异丙酚对腹腔镜胆囊切除病人术后恶心呕吐的防治作用  

The antiemetic effect of propofol in patients undergoing laparoscopic cholecystectomy

作　　者：兰海涛[1] 李杰[1] 姚尚龙[1] 包光兴[1] 

机构地区：[1]华中科技大学同济医学院协和医院麻醉学教研室

出　　处：《中华麻醉学杂志》2001年第4期217-219,共3页Chinese Journal of Anesthesiology

摘　　要：目的　探讨异丙酚的镇吐作用及可能的作用机制。方法　 6 0例ASAⅠ～Ⅱ级行择期腹腔镜胆囊切除术患者 ,随机分为三组 :对照组 (C组 )行常规气管插管吸入全麻 ,恩丹西酮组 (O组 )入室后静脉注射恩丹西酮 4mg ,其他处理C组 ,异丙酚组 (P组 )诱导插管同C组 ,麻醉维持用异丙酚微泵静滴。分别测定入室 (基础值 )、气管插管后、术毕、术后 6h血浆胃动素的水平 ,并观察术后恶心呕吐程度及发生率。结果　C组 2 0例中有 9例发生Ⅱ～Ⅲ级恶心、呕吐 ,发生率为 4 6 7% ,O组为 4例 ,P组为 3例 ,发生率分别为 2 0 %、13 3%。围术期胃动素水平 :C组术毕明显高于基础值 (P >0 0 1) ,术后P组明显低于C组及O组。结论　异丙酚静脉麻醉能降低腹腔镜胆囊切除术后恶心呕吐发生率 ,可能与抑制血浆胃动素合成及分泌有关。Objective To explore the antiemetic mechanism of propofol in patients subjected to laparoscopic cholecystectomy under general anesthesia Methods Sixty ASA Ⅰ Ⅱ patients of either sex undergoing elective laporoscopic cholecystectomy were randomly assigned to three groups : control group (group C), ondansetron group (group O) and propofol group(group P) Anesthesia was induced with thiopental 5 7 mg·kg -1 and intubation was facilitated with succinylcholine 1 1.5mg·kg -1 In group C and O anesthesia was maintained with inhalation of 1 0% 1 5% isoflurane and intermittent bolus of vecuronium In group O ondansetron 4 mg was given intravenously before induction of anesthesia In group P anesthesia was maintained with continuous intravenous infusion of 1% propofol at a rate of 50 150 μg·kg -1 ·min -1 and intermittent bolus of vecuronium At the end of operation neostigmine 1mg and atropine 0 5 mg were regularly given to antagonize the residual neuromuscular blockade Venous blood samples were taken before anesthesia (baseline), after intubation, at the end of operation and 6h after operation for determination of plasma motilin(MTL) level Postoperative nausea and vomiting (PONV) was assessed according to WHO standard in four grades from no nausea to severe vomiting with gastric content Results In group C the plasma MTL level at the end of operation was significantly higher than that before anesthesia (P<0 05) The baseline MTL concentrations were comparable between the 3 groups, but the plasma MTL at the end of operation in group P was significantly lower than that in group C and O The incidence of PONV was 46 7% in group C, 20% in group O and 13 3% in group P Conclusions Propofol anesthesia can greatly reduce the incidence of PONV after laparoscopic cholecystectomy Inhibition of synthesis and secretion of motolin may be the mechanism

关 键 词：二异丙酚 手术后 恶心 呕吐 腹腔镜胆囊切除术 

分 类 号：R614[医药卫生—麻醉学]