临床科研试验计划书题目经皮穴位电刺激复合右美托咪定对神经外科.DOCVIP

临床科研试验计划书 题目：经皮穴位电刺激复合右美托咪定对神经外科开颅手术后恶心呕吐的影响 （一）立题依据： 术后恶心呕吐（PONV）是手术麻醉后常见并发症，发生率超过30%，高危人群超过70%。PONV延迟病人的恢复，延长住院时间并增加医疗成本[1] 。神经外科开颅手术发生PONV可使颅内血管压力增高并增加颅内压，可引起颅内出血等严重后果。有研究表明神经外科开颅手术术后患者PONV的发生率高达50%以上，并将开颅手术作为预测PONV的一项独立危险因素[2] 。并认为幕上和幕下肿瘤开颅手术患者术后PONV发生率无明显差别[2] [3] 。 HYPERLINK /pubmed?term=Massad%20IM%5BAuthor%5Dcauthor=truecauthor_uid\t _parent Massad IM等[4]发现在腹腔镜手术患者平衡麻醉中，静脉泵注右美托咪定（Dex）组术后恶心呕吐的发生率较对照组明显降低。 HYPERLINK /pubmed?term=Soliman%20RN%5BAuthor%5Dcauthor=truecauthor_uid\t _parent Soliman RN等[5]发现在神经外科开颅手术中静脉泵注Dex可降低术后患者对止吐药物的需求。Charbit B等[6]认为氟哌利多及5-羟色胺受体拮抗剂有利于改善术后恶心呕吐，但可引起QT间期延长以及心律失常等严重并发症。Wang XQ等[7]发现经皮电刺激P6穴位，可显著降低幕上开颅肿瘤手术者PONV，是一种有效的辅助手段。He等[8]研究证实电针足三里等穴位对治疗胃肠肿瘤术后功能性胃肠动力障碍方面有疗效。白红梅，孙建华，张杰[9]研究表明，电针双侧内关、足三里等穴位，可有效降低PONV的发生。那么经皮穴位电刺激复合右美是否能更进一步降低PONV的发生率？ 参考文献： 1.Gan TJ. Postoperative nausea and vomiting-can it be eliminated??JAMA.?2002;287:1233–1236.? 2.Latz B, Mordhorst C, Kerz T, Schmidt A, Schneider A, Wisser G, Werner C, Engelhard K.?Postoperative nausea and vomiting in patients after craniotomy: incidence and risk factors. J Neurosurg?2011,?114:491-496. 3.Irefin SA, Schubert A, Bloomfield EL, DeBoer GE, Mascha EJ, Ebrahim ZY.?The effect of craniotomy location on postoperative pain and nausea. J Anesth?2003,?17:227-231. 4.Massad IM,Mohsen 5.Soliman RN,Hassan AR,Rashwan AM, Omar AM. Prospective, randomized study to assess the role of?dexmedetomidine?in patients with supratentorial tumors undergoing?craniotomy?under general anaesthesia. Middle East J Anesthesiol.2011 Oct;21(3):325-34. 6. Charbit B, Albaladejo P, Funck-Brentano C, Legrand M, Samain E, Marty J. Prolongation of QTc interval after postoperative nausea and vomiting treatment by droperidol or ondansetron. Anesthesiology 2005;102:1094–1100 7. Wang XQ,Yu JL,Du ZY,et al. Electroacupoint stimulation for?postoperative nausea and vomiting?in patients undergoing supratentorial craniotomy. J Neurosurg Anesthesiol.2010 Apr;22(2):128-31. 8.He J，Ch