帕洛诺司琼预防腹腔镜胆囊切除术后地佐辛持续镇痛引起恶心呕吐的最佳给药方式与剂量  

Appropriate dosage and administration of palonosetron for preventing nausea and vomiting caused by continuous analgesia with dezocine after laparoscopic cholecystectomy

作　　者：朱心愿 李德东[2] 周丽[3] Zhu Xinyuan;Li Dedong;Zhou Li(Department of Cardiovascular Surgery,Tianjin Medical University General Hospital,Tianjin 300041,China)

机构地区：[1]天津医科大学总医院心血管外科,300041 [2]天津医科大学第二医院麻醉科,300211 [3]河北医科大学第四医院期刊社,石家庄050011

出　　处：《实用疼痛学杂志》2018年第6期449-452,共4页Pain Clinic Journal

摘　　要：目的 探讨帕洛诺司琼预防胆囊切除术后地佐辛持续镇痛所致恶心、呕吐的效果和最佳给药方式及剂量.方法 选择2016年3月至2018年3月来自天津医科大学总医院在腹腔镜下行胆囊切除术的胆囊结石患者80例,随机分为4组(A、B、C、D组):A组帕洛诺司琼0.25 mg加入地佐辛镇痛泵持续输注;B组帕洛诺司琼0.25 mg在术前10 min内缓慢静脉注射;C组帕洛诺司琼0.125 mg在术前10 min单次缓慢静脉注射并将0.125 mg于镇痛泵中持续输注;D组在术前10 min内静脉注射生理盐水5 ml,所有患者均行术后地佐辛静脉自控镇痛(PCA).观察并记录4组患者术后1、4、8、12、24、48 h时疼痛VAS评分及术后恶心呕吐(PONV)评分.结果 组内比较,术后12、24、48 h时A、B两组PONV评分较术后1、4、8h时明显降低(P<0.05).术后1、4、8、12、24、48 h时PONV评分A、B、C组明显低于D组(P<0.05),C组低于A、B两组(P<0.05),A、B组间差异无统计学意义(P≥0.05);4组间不同时点疼痛VAS评分差异无统计学意义.结论 帕洛诺司琼可有效预防腹腔镜胆囊切除术后地佐辛镇痛引起的恶心、呕吐,且在术前10 min内单次缓慢静脉注射0.125 mg,并以0.125 mg于PCA泵中持续输注,预防效果最佳.Objective To explore the appropriate dosage and administration method of palonosetron for preventing nausea and vomiting caused by continuous analgesia with dezocine after laparoscopic cholecystectomy.Methods Eighty patients with cholecystolithiasis underwent laparoscopic cholecystectomy in Tianjin Medical University General Hospital from March 2016 to March 2018 were randomly divided into four groups (group A,B,C and D),20 cases in each group.All patients received postoperatively intravenous patient-controlled analgesia (PCA) with dezocine.Palonosetron 0.25 mg was added into PCA pump in group A,0.25 mg intravenously injected slowly within 10 minutes before the operation in group B,took the above two ways of administration with 0.125 mg in group C,and normal saline 5 ml intravenously injected within 10 minutes before the operation as control in group D.VAS and postoperative nausea and vomiting (PONV) scores were recorded at 1,4,8,12,24 and 48 h after the operation.Results PONV score decreased significantly in group A and group B at 12,24 and 48 h after the operation than those at 1,4 and 8 h after the operation (P< 0.05).PONV scores were significantly lower in group A,B and C than those in group D at 1,4,8,12,24 and 48 h after the operation (P<0.05),while those were lower in group C than those in group A and B (P<0.05),without significant difference between group A and B.There was no significant difference for VAS at different time points among the four groups.Conclusion Palonosetron can effectively prevent nausea and vomiting caused by continuous analgesia with dezocine after laparoscopic cholecystectomy.The best preventive effect was shown with intravenous palonosetron 0.125 mg injected slowly within 10 minutes before the operation and 0.125 mg added into PCA pump.

关 键 词：止吐药 地佐辛 疼痛 手术后 手术后恶心呕吐 胆囊切除术 腹腔镜 

分 类 号：R6[医药卫生—外科学]