地塞米松和格拉司琼预防腹腔镜胆囊切除术后恶心呕吐比较的研究_临床医学论文.docVIP

地塞米松和格拉司琼预防腹腔镜胆囊切除术后恶心呕吐比较的研究_临床医学论文 地塞米松和格拉司琼预防腹腔镜胆囊切除术后恶心呕吐比较的研究_临床医学论文 作者：卜祥梅　戚晓良　王舟　于文滨　王志刚 【摘要】 目的：研究地塞米松和格拉司琼预防腹腔镜胆囊切除术后恶心呕吐的临床效果及两者有无交互作用。方法：80 例ASAⅠ～Ⅱ级择期全身麻醉下行腹腔镜胆囊切除术的患者，随机分为4 组：地塞米松组、格拉司琼组、地塞米松+格拉司琼组和对照组，每组20人。各组患者均于麻醉诱导前经静脉给予止吐药，记录术后24 h内恶心呕吐评分及刀口愈合情况。结果：各实验组术后恶心呕吐评分均低于对照组（P＜0.05）；地塞米松组和格拉司琼组相比差异无统计学意义（Pgt;0.05）；地塞米松+格拉司琼组与格拉司琼组、地塞米松组相比均降低（P＜0.05）；析因分析认为地塞米松和格拉司琼两药联合应用对预防术后恶心呕吐具有协同作用；各组术后刀口愈合均良好。结论：地塞米松和格拉司琼均能较好预防术后恶心呕吐，两者效果无明显差异，两药联合应用具有协同作用。 【关键词】 胆囊切除术，腹腔镜·手术后恶心呕吐·地塞米松·格拉司琼 【ABSTRACT】 Objective: To compare dexamethasone and granisetron for the prevention of PONV（Postoperative nausea and vomiting） after LC（Laparoscopic cholecystemy）. Methods: A total of 80 patients were randomly divided into four groups （n= 20 each）. A： dexamethasone 8 mg group； B： granisetron 3 mg， C： combined application group，D were the control group. All patients were given the similiar standardized anesthesia and operative treatment. PONV were assessed during the first 24 h after operations. Results: Group A,B and C got higher scores of PONV than the control group（P＜0.05）. Both group A and B got lower scores of PONA than group C（P＜0.05）. But there were no statistical significance between group A and B. The two drugs had interaction when used combined. Conclusion: Either dexamethasone or granisetron decreases the incidence and degree of PONV after LC. And the two drugs can enhance curative effect each other. [KEY WORDS] Cholecystemy·Laparoscopic·Postoperative nausea and vomiting·Dexamethasone·Granisetron 　　腹腔镜胆囊切除术（laparoscopic cholecystemy,LC） 因其创伤小、手术时间短、术后恢复快，已经广泛应用于临床。然而，腹腔镜手术后恶心呕吐（postoperative nausea and vomiting, PONV ）的发生率高达70%左右［1］，PONV给术后恢复带来了不良影响，如加剧伤口痛、患者误吸、水电解质及酸碱失衡、延长住院时间等［2］。因此，探索预防LC后恶心呕吐的药物和方法具有重要的临床意义。本研究旨在观察地塞米松和格拉司琼在麻醉诱导前给药预防LC 后恶心呕吐的临床效果及两者有无交互作用。 1　资料与方法 1.1　一般资料　2006年8月—2007年11月山东大学第二医院择期行LC患者80例，男34例，女46例。ASA分级Ⅰ～Ⅱ级，年龄19～52岁，中位年龄37岁，体质量40～80 kg，肝肾功能及电解质正常，术前无恶心呕吐、眩晕病史，术前48 h未用任何止吐药。将研究对象随机分为4组，每组20人。地塞米松组：麻醉诱导前静脉给予地塞米松8 mg；格拉司琼组：麻醉诱导前静脉给予格拉司琼3 mg；地塞米松+格拉