椎管内麻醉患者术后恶心呕吐相关因素与临床干预研究  

Study on Related Factors of Postoperative Nausea and Vomiting and Clinical Intervention in Patients with Intraspinal Anesthesia

作　　者：赵翠红[1] 陶怡秀 王盛海[1] 赵强[1] 孟庆勇 张汉湘[1] 秦明英[1] 马文霞[2] 弥曼[2] ZHAO Cui-hong;TAO Yi-xiu;WANG Sheng-hai;ZHAO Qiang;MENG Qing-yong;ZHANG Han-xiang;QING Ming-ying;MA Wen-xia;MI Man(Hanzhong Central Hospital, Shanxi Hanzhong 723000, China;The Second Affiliated Hospital of Xi＇an Medical University, Shanxi Xi＇an 710038, China)

机构地区：[1]汉中市中心医院,陕西汉中723000 [2]西安医学院第二附属医院,陕西西安710038

出　　处：《中国药物警戒》2018年第4期201-204,共4页Chinese Journal of Pharmacovigilance

基　　金：陕西省卫生厅科研基金中标项目E类(2012E8):椎弓根形态与胸腰段骨折伤椎置钉;植骨关系的研究

摘　　要：目的研究阿片类药物、5-羟色胺3(5-HT3)受体拮抗剂与术后恶心呕吐(PONV)相关性,指导临床合理用药。方法通过530例椎管内麻醉患者,研究手术患者使用阿片类药物,干预与未干预对PONV的影响及差异性,并比较了临床常用的3种5-HT3受体拮抗剂预防恶心呕吐的疗效与差异性,同时,还研究了不同阿片类药物术后PONV发生的时间特点。结果使用阿片类药物后,5-HT3受体拮抗剂干预与未干预,PONV的发生有显著差异(P<0.05);3种5-HT3受体拮抗剂干预PONV疗效肯定,无差异(P>0.05);不同阿片类药物PONV发生时间集中发生在术后2~6 h之间,占69.23%~76.92%。24 h后发生机率小,占1.54%。结论 5-HT3受体拮抗剂对术中、术后恶心呕吐的预防疗效良好,3种5-HT3受体拮抗剂对术中、术后恶心呕吐的预防效果相似,考虑到经济性,临床采用昂丹司琼预防术中、术后恶心呕吐较为经济。不同阿片类药物引发PONV程度不同,无PONV高发因素,不宜预防使用5-HT3受体拮抗剂,避免过度治疗。Objective To study the relationship of PONV（postoperative nausea and vomiting） between opioids and5-HT3 receptor antagonists to guide the clinical rational use of drugs. Methods Through the 530 cases of the use of opioids in spinal anesthesia patients, study the intervention and nonintervention effect on PONV and difference, and compare the effects of three differences kinds of 5-HT3 receptor antagonists in preventing nausea and vomiting. At the same time, the time characteristics of PONV after different opioids is also studied. Results There was a significant difference in the incidence of PONV between the use of opioids and 5-HT3 receptor antagonist（P 0.05）. The effects of different 5-HT3 receptor antagonists on PONV was positive（P 0.05）. The occurrence time of PONV by different opioids was basically the same, which occurred between 2~6 h postoperatively, accounting for 69.23%~76.92%. The incidence of PONV after 24 h was very small, accounting for 1.54%. Conclusion The efficacy of 5-HT3 receptor antagonist on intraoperative and postoperative nausea and vomiting prevention is good. The prevention effect of three kinds of 5-HT3 receptor antagonists on intraoperative and postoperative nausea and vomiting is similar. But take into account the economy, ondansetron is used for preventing postoperative nausea and vomiting in clinical. Different opioids lead to different levels of PONV. It is no need to use 5-HT3 receptor antagonists preventively without the high risk factor of PONV, so that to avoid overtreatment.

关 键 词：阿片类药物 术后恶心呕吐(PONV) 5-羟色胺3受体拮抗剂(5-HT3) 药品不良反应(ADR) 

分 类 号：R916.61[医药卫生—药学]