东莨菪碱透皮贴预防全膝关节置换术后恶心呕吐的有效性及安全性  

The effectiveness and safety of transdermal scopolamine in preventing nausea and vomiting after total knee arthroplasty

作　　者：王曦 王志远[1] 马建兵[1] 肖琳[1] Wang Xi;Wang Zhiyuan;Ma Jianbing(Knee Joint Ward,Arthropathy Hospital,the Affiliated Honghui Hospital of Xi’an Jiaotong University,Xi’an 710054,China)

机构地区：[1]西安交通大学附属红会医院关节病医院膝关节病区,710054

出　　处：《美中国际创伤杂志》2021年第3期17-20,57,共5页U.S.Chinese International Journal of Traumatology

摘　　要：目的:通过观察东莨菪碱透皮贴对TKA术后患者P0NV发生率及其量化评分的改善,以及术后首次下地时间来评价该药的有效性及安全性。方法:选取2019年6月至2020年6月于本院膝关节科行初次TKA术患者41例,随机分为东莨菪碱透皮贴组(实验组)20例和安慰剂贴组(对照组)21例。两组均于术前4h在患者耳后贴敷贴片,并保留72h。所有患者均采用全麻+股神经阻滞麻醉,术前宣教、手术操作、术后康复及多模式镇痛均由同一组医生完成。最后由独立的观察者记录并统计术后4-24h、24-48h、48-72h以及72h后恶心呕吐发生情况及其量化评分的改善,以及患者术后首次下地时间。结果:实验组在术后4-24h、24-48h、48-72h内P0NV的发生率显著低于对照组(P<0.05),但在72h后两组P0NV发生率未见显著差异;在恶心呕吐VAS评分上,实验组显著优于对照组(P<0.05);对术后两组首次下地时间而言,实验组术后24h内下地率为85.0%,对照组为61.9%,两组差异未见统计学意义(P>0.05)。结论:TDS对减少TKA术后P0NV发生具有正向作用,安全性较高,且不影响患者早期下床进行康复锻炼。Objective:To evaluate the effectiveness and safety of transdermal scopolamine(TDS)in preventing postoperative nausea and vomiting(PONV)after total knee arthroplasty(TKA)by observing the incidence of PONV and the improvement of quantitative score as well as the time of first landing after surgery.Methods:From June 2019 to June 2020,41 patients who underwent TKA for the first time in the knee joint department of our hospital were selected and randomly divided into TDS group(experimental group,20 patients)and placebo patch group(control group,21 patients).In both groups,the patch was applied behind the patient's ear 41i before the operation and kept for 72h.All patients underwent general anesthesia+femoral nerve block anesthesia,preoperative education,surgical operations,postoperative rehabilitation and multi-modal analgesia are all clone by the same team of doctors.Finally,an independent observer recorded and counted the occurrence of nausea and vomiting 4-24h,24-48h,48-72h and 72h after the operation and the improvement of their quantitative scores,as well as the patient’s first landing time after surgery.Results:The incidence of PONV in the experimental group was significantly lower than that in the control group within 4-24h,24-48h,and 48-72h after surgery(P<0.05),but no significant difference between the two groups after 72h.On the VAS score of nausea and vomiting,the experimental group was significantly better than the control group(P<0.05).In terms of the time to land for the first time in the two groups after operation,the rate of landing in the experimental group within 24 hours after operation was 85.0%,and that of the control group was 61.9%.The difference was not statistically significant(P>0.05).Conclusion:TDS has a positive effect on reducing the occurrence of PONV after TKA,is safer,and does not affect patients early getting out of bed for rehabilitation exercises.

关 键 词：全膝关节置换术 东莨菪碱透皮贴 术后恶心呕吐 

分 类 号：R47[医药卫生—护理学]