恩丹西酮预防全麻上腹部手术后恶心呕吐临床研究.docVIP

恩丹西酮预防全麻上腹部手术后恶心呕吐临床研究 　　[摘要] 目的 探讨病人硬膜外自控镇痛时,不同途径应用不同剂量的恩丹西酮预防术后恶心、呕吐的疗效。方法 120例普外科择期手术患者,ASAI～II级,以随机双盲法分为两组,分别经静脉给予恩丹西酮8mg,观察术后24h内恶心、呕吐的发生率,并对其恶心、呕吐程度进行评分。结果 两组患者镇痛后血压、呼吸均平稳。均有恶心、呕吐患者,但恶心、呕吐发生率及程度不同,加用恩丹西酮后恶心、呕吐发生率明显降低(P 　　[关键词] 恩丹西酮;恶心;呕吐 　　[中图分类号] R614.2[文献标识码] A [文章编号] 1673-9701(2009)36-61-02 　　 　　Ondansetron in Prevention of Nausea and Vomiting Due to General Anesthesia after Upper Abdominal Surgery 　　HU Chengxia 　　Department of Anaesthesiology,Haiyang City People’s Hospital,Haiyang 265100,China 　　 　　[Abstract] Objective To explore the curative efficacy of different doses of ondansetron in different ways in the prevention of postoperative nausea and vomiting in patient-controlled epidural analgesia. Methods Total 120 patients who underwent general surgery were divided into two groups in a random double-blind method with 60 for each group: experimental group and control group. The experimental group was given intravenous ondansetron 8mg,and the nausea and vomiting incidence was observed 24h after surgery and the nausea and vomiting extent was scored. Ondasetron was not given to the control group. Results The heart rate and blood pressure were kept stable in both groups in 24h after operation. Respiratory depression did not occur in all patients.The incidence of nausea and vomiting was significantly lower in the experimental group than that in the control group(P0.05)。术前24h未用任何抗呕吐药物,所有患者均无手术及麻醉史。对药物过敏者、有精神性恶心、呕吐者,以及经解释不能正确使用PCEA泵的患者不列入本研究。 　　1.2麻醉方法 　　两组均在术前30min肌注阿托品0.01mg/kg,采用静吸复合全麻,诱导用异丙酚(0.5～2)mg/kg,芬太尼(2～4)μg/kg,维库溴铵(0.12～0.15)mg/kg。静注后行气管插管,纯氧机械通气,潮气量(VT)(8～10)mL/kg,频率(RR)(10～12)次/min。用0.5%～2%异氟醚持续吸入及微量泵持续静注异丙酚(4～12)mg/(kg?h),40～60min静注维库溴铵(0.08～0.1)mg/kg维持麻醉。两组患者均在手术结束后接PCIA,配方为芬太尼1.0mg加0.9%生理盐水至100mL,设定持续注速2mL/h,单次剂量为1mL,锁定时间为15min。试验组另取恩丹西酮8mg加入PCIA中。分别取以上药液3～5mL静注作为负荷量后接镇痛泵回病房,术后4、8、12、24h进行随访记录疼痛评分、镇静评分及恶心呕吐的发生情况。术后24h经鼻吸氧及监测血压、呼吸频率、心率和脉搏氧饱和度。 　　1.3评估等级 　　从术毕开始至术后24h,其中前4小时每小时记录1次。重点观察有无恶心、呕吐反应。恶心分级:0度为无恶心,1度为休息时无恶心、运动时稍有恶心感,2度为休息时有间断恶