术后镇痛10年后的质量控制探讨：1168例回顾性研究

目的 了解术后镇痛的现状，探讨术后镇痛的质量控制问题。方法 回顾近3个月1168例术后镇痛所采用的镇痛方法和预防术后恶心呕吐的方法，了解镇痛效果和副作用的发生情况，并分析影响镇痛效果和副作用发生率的有关因素，患者的满意度情况。结果 90％采用了连续硬膜外镇痛法，配方主要是小剂量吗啡复合低浓度布比卡因或罗比卡因，静脉镇痛主要采用吗啡复合氯诺昔康。预防术后恶心呕吐（PONV）的方法有5-HT3受体拮抗剂（昂丹司琼或阿扎司琼），氟哌啶，地塞米松等，单用或复合应用。连续硬膜外镇痛需要补救镇痛者约5％，静脉镇痛补救镇痛者约10％。PONV总体发生率低，妇科开腹手术低至20％，女性非妇科手术低至10％，剖宫产术低至1％，使用氟哌啶使妇科手术PONV降低约50％。1例高龄患者出现血氧饱和度下降至82％，经停药、吸氧等处理好转。硬膜外导管脱落0．5％。瘙痒、头晕等并发症小于5％。通过补救镇痛，及时处理并发症，患者满意度在90％以上。结论 硬膜外镇痛方法效果优于静脉镇痛方法，适度镇痛，减少镇痛药量，增加安全性，重视PONV的预防，及时处理镇痛不足和副作用，从而提高患者的满意度，是术后镇痛质量控制的可行的理念和方法。     

Single-dose oral omeprazole for reduction of gastric residual acidity in adults for outpatient surgery

Omeprazole is a substituted benzimidazole that causes dose-dependent intracellular inhibition of gastric acid secretion in humans. This double-blind study examined the effect of omeprazole in decreasing gastric acidity and gastric residual volume in outpatient adults. Unpremedicated outpatients, ASA I-III, 18 years or older (n = 17), were randomly assigned to receive omeprazole 80 mg, or placebo by mouth the night before scheduled elective outpatient surgery. The patients were fasted for 8 h prior to surgery. After the patient was anesthetized, an orogastric tube was inserted with proper placement verified by auscultation for gastric sounds. Gastric residual contents were withdrawn into a Luken's trap, and pH was then determined and gastric volume indexed to weight (ml.kg-1). Data were analyzed by a t-test, with P less than 0.05 considered statistically significant. Patient characteristics of both groups were similar. There was a statistically significant difference between the two groups for pH (P = 0.02), but not between the two groups for gastric volume indexed to weight (P = 0.07).     

欧丹西酮预防曲马多硬膜外术后镇痛期间恶心、呕吐的定量研究

目的　寻找欧丹西酮 (Ondansetron)预防妇产科手术后曲马多连续硬膜外镇痛期间恶心和呕吐的最佳剂量。方法　ASAⅠ～Ⅱ级妇产科手术病人 12 0例 ,随机分为 4组 (n =30 ) ,于关腹后接镇痛泵前 (配方为曲马多 80 0mg+布比卡因 112 .5mg ,总量 10 0ml,泵速 2ml/h)分别接受欧丹西酮 2mg、4mg、6mg和生理盐水 2ml静注。观察镇痛期不同时点的VAS值和 0～ 2 4h的恶心、呕吐发生率。结果　 4组VAS均值无明显差异 (P >0 .0 5 )。在 0～2 4h ,恶心 :2mg组 30 .4 % (7) ,4mg组 3.3% (1) ,6mg组 3.3% (1)和生理盐水组 4 6 .7% (14 ) ;呕吐 :2mg组2 0 .0 % (6 ) ,4mg组 3.3% (1) ,6mg组 3.3% (1)生理盐水组 4 3.3% (13)。在预防恶心和呕吐两个事件方面 ,所有用药组与对照组相比均有显著差异 (P <0 .0 5 ) ;在用药组中 ,2mg组与 4mg和 6mg组间比较P <0 .0 5 ,而后 2个剂量组间无差别。结论　本文 3个剂量组的欧丹西酮均有预防妇产科手术后曲马多连续硬膜外镇痛期间恶心和呕吐的作用 ,其中以 4mg组最优。     

Vomiting after ophthalmic surgery

The usefulness of intra-operative antiemetics and postoperative oral fluid restriction in the prevention of vomiting following anaesthesia for ophthalmic surgery, was studied in 200 patients. They were allocated into four groups of 50 and given either saline (as control), droperidol, metoclopramide or prochlorperazine. Oral intake was restricted postoperatively in half of the patients of each group. Anaesthesia comprised morphine and atropine premedication and a halothane, nitrous oxide and oxygen spontaneous breathing technique. No significant beneficial effects resulted from intra-operative antiemetics; vomiting incidences of 26% after saline and droperidol, 28% after metoclopramide and 14% after prochlorperazine were observed. Younger patients and females vomited most frequently. Restriction of oral fluids did not decrease the incidence of vomiting but demonstrated that approximately half of those patients who vomit do so with their first postoperative oral intake. Vomiting was observed more frequently after non intra-ocular surgery than after intra-ocular surgery (37% cf. 16%, p less than 0.01) and postoperative analgesics were required by more non intra-ocular patients than by intra-ocular patients (25% cf. 5%, p less than 0.001). Squint patients vomited most frequently (48%) and most frequently required postoperative analgesia (35%).     

盐酸托烷思琼预防脑动脉瘤栓塞术后恶心呕吐的观察

目的:观察盐酸托烷思琼对预防脑动脉瘤栓塞术患者术后恶心呕吐(PONV)的有效性和安全性。方法:选择行颅内动脉瘤栓塞术患者45例,随机分为3组,每组15例,于手术结束前30分钟A组患者缓慢静注盐酸托烷思琼5mg,B组患者缓慢静注盐酸托烷思琼3mg,C组患者给予生理盐水。术后观察并记录以下指标:(1)术后24h内恶心呕吐发生率及强度;(2)术后2、8h镇静评分(OAA/S);(3)术后2、8h平均动脉压(MAP),心率(HR);(4)各组不良反应的发生情况。结果:术后24h内两治疗组恶心呕吐发生率显著低于对照组,差异有统计学意义(P<0.05或P<0.01)。托烷思琼5mg组恶心呕吐发生率略低于3mg组,但差异无统计学意义(P>0.05)。结论:托烷思琼可降低脑动脉瘤栓塞术患者术后恶心呕吐的发生率。托烷思琼3mg不仅可以减少药物用量,而且能减少副作用的发生,是一种经济、有效、安全的止吐方法。     

地塞米松减轻曲马多术后镇痛时恶心呕吐的临床观察

目的 :探讨地塞米松减轻曲马多术后镇痛时恶心呕吐的临床效果。方法 :选择术后自愿硬膜外镇痛(PCEA)的病例 6 0例 ,随机分为试验组 (地塞米松 曲马多 0 .15 %布比卡因 )和对照组 (格拉司琼 曲马多 0 .15 %布比卡因 )。结果 :两组病人术后疼痛评分 (VAS法 ) ,镇静评分及恶心呕吐的发生率无明显差异 (P >0 .0 5 )。结论 :地塞米松可以减轻曲马多术后镇痛时恶心呕吐的发生 ,效果良好 ,不增加副作用 ,价格便宜     

The effect of subhypnotic doses of propofol on the incidence of pruritus after intrathecal morphine for Caesarean section

The effect of subhypnotic doses of propofol on intrathecal morphine-induced pruritus was studied in a prospective, randomly allocated, double-blind controlled trial. Fifty-eight women undergoing elective lower segment Caesarean section for a singleton fetus received spinal anaesthesia with 2.5 ml hyperbaric 0.5% bupivacaine and 0.2 mg of preservative-free morphine. They then received propofol 1 ml (10 mg) or Intralipid 1 ml (control group) intravenously after delivery. Pruritus was assessed using a five-point verbal rating scale at hourly intervals for 8 h. A second dose of their allocated treatment drug was administered at the first recording of significant pruritus. The pruritus score was reassessed after 5 min and the treatment was repeated if pruritus remained. There were no differences between the groups in the onset of pruritus or its successful treatment. No adverse side-effects were associated with this dose of propofol. There were no differences in the incidence of post-operative nausea and vomiting between the two groups. Subhypnotic propofol is not an effective treatment for intrathecal morphine-induced pruritus in women following Caesarean section.     

A comparison of different severities of nausea and vomiting during pregnancy relative to stress, social support, and maternal adaptation

A cross-sectional and comparative research design with convenience sampling was used to recruit pregnant women from prenatal clinics in southern Taiwan between 2002 and 2003 to examine the differences in perceived stress, social support, and maternal psychosocial adaptation among women with different severities (mild or less than mild, moderate, and severe) of nausea and vomiting during pregnancy. A total of 150 pregnant women participated in this study. One-way analysis of variance indicated that perceived stress was significantly different among the 3 groups. The least significant difference post-hoc test revealed that pregnant women with mild nausea and vomiting had significantly lower stress than did pregnant women with severe nausea and vomiting. The severity of nausea and vomiting was significantly associated with the Prenatal Self Evaluation Questionnaire subscales for "acceptance of pregnancy" and "fear of helplessness and loss of control in labor." Social support and maternal psychosocial adaptation were not significantly different among these three groups. The degree of perceived stress and maternal psychosocial adaptation may be related to the severity of nausea and vomiting during pregnancy.     

术后恶心呕吐的危险因素分析及防治

恶心呕吐是术后常见的并发症，而且可引起切口裂开、吸入性肺炎、水电解质紊乱等严重后果。近年来，虽然对术后恶心呕吐(PONV)的发生机制进行了大量的研究，也出现了很多新型的抗呕吐药，但PONV发生率依然较高。PONV的治疗可分为非药物疗法和药物疗法，作者对药物疗法进行综述。