恩丹西酮抗呕吐作用在妇科腹腔镜手术中的临床研究  

The Clinical Study of Prophylactic Antiemetic Effect of Ondansetron in Women Undergoing Gynaecological Laparoscopic Surgery.

作　　者：黄绍强[1] 焦静[1] 解轶[1] 余央利[1] 

机构地区：[1]复旦大学附属妇产科医院麻醉科,上海200011

出　　处：《中国临床医学》2005年第4期654-656,共3页Chinese Journal of Clinical Medicine

摘　　要：目的:比较恩丹西酮与地塞米松预防妇科腹腔镜手术后恶心、呕吐(PONV)的效果,研究这类手术中恩丹西酮预防性用药的适宜剂量和方法。方法:300例ASAⅠ-Ⅱ级择期行妇科腹腔镜手术病例随机分为5组,每组60例,于麻醉诱导后即刻,O1组静注恩丹西酮4mg,O2组、OD组、D组和C组分别静注恩丹西酮4mg、恩丹西酮4mg+地塞米松5mg、地塞米松5mg和生理盐水。另外,O2组于手术结束拔管前再静注恩丹西酮4mg。以异丙酚及异氟醚静吸复合维持麻醉。术后随访PONV发生情况及严重程度以及VAS疼痛评分,观察药物不良反应。结果:由于手术时间过长或过短等原因22例从本研究中被剔除。总的PONV发生率01(21.4%)、O2(23.1%)、OD(23.6%)及D组(41.6%)均明显低于C组(74.5%),均有极显著差异(P<0.01);用恩丹西酮的3个组PONV发生率与D组相比也均明显降低(P<0.05),但恩丹西酮3组之间无论总的PONV发生数还是呕吐或严重呕吐的发生数都无显著差异。结论:恩丹西酮与地塞米松均能明显降低妇科腹腔镜手术PONV的发生率,两者相比恩丹西酮更为有效;对这类手术恩丹西酮预防性给药的最佳剂量是4mg,更大剂量并不能进一步降低PONV的发生率,与地塞米松合用也未见优于单用恩丹西酮。Objective： To compare the effect of ondansetron and dexamethasone on preventing postoperative nausea and vomiting （PONV） after gynaecological laparoscopic surgery. Properly prophylactic use of ondansetron in these operations is to be investigated. Methods： 300 patients （n = 60 in each of five groups） scheduled for gynaecological laparoscopic surgery were enrolled in this randomized, double-blinded study. Immediately after the induction of anesthesia, Group O1 received IV ondansetron 4mg, whereas Group O2, Group OD, Group D and Group C received IV ondansetron 4 rag, ondansetron 4 mg plus dexamethasone 5mg, dexamethasone 5 mg and saline, respectively. In addition, Group O2 received IV ondansetron 4 mg again before extubation when the operation was completed. Anesthesia was induced with propofol and maintained with isoflurane and propofol. Postoperatively patients were assessed during the first 24b for nausea, vomiting and pain. Any adverse effect of ondansetron or dexamethasone was noted. Results： 22 patients were excluded for the operation period was too short （ 〈0.5h） or too long （ 〉 2h）. The total incidence of PONV was 21.4% in Group O1, 23. 1% in Group O2, 23.6% in Group OD and 41.7% in Group D, significantly less that of Group C, 74. 5% （P〈0. 01）, and the incidence of PONV was greater in Group D than that of Group O1,O2, OD （P〈0. 05）. There was no significant difference among Group O1, O2, OD. Concluslon：Ondansetron and dexamethasone could significantly decrease the incidence of PONV after gynaecological laparoscopic surgery, and ondansetron is more effective than dexamethasone. In these operations, ondansetron 4 rag,the optimal dose for prophylactic use, has the same effect as ondansetron 8 mg or the combination of ondansetron and dexamethasone for antiemesis.

关 键 词：恩丹西酮 地塞米松 术后恶心呕吐 妇科腹腔镜手术 

分 类 号：R975.4[医药卫生—药品]