Billett A L, Sallan S E
Department of Pediatrics, Dana-Farber Cancer Institute, Boston, MA 02115.
Support Care Cancer. 1994 Sep;2(5):279-85. doi: 10.1007/BF00365578.
Nausea and vomiting are debilitating side effects that often accompany the administration of chemotherapy and may lead to adverse physiological and psychological effects. Chemotherapy agents usually stimulate the chemoreceptor trigger zone, which then sends signals to the vomiting center in the medullary lateral reticular formation. The neurochemistry of vomiting involves serotonin and serotonin S3 receptors. Nausea and vomiting are difficult to treat once they have occurred, and prior poor antiemetic control may lead to future anticipatory nausea and vomiting. Thus, good antiemetic regimens must be prophylactic, scheduled, and individualized. Specific regimens must be adjusted to account for the emetogenic potential of the chemotherapy drug(s) being administered and the individual patient's preferences. The major classes of antiemetics include serotonin S3 receptor antagonists, phenothiazines and metoclopramide. Steroids are ineffective antiemetics alone but good potentiators of other antiemetics. We usually recommend a serotonin S3 receptor antagonist alone for less emetogenic regimens or in conjunction with dexamethasone for more emetogenic regimens. For breakthrough vomiting, we usually add lorazepam and/or scopolamine.
恶心和呕吐是化疗给药时常伴随出现的使人虚弱的副作用，可能会导致不良的生理和心理影响。化疗药物通常会刺激化学感受器触发区，该区域随后会向延髓外侧网状结构中的呕吐中枢发送信号。呕吐的神经化学涉及血清素和血清素S3受体。恶心和呕吐一旦发生就很难治疗，而且之前止吐控制不佳可能会导致未来出现预期性恶心和呕吐。因此，良好的止吐方案必须是预防性的、有计划的且个体化的。必须根据所使用化疗药物的致吐潜力和个体患者的偏好来调整具体方案。主要的止吐药类别包括血清素S3受体拮抗剂、吩噻嗪类和甲氧氯普胺。类固醇单独作为止吐药无效，但却是其他止吐药的良好增效剂。对于致吐性较低的方案，我们通常推荐单独使用血清素S3受体拮抗剂；对于致吐性较高的方案，则推荐与地塞米松联合使用。对于突发性呕吐，我们通常会加用劳拉西泮和/或东莨菪碱。
