昂丹司琼预防腹腔镜胆囊切除术后恶心呕吐的疗效观察.DOCVIP

临床医学论文-昂丹司琼预防腹腔镜胆囊切除术后恶心呕吐的疗效观察 【摘要】? 目的? 探讨腹腔镜胆囊切除手术后静脉注射昂丹司琼对术后恶心呕吐的预防疗效。方法? 90例ASAⅠ～Ⅱ级，择期腹腔镜胆囊切除术患者随机分成3组。第Ⅰ组对照组，术后给予生理盐水5ml。第Ⅱ组氟哌利多组，术后静注氟哌利多1.25mg。第Ⅲ组术后静注枢复宁4mg。观察术后24h患者的恶心呕吐情况。结果? 第Ⅰ、Ⅱ、Ⅲ组患者恶心呕吐发生率分别为60.0%、30.0%、26.7%。第Ⅱ组与第Ⅰ组之间差异有显著性（P0.05），第Ⅲ组与第Ⅰ组之间差异有非常显著性（P0.01)。第Ⅱ组与第Ⅲ组之间差异无显著性（P0.05)。结论? 本研究示术毕时静脉注射昂丹司琼4mg与氟哌利多1.25mg均能有效防止、预防腹腔镜术后恶心呕吐。 　　【关键词】? 术后恶心呕吐；昂丹司琼??? 　　【Abstract】? Objective? To evaluate the prophylactic efficacy of ondansetron on postoperative nausea and vomiting on the laparoscopic cholecystectomy(LC).Methods? In a prospective,randomized,single blind placebo controlled trial,90 patients of ASA Ⅰ-Ⅱ scheduled for LC were received one three regimens:placebo group (group 1 physiological saline 5 ml),droperidol group (group 2,droperidol 1.25 mg),ondensetron group(group 3,ondansetron 4 mg).Patients were followed for 24hr with regards to PONV after surgery.Results?It had significant difference between group 2 and group 1(P0.05),it had significant difference between group 3 and group 1 (P0.01),it had not significant difference between group 2 and group 3(P0.05).At 24hr,PONV rate was 60% in group 1,30% in group 2,26.7% in group 3.Conclusion Odansetron is as effective as droperidol in the prevention of PONV for the patients undergoing laparoscopic cholecystectomy(LC). 　　【Key words】? postoperation nausea and vomiting;odansetron 　　恶心呕吐是全麻常见的并发症，腹腔镜术能增加术后恶心呕吐的发生率［1］，并且已经引起人们的高度关注。昂丹司琼能有效预防术后恶心呕吐的发生率［2］，但对预防腹腔镜胆囊切除术后恶心呕吐的疗效存在争议［1］。本研究对接受腹腔镜胆囊切除术患者90例进行了观察，旨在了解昂丹司琼对预防腹腔镜术后恶心呕吐的疗效。 　　1? 资料与方法 　　1.1? 一般资料? 择期腹腔镜胆囊切除术患者90例，年龄23～61岁，ASAⅠ～Ⅱ级，无全身麻醉史，术前48h未服用与恶心呕吐有关的药物。 　　1.2? 方法? 术前30min肌注安定10mg，阿托品0.5mg。随机化、单盲法将患者分为对照组、氟哌利多组、昂丹司琼组。每组30例。采用异丙酚2mg/kg，琥珀胆碱2mg/kg诱导插管，吸入异氟醚-N2O-O2（1∶1）维持麻醉，选用阿曲库胺0.3～0.6mg维持肌松，间断给予芬太尼0.1～0.2mg。术中常规用新斯的明0.5～2mg，阿托品0.5mg拮抗残余肌松作用。纳洛酮0.4mg拮抗芬太尼的呼吸抑制及镇痛作用。术毕后对照组给予生理盐水5ml静注。氟哌利多组给予氟哌利多1.25mg静注。昂丹司琼组给予昂丹司琼4mg静注。术后常规不给予镇痛药，除非无法忍受疼痛的患者给予哌替啶50mg肌注。观察各组患者术后24h内恶心呕吐的发生率、严重程度及治疗情况。 　　1.3? 统计学方法? 各组恶心呕吐的发生率采用卡方检验，组间比较采用卡方分割法。 　　2? 结果 　　各组间一般情况（年龄、性别