地塞米松联合恩丹西酮对术后硬膜外吗啡持续镇痛所致恶心呕吐的影响

目的:观察地塞米松联合恩丹西酮对术后患者硬膜外腔吗啡镇痛所致恶心呕吐的防治效果.方法:随机将240例在腰硬联合麻醉下行腹部手术的女性患者分为四组:对照(A)组于手术关腹膜时静脉注射生理盐水4 ml;恩丹西酮(B)组静脉注射恩丹西酮8 mg;地塞米松(C)组静脉注射地塞米松10 mg;恩丹西酮与地塞米松联合(D)组静脉注射地塞米松10 mg 恩丹西酮8 mg.所有患者在手术后均接受硬膜外吗啡镇痛.观察术后48 h内患者镇痛效果和恶心呕吐发生情况.结果:各组间镇痛效果无明显差异.A组恶心呕吐发生率为52.6%,明显高于B组和C组,P＜0.05;D组恶心呕吐发生率为17.5%,与A组比较,P＜0.01,与B组和C组比较,P＜0.05.结论:地塞米松和恩丹西酮单独应用均能有效地减少术后硬膜外吗啡镇痛所致的恶心呕吐;两药联合应用可进一步降低患者的恶心呕吐发生率.

Influence of dexamethasone combined with ondansetron on postoperative nausea and vomiting related to epidural morphine for analgesia

Objective: To observe the effect of dexamethasone combined with ondansetron on postoperative nausea and vomiting related to epidural morphine analgesia.Methods: All of 240 female-patients scheduled for abdominal surgeries under combined spinal-epidural anesthesia were randomly divided into four groups.At the end of operation,Group A(control) received normal saline(NS) 4 ml.Group B received ondansetron 8 mg;Group C received dexamethasone 10 mg.Group D received dexamethasone 10 mg and ondansetron 8 mg.All patients received epidural morphine for analgesia after the surgery.Pain rating,nausea and vomiting were recorded for 48h after surgery. Results: The incidence of nausea and vomiting in group A(52.6%) was higher than that in group B and group C(P<0.05),while nausea and vomiting in group D(17.5%) was lower than that in group A(P<0.01),group B and group C(P<0.05). Conclusion: Dexamethasone or ondansetron to be given alone can decrease the incidence of nausea and vomiting during epidural morphine for analgesia.A combination of the two antiemetics can reduce the incidence of nausea and vomiting further.