奧氮平（Olanzapine），是一種新的非典型神經安定藥，能與多巴胺受體、5-HT受體和膽鹼能受體結合，並具有拮抗作用。拮抗D2受體與治療精神分裂症的陽性症狀有關；拮抗5-HT2A受體與治療精神分裂症的陰性症狀有關。奧氮平是治療精分症的一種藥物，它能預防術後噁心嘔吐？術後噁心嘔吐是一種常見的併發症，影響患者術後恢復，其好發因素、易感人群及防治在本公眾號前期文章中有專門的闡述。這篇發表在anesthesiology的文章採用前瞻性隨機對照研究考察了Olanzapine對門診手術出院後噁心嘔吐的預防作用。
摘要翻譯
奧氮平預防門診手術出院後噁心嘔吐的隨機對照試驗
背景：
非臥床手術的出院後噁心和嘔吐是目前實踐中未得到充分解決的常見問題。這項前瞻性、隨機、雙盲、平行組、安慰劑對照研究旨在驗證口服奧氮平在預防出院後噁心嘔吐方面優於安慰劑的假設。
方法：
在一項單中心、雙盲、隨機、安慰劑對照試驗中，作者比較了50歲或50歲以下的成年女性患者在全麻下行婦科或整形手術時，術前單劑量奧氮平（10毫克）與安慰劑的療效。所有患者均接受地塞米松和昂丹司瓊的標準止吐預防。主要的綜合結果是出院後24小時內噁心和/或嘔吐。次要結果包括嚴重噁心、嘔吐和副作用。
結果：
該研究共隨機評估了140名患者。安慰劑組69例患者中的26例（38%）出現噁心嘔吐，奧氮平組71例患者中只有10例（14%）（相對危險度，0.37；95%CI，0.20-0.72；P=0.003）。安慰劑組14例（20%）和奧氮平組4例（6%）出現嚴重噁心（相對危險度0.28；95%可信區間0.10~0.80）。安慰劑組8名患者（12%）和奧氮平組2名患者（3%）出現嘔吐（相對危險度為0.24；95%可信區間為0.05至1.10）。在出院後24小時內，安慰劑組的鎮靜中位得分（0到10分，其中10分最高）為4分（四分位數範圍，2到7），奧氮平組為6分（四分位數範圍，3到8）（P=0.023）。
結論：
當與昂丹司瓊和地塞米松聯合使用時，相對於安慰劑，奧氮平的添加降低了24小時門診出院患者噁心和/或嘔吐的風險約60%，同時報告的鎮靜作用略有增加。
關於這個話題我們已經知道：
儘管使用了當前的止吐藥，但門診手術出院後噁心和嘔吐仍然很常見。
這篇文章告訴我們的是新的：
作者將接受日間手術的婦女隨機分為奧氮平10毫克組或安慰劑組。同時給予地塞米松和昂丹司瓊，奧氮平在出院後24小時內噁心嘔吐從38%減少到14%，相當於只需治療4名患者。
原文摘要
Olanzapine for the Prevention of Postdischarge Nausea and Vomiting after Ambulatory Surgery: A Randomized Controlled Trial.
BACKGROUND:
Postdischarge nausea and vomiting after ambulatory surgery is a common problem that is not adequately addressed in current practice. This prospective, randomized, double-blind, parallel-group, placebo-controlled study was designed to test the hypothesis that oral olanzapine is superior to placebo at preventing postdischarge nausea and vomiting.
METHODS:
In a single-center, double-blind, randomized, placebo-controlled trial, the authors compared a single preoperative dose of olanzapine 10 mg to placebo, in adult female patients 50 years old or less, undergoing ambulatory gynecologic or plastic surgery with general anesthesia. All patients received standard antiemetic prophylaxis with dexamethasone and ondansetron. The primary composite outcome was nausea and/or vomiting in the 24 h after discharge. Secondary outcomes included severe nausea, vomiting, and side effects.
RESULTS:
A total of 140 patients were randomized and evaluable. The primary outcome occurred in 26 of 69 patients (38%) in the placebo group and in 10 of 71 patients (14%) in the olanzapine group (relative risk, 0.37; 95% CI, 0.20 to 0.72; P = 0.003). Severe nausea occurred in 14 patients (20%) in the placebo group and 4 patients (6%) in the olanzapine group (relative risk, 0.28; 95% CI, 0.10 to 0.80). Vomiting occurred in eight patients (12%) in the placebo group and two patients (3%) in the olanzapine group (relative risk, 0.24; 95% CI, 0.05 to 1.10). The median score for sedation (scale 0 to 10, with 10 being highest) in the 24 h after discharge was 4 (interquartile range, 2 to 7) in the placebo group and 6 (interquartile range, 3 to 8) in the olanzapine group (P = 0.023).
CONCLUSIONS:
When combined with ondansetron and dexamethasone, the addition of olanzapine relative to placebo decreased the risk of nausea and/or vomiting in the 24 hafter discharge from ambulatory surgery by about 60% with a slight increase in reported sedation.
WHAT WE ALREADY KNOW ABOUT THIS TOPIC:
Nausea and vomiting after discharge from ambulatory surgery remains common despite use of current antiemetics.
WHAT THIS ARTICLE TELLS US THAT IS NEW:
The authors randomized women having day surgery to olanzapine 10 mg or placebo. All were also given both dexamethasone and ondansetron.Olanzapine reduced nausea and vomiting in the 24 h after hospital discharge from 38% to 14%, corresponding to a number-needed-to-treat of just four patients.
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