, Schulz Christian, Sağlam Murat, Ramaioli Cecilia, Heuberger Maria, Wagner Klaus J, Jahn Klaus, Schneider Erich, Brandt Thomas, Glasauer Stefan, Lehnen Nadine
Department of Anaesthesiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
German Centre for Vertigo and Balance Disorders, Klinikum der Universität München, Munich, Germany.
PLoS One. 2017 Mar 14;12(3):e0173925. doi: 10.1371/journal.pone.0173925. eCollection 2017.
Although opioid-induced nausea and vomiting (OINV) is common and debilitating, its mechanism is still unclear. Recently, we suggested that opioids affect semicircular canal function and that this leads to a mismatch between canal input and other sensory information during head motion, which triggers OINV. Here, we assess if visual input is relevant for this mismatch. In a randomized-controlled crossover study 14 healthy men (26.9±3.4 years, mean±SD) were tested twice, once blindfolded and once with eyes open, with at least one-day washout. The opioid remifentanil was administered intravenously (0.15 μg/kg/min) for 60 minutes. After a thirty-minutes resting period, subjects' head and trunk were passively moved. Nausea was rated before remifentanil start (T0), before the movement intervention (T30) and after 60 minutes (T60) of administration. At rest (T0, T30), median nausea ratings were zero whether subjects were blindfolded or not. Movement triggered nausea independently of visual input (nausea rating 1.5/3.0 (median/interquartile range) in the blindfolded, 2.5/6 in the eyes-open condition, χ2(1) = 1.3, p = 0.25). As movement exacerbates OINV independently of visual input, a clash between visual and semicircular canal information is not the relevant trigger for OINV. To prevent OINV, emphasis should be put on head-rest, eye-closure is less important.
尽管阿片类药物引起的恶心和呕吐（OINV）很常见且令人虚弱，但其机制仍不清楚。最近，我们提出阿片类药物会影响半规管功能，这会导致头部运动期间半规管输入与其他感觉信息之间的不匹配，从而引发OINV。在此，我们评估视觉输入是否与这种不匹配有关。在一项随机对照交叉研究中，对14名健康男性（26.9±3.4岁，平均值±标准差）进行了两次测试，一次蒙眼，一次睁眼，两次测试之间至少间隔一天的洗脱期。静脉注射阿片类药物瑞芬太尼（0.15μg/kg/分钟），持续60分钟。在30分钟的休息期后，被动移动受试者的头部和躯干。在瑞芬太尼开始给药前（T0）、运动干预前（T30）和给药60分钟后（T60）对恶心程度进行评分。在休息时（T0、T30），无论受试者是否蒙眼，恶心评分中位数均为零。运动引发的恶心与视觉输入无关（蒙眼时恶心评分为1.5/3.0（中位数/四分位间距），睁眼时为2.5/6，χ2(1)=1.3，p=0.25）。由于运动独立于视觉输入而加重OINV，因此视觉和半规管信息之间的冲突不是OINV的相关触发因素。为预防OINV，应重点关注头部休息，闭眼的重要性较低。
