昂丹司琼预防急诊剖宫产术后硬膜外吗啡镇痛瘙痒的效果和安全性研究  

Efficacy and safety of ondansetron to prevent the side effect of pruritus induced by epidural morphine after emergency cesarean section

作　　者：戚忠 汪云飞[1] 王加芳[1] 祝德刚[1] 李进[1] 王洁[2] 

机构地区：[1]武汉市第一医院麻醉科,武汉430020 [2]华中科技大学同济医学院附属协和医院麻醉科

出　　处：《临床急诊杂志》2017年第4期303-306,共4页Journal of Clinical Emergency

摘　　要：目的:评价昂丹司琼用于预防急诊剖宫产术后硬膜外吗啡镇痛瘙痒的有效性和安全性。方法:急诊在腰硬联合麻醉下行剖宫产手术患者60例,ASAⅠ~Ⅱ级,18~35岁,进入本项研究,接受术后硬膜外吗啡镇痛,采用随机数字表法分为2组,分别为昂丹司琼组(O组)和生理盐水组(P组),每组各30例。O组断脐后静脉给予昂丹司琼8mg(4ml),P组断脐后静脉给予生理盐水4ml。术后镇痛方案:断脐后,硬膜外腔给予吗啡4mg。术后随访至48h,记录生命体征、瘙痒评分、镇静评分以及恶心呕吐等不良反应发生情况。结果:2组患者一般情况比较差异无统计学意义,术后48h内生命体征基本平稳。术后4、8、24、48h,O组的瘙痒评分显著低于P组(P<0.05);O组的瘙痒发生率显著低于P组(P<0.05)。不良反应方面,O组患者恶心呕吐的发生率显著低于P组(P<0.05);而2组患者嗜睡、头晕的发生率比较差异无统计学意义。结论:预防性使用昂丹司琼能安全有效地减少急诊剖宫产术后硬膜外吗啡镇痛瘙痒的发生率和显著减轻瘙痒的程度。Objective：To assess the efficacy and safety of Ondansetron in preventing the side effect of pruritus induced by epidural morphine after emergency cesarean section. Method：Sixty patients, undergoing emergency ce- sarean section with combined spinal-epidural anesthesia, ASA Ⅰ-Ⅱ , 18 - 35 years old, were randomly double blindly divided into two groups. Group O （n = 30） received ondansetron 8mg （4 ml） by intravenous route after clamping of the umbilical cord Group P （n=30） received 0. 9% NaC1 （4 ml） by intravenous route after clamping of the umbilical cord. The protocol of postoperative epidural analgesia was epidural morphine 4mg. The patients were followed up for 48 h after operation, and vital signs, pruritus severity, and other adverse effects were recor- ded. Result：There was no significant difference in the age,body weight and surgery duration between the 2 groups. The vital signs were stable within 48h after operation. Group O patients had lower pruritus scores than the other group at 4,6,8,24 and 48 h after operation （P〈0.05）. The ratio of pruritus nausea and vomiting occurred in group O was significantly lower than that of group P （P〈0.05）. There was no difference in the incidence of the other adverse effects in the two groups. Conclusion. Ondansetron to patients who received epidural morphine anal- gesia after emergency cesarean section provides a significant reduction of morphine-induced pruritus and nausea and vomiting.

关 键 词：瘙痒 昂丹司琼 吗啡 硬膜外阿片药物镇痛 急诊剖宫产术 

分 类 号：R614[医药卫生—麻醉学]