双联抗呕吐方案在腹腔镜术后呕吐预防中的应用研究  

Research of applied double anti-vomiting scheme in preventing and treatment postoperative nausea and vomiting after laparoscopic operation

作　　者：鲁斌[1] 杨一唯 王海明[1] 

机构地区：[1]绍兴文理学院附属医院普外科,浙江绍兴312000

出　　处：《全科医学临床与教育》2015年第1期37-39,共3页Clinical Education of General Practice

摘　　要：目的探讨5-羟色胺(5-HT3)受体拮抗剂昂丹司琼与多巴胺受体拮抗剂甲氧氯普安联合应用在防止腹腔镜手术后呕吐中的效果。方法选取腹腔镜胆囊切除手术263例患者为研究对象,按知情自愿的原则分为昂丹司琼+甲氧氯普安组(双联组,95例),单用昂丹司琼(5-HT组,87例)和单用甲氧氯普安(胃复安组,81例),分析并比较三组患者术后48 h内呕吐和并发症的发生率。结果双联组患者完全控制率84.21%,缓解率13.68%,无效率2.11%;5-HT组患者完全控制率、缓解率、无效率分别为:71.26%、19.54%和9.20%;胃复安组分别为:55.56%、33.33%和11.11%。双联组完全控制率明显高于5-HT组和胃复安组,差异有统计学意义(χ2=4.43、17.44,P均<0.05),且双联组总有效率显著高于其余两者(χ2=4.30、6.05,P均<0.05)。虽然5-HT组的完全控制率较胃复安组明显升高(χ2=4.47,P<0.05),但是两组总有效率比较差异无统计学意义(χ2=0.16,P>0.05)。所有患者治疗后均未观察到明显并发症发生。结论在腹腔镜术后呕吐的预防和治疗中,联合使用昂丹司琼和甲氧氯普安不仅未增加不良反应发生率,且治疗效果明显高于两药单独使用。Objective To study the effect of 5-HT3 receptor antagonist ondansetron combined with dopamine receptor antagonists metoclopramide on preventing postoperative nausea and vomiting（PONV） after laparoscopic operation. Methods A total of 263 patients accepted laparoscopic operation under general anesthesia were enrolled. According to the principle of voluntarines and legitimacy,they were divided into three groups,ondansetron joined metoclopramide（combination group,95 cases）,ondansetron（5-HT group, 87 cases） and metoclopramide group（81 cases）. The vomiting and complication rates in 48 hours after operation were analyzed. Results In combination group,the complete control rate,remission rate,no efficiency rate were 84.21%,13.68% and 2.11%,respectively. In 5-HT group,the complete control rate,remission rate,no efficiency rate were 71.26%,19.54% and 9.20% respectively. In metoclopramide group,the complete control rate,remission rate,no efficiency rate were 55.56%,33.33% and 11.11% respectively. No obvious complications were recorded. The complete rate in combination group were higher than those in other two groups with statistic significances（χ^2=4.43,17.44,P 〈0.05）;the total effective rate（complete control and remission） were also higher with statistic significances（χ^2=4.30,6.05,P〈 0.05）. The complete control rate was higher in 5-HT group than that in the metoclopramid group with statistic significance（χ^2=4.47,P〈0.05）,but the total effective rate between two groups had no difference（χ^2=0.16,P〉 0.05）. Conclusion The effect of combined ondansetron and metoclopramide in preventing and treatment PONV after laparoscopic operation was better than individually using, and had no increased treatment-related adverse events.

关 键 词：术后恶心呕吐 腹腔镜 昂丹司琼 甲氧氯普胺 

分 类 号：R619[医药卫生—外科学]