Mallick-Searle Theresa, Fillman Mechele
Division Pain Medicine, Stanford Health Care, Redwood City, California.
Division Pain Medicine, Stanford Health Care, Stanford, California.
J Am Assoc Nurse Pract. 2017 Nov;29(11):704-710. doi: 10.1002/2327-6924.12532.
Opioid medications are integral in managing acute moderate-to-severe pain. Opioid analgesics bind to μ (mu), κ (kappa), or δ (delta) opioid receptors in the brain, spinal cord, and digestive tract. However, opioids cause adverse effects that may interfere with their therapeutic use. Some adverse effects wane over time, but patients using opioids for acute pain struggle with opioid-induced nausea and vomiting (OINV) the entire time they take the opioid. This article discusses the underlying mechanisms, clinical implications, and treatment strategies of OINV.
Systematic search and review of Medline, PubMed, and Google Scholar for articles relating to OINV. In addition, package inserts provided pharmacologic data and dose recommendations as needed.
Research suggests approximately 40% of patients may experience nausea and 15%-25% of patients may experience vomiting after opioid administration. Nausea often precedes vomiting, although they can occur separately. Many patients receiving opioids rate the nausea and vomiting as worse than their pain. Nausea and vomiting can lead to complications including electrolyte imbalances, malnutrition, and volume depletion, and can also negatively affect quality of life and postoperative recovery.
There are several medications that can be used to treat OINV including serotonin receptor antagonists, dopamine receptor antagonists, and neurokinin-1 receptor antagonists. Healthcare providers should be proactive about discussing OINV with patients, as this may improve patient outcomes and pain relief.
阿片类药物在急性中重度疼痛管理中不可或缺。阿片类镇痛药与大脑、脊髓和消化道中的μ（μ）、κ（κ）或δ（δ）阿片受体结合。然而，阿片类药物会产生不良反应，可能会干扰其治疗用途。一些不良反应会随着时间推移而减弱，但使用阿片类药物治疗急性疼痛的患者在服用阿片类药物期间一直会受到阿片类药物引起的恶心和呕吐（OINV）的困扰。本文讨论了OINV的潜在机制、临床意义和治疗策略。
对Medline、PubMed和谷歌学术进行系统检索和综述，以查找与OINV相关的文章。此外，药品说明书根据需要提供了药理数据和剂量建议。
研究表明，约40%的患者在服用阿片类药物后可能会出现恶心，15%-25%的患者可能会出现呕吐。恶心通常先于呕吐出现，不过二者也可能单独发生。许多接受阿片类药物治疗的患者认为恶心和呕吐比疼痛更严重。恶心和呕吐会导致包括电解质失衡、营养不良和容量耗竭在内的并发症，还会对生活质量和术后恢复产生负面影响。
有几种药物可用于治疗OINV，包括5-羟色胺受体拮抗剂、多巴胺受体拮抗剂和神经激肽-1受体拮抗剂。医疗服务提供者应积极与患者讨论OINV，因为这可能会改善患者的治疗效果和疼痛缓解情况。
