多模式镇吐措施对预防妇科腹腔镜术后恶心呕吐的疗效观察  

Effect of multimodal-antiemetic therapy on postoperative nausea and vomiting in patients undergoing gynecological laparoscopy： a randomized controlled study

作　　者：苏仙 耿志宇[1] 郑义林[1] 

机构地区：[1]北京大学第一医院麻醉科,100034

出　　处：《中华医学杂志》2013年第1期41-43,共3页National Medical Journal of China

摘　　要：目的观察多模式镇吐措施预防妇科腹腔镜手术患者术后恶心呕吐（eoNv）的效果。方法经医院伦理委员会审核批准，2011年8月至10月北京大学第一医院择期行妇科腹腔镜患者129例按照随机数字表随机分为两组：多模式镇吐组（M组）与对照组（c组）。M组患者术中以丙泊酚、瑞芬太尼靶控输注维持麻醉，并在诱导后静脉给予地塞米松10mg、手术结束前30rain给予托烷司琼4mg及帕瑞昔布钠40mg。C组患者术中以持续吸人50％N：O和七氟烷维持麻醉，手术结束前30min给予昂丹司琼4mg。记录术后24h内两组病人的PONV发生率。结果M组术后24h的PONV发生率29％显著低于c组70％（P〈0．05），M组术后0～2、2～6、6～24h内的PONV发生率分别是8％、6％和25％均低于C组33％、30％和66％（P〈0．05）。结论丙泊酚静脉全麻、术前给予地塞米松10mg、术毕给予长效止吐剂托烷司琼4mg及复合COX-2抑制剂进行多模式镇痛可显著降低妇科腹腔镜患者术后24h恶心呕吐的发生率。Objective To evaluate the efficacy of multimodal-antiemetic therapy on postoperative nausea and vomiting （PONV） in patients undergoing gynecological laparoscopy. Methods 129 patients scheduled for gynecological laparoscopy were randomly allocated to a multimodal-antiemetic group （ group M, with 65 cases） or an ondansetron control group （ group C, with 64 cases）. In group M patients received a target-controlled infusion of propofol and remifentanil, prophylactic dexamethasone 10 mg and tropisetron 4 mg were given and parecoxib sodium 40 mg was used 30 minutes before the end of surgery. In group C patients received sevoflurane and 50% nitrous oxide. Prophylactic ondansetron 4 mg was given to patients 30 min before the end of surgery. The incidence of nausea and vomiting, use of rescue antiemetic drugs were recorded for 24 h. Results 24 h after surgery, the incidence of patients who suffered PONV was significantly lower in Group M compared with Group C （29% vs 70%, P 〈0. 05）. At 0 -2 h, 2 -6 h, 6 - 24 h after surgery, the incidences of PONV were 8% , 6% and 25% for group M respectively, significantly lower than those for group C, which were 33%, 30% and 66% respectively （ P 〈 0. 05 ）. Conclusions Multimodal-antiemetic therapy; a regimen including total intravenous anaesthesia with propofol and remifentanil, prophylactic antimetics （dexamethasone at induction and tropisetron at end of surgery）, and muhimodal analgesia with parecoxib sodium could significantly reduce the incidence of PONV after gynecological laparoscopy.

关 键 词：术后恶心呕吐 腹腔镜 手术 妇科 多模式镇吐 

分 类 号：R614[医药卫生—麻醉学]