枢星防治曲马多术后镇痛患者恶心呕吐的研究  

Effect of Granisetron in different administration mode on patient's gastrointestinal motility undergoing tramadol PCA

作　　者：刘红晶[1] 徐海春[1] 姚鹏[1] 

机构地区：[1]中国医科大学附属盛京医院,沈阳110004

出　　处：《实用药物与临床》2008年第3期132-134,共3页Practical Pharmacy and Clinical Remedies

摘　　要：目的观察枢星（格拉司琼）不同给药模式对曲马多经静脉自控术后镇痛（PCIA）时恶心呕吐及血浆胃动素水平的影响。方法54例择期子宫切除术患者,术后行曲马多PCIA。按枢星给药模式不同分成3组,Ⅰ组为枢星3 mg加入曲马多镇痛泵中;Ⅱ组为枢星3 mg在给曲马多负荷量前5 min缓慢静注;Ⅲ组为单次静注枢星3 mg,并在镇痛泵中加枢星3 mg。分别测定入室、术毕、术后6、24、42 h血浆胃动素水平,并观察恶心、呕吐程度及发生率。结果Ⅰ组有8例发生Ⅱ-Ⅳ级恶心、呕吐,发生率为44.4%,Ⅱ组为3例,Ⅲ组为2例,分别为16.7%和11.1%。从入室到术毕胃动素浓度增高,Ⅰ组术后仍维持较高水平,Ⅱ、Ⅲ组术后6 h低于术毕水平（P〈0.05）;同时Ⅱ、Ⅲ组在术后6 h2、4 h时低于Ⅰ组（P〈0.05）。结论应用枢星防治曲马多所致恶心呕吐时,须使用负荷量,且其作用与抑制血浆胃动素的合成及分泌有关。Objective To evaluate the effect of Granisetron in different administration mode on patient＇s PONV, time to postoperative first flatus and plasma motilin level, Methods 54 ASA Ⅰ -Ⅱ female patients who were scheduled for abdominal hysterectomies under CSEA were enroUed in the study. AU patients received 48 hours of postoperative pain control with tramadol intravenous PCA. Tramadol dose was 0.25 mg/（kg·h）, and loading dose was 1.5 mg/kg. Patients were divided randomly into three groups （n = 18 for each group）. Group I ： Grardsetron 3 mg added into the pump of tramadol intravenous PCA; Group H ： Granisetron 3 mg intravenous injection, 5 rain before tramadol analgesia;Group Ⅲ ： Granisetron 3 mg intravenous injection and 3 mg added into the pump of trarnadol intravenous PCA, Venous blood samples were taken before and Oh, 6h, 24h, 42h after operation for determination of plasma motilin level. Postoperative nausea and vomiting （PONV） was assessed according to WHO standard in four grades from no nausea to severe vomiting with gastric content, and visual analog scale （VAS） scores were recorded. Results The incidenees of PONV were 44,4 96,16.7 %, 11.1% in Group I , Group Ⅱ , Group ill respectively. Plasma motilin concentratiorns increased after operation, and still maintained higher level in group I during 24h, but in group Ⅱ , Ⅲ it decreased at 6h after opemtion（P 〈 0.05） ;At the time of 6h.24h after operation, motilin concentrations in group Ⅱ . Ⅲ was significantly lower than that of group I （P 〈 0.05）. Conclusion Granisetron was used to inhibit the PONY of prophylaxi tramadol, the loading dose of should be given, and inhibition of synthesis and secretion of motilin might be one of the mechanism.

关 键 词：枢星 曲马多 静脉自控镇痛 恶心呕吐 胃动素 

分 类 号：R614[医药卫生—麻醉学]