阿扎司琼联合地塞米松应用于不同全麻方式下预防术后恶心呕吐的临床效果  

General anesthesia with azasetron and dexamethasone in two different methods in prevention of postoperative nausea and vomiting

作　　者：王从辉 吴毅[2] 盛福庭 吴世民 秦生 贺腾芳 Wang Conghui;Wu Yi;Sheng Futing;Wu Shimin;Qin Sheng;He Tenfang(Department of Anesthesiology,Third People's Hospital of Longgang District,Shenzhen 518115,China;Department of Anesthesiology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou 510120,China)

机构地区：[1]深圳市龙岗区第三人民医院麻醉科,518115 [2]中山大学孙逸仙纪念医院麻醉科,510120

出　　处：《国际医药卫生导报》2018年第8期1243-1246,共4页International Medicine and Health Guidance News

摘　　要：目的 比较阿扎司琼联合地塞米松用于不同全麻方式下预防术后恶心呕吐的临床效果。方法 选择2015年1月至2018年1月在本院接受妇科腹腔镜手术的120例患者，随机分为四组：丙泊酚组（P组），丙泊酚和阿扎司琼联合地塞米松组（PAD组），七氟醚组（S组），七氟醚和阿扎司琼联合地塞米松组（SAD组），每组各30例。P和PAD组以丙泊酚靶控输注3～4μg/ml维持麻醉，PAD组在气管插管后静注地塞米松10 mg，术毕时静注阿扎司琼10 mg，S和SAD组以吸入七氟醚2.5%～3.0%维持麻醉，SAD组在气管插管后静注地塞米松10 mg，术毕时静注阿扎司琼10 mg，观察并记录术后24 h内恶心呕吐的发生情况。结果 四组患者的一般资料、血流动力学变化、手术时间、麻醉时间、拔管时间、芬太尼用量及术后24 h内视觉模拟评分（VAS），差异均无统计学意义（均P＞0.05）。S组在术后24 h内满意度评分低于P、PAD和SAD组，差异有统计学意义（P＜0.05）；PAD组术后恶心呕吐发生率（6.7%）明显低于P组（30.0%），差异有统计学意义（P=0.042），SAD组术后恶心呕吐发生率（13.3%）明显低于S组（50.0%），差异有统计学意义（P=0.005），相对于七氟醚麻醉，接受丙泊酚麻醉发生术后恶心呕吐的相对危险度为0.6，接受阿扎司琼联合地塞米松与丙泊酚或七氟醚麻醉发生术后恶心呕吐的相对危险度为0.22或0.27，相对于未接受干预措施，接受干预措施（阿扎司琼联合地塞米松治疗）发生术后恶心呕吐的相对危险度为0.25。结论 七氟醚麻醉较丙泊酚麻醉更易发生术后恶心呕吐；阿扎司琼联合地塞米松对这两种全麻方式下术后恶心呕吐均具有良好的预防效果，尤其是对七氟醚麻醉引起的术后恶心呕吐。Objective To compare the clinical effects of general anesthesia with azasetron and dexamethasone in two different methods in prevention of postoperative nausea and vomiting(PONV).Methods 120 patients undergoing gynecologic laparoscopic surgery at our hospital from January,2015 to January,2018 were selected and randomly divided into a propofol(group P),a propofol+azasetron+dexamethasone(group PAD),a sevoflurane(group S),and a sevoflurane+azasetronl+dexamethasone(group SAD),30 cases for each group.Group P and group PAD were maintained by target controlled infusion(TCI)of 3-4μg/ml propofol;10 mg dexamethasone was given after intubation and 10 mg azasetron was given at the end of operation in group PAD.Group S and SAD were maintained by 2.5%-3.0%sevoflurane;10 mg dexamethasone was given after intubation and 10 mg azasetron was given at the end of operation in group SAD.The occurrences of nausea and vomiting within 24 hours after surgery were observed and recorded.Results There were no statistical differences in patient characteristics,hemodynamic changes,surgery time,anesthesia time,extubation time,the fentanyl dosage,and Visual analogue scale(VAS)within 24 hours after surgery among the 4 groups(all P>0.05).Compared with other groups,the satisfaction score within 24 hours after surgery in group S was significantly decreased(P<0.05).Compared with group P,the incidence of PONV in group PAD was significantly decreased(6.7%vs.30.0%)(P=0.042).Compared with group S,the incidence of PONV in group SAD was significantly decreased(13.3%vs.50.0%)(P=0.005).Compared with those received sevoflurane anesthesia,the relative risk of PONV for those received propofol was 0.6.The relative risks of PONV for those received azasetron combined with dexamethasone and propofol or sevoflurane anesthesia were 0.22 or 0.27.Compared with those received only anesthetics,the relative risk of PONV for those received antiemetics was 0.25.Conclusion Compared with propofol anesthesia,sevoflurane anesthesia is inclined to PONV in patients;azasetronl co

关 键 词：阿扎司琼 地塞米松 全身麻醉 妇科腹腔镜 术后恶心呕吐 

分 类 号：R614[医药卫生—麻醉学]