托烷司琼联合地塞米松预防剖宫产术后硬膜外镇痛所致恶心呕吐的临床观察

目的观察托烷司琼联合地塞米松对剖宫产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320例在腰硬膜外联合麻醉下行剖宫产手术的患者分为四组：分别于手术关腹膜时静脉注射生理盐水5ml（Ⅰ组）、托烷司琼5mg（Ⅱ组）、地塞米松10mg（Ⅲ组）和地塞米松10mg＋托烷司琼5mg（IV组）。所有患者在手术后均接受硬膜外吗啡镇痛。观察术后48h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。Ⅰ组恶心呕吐发生率明显高于Ⅱ组和Ⅲ组（P〈0．05）；Ⅳ组恶心呕吐发生率与Ⅰ组比较，P〈0．01，与Ⅱ组和Ⅲ组比较，P〈0．05。结论托烷司琼联合地塞米松比其单独应用更能有效地减少剖宫产术后硬膜外吗啡镇痛所致的恶心呕吐症状，值得临床推广应用。

Clinical observation of tropisetron combined with dexamethasone in the prevention of nausea and vomiting caused by epidural analgesia after cesarean section

Objective To observe the effects of tropisetron combined with dexamethasone in the prevention and treatment of nausea and vomiting caused by epidural morphine analgesia after cesarean section. Methods Three hundred and twenty patients undergoing cesarean section under the combined spinal-epidural anesthesia were random- ly divided into 4 groups ： received intravenous injection of physiological saline 4 ml at closing peritoneum during operation as group Ⅰ ,5 mg of tropisetron as group Ⅱ, 10 mg of dexamethasone as group Ⅲ and 10 mg dexamethasone plus 5 mg of tropisetron as group Ⅳ. All patients received epidural morphine analgesia after operation. The result of analgesia, nausea and vomiting of patients within 48 hours after operation were observed. Results There was no distinct difference in analgesia results between the groups. The occurring rate of nausea and vomiting in group I was obviously higher than that in group Ⅱ and m （P 〈 0. 05 ） ; while compared occurring rate of nausea and vomiting in group Ⅳ with that of group Ⅰ the difference was distinct（P 〈0. 01 ） ;with that of group Ⅱ and m the difference was distinct （ P 〈 0. 05 ）. Conclusion Tropisetron combined with dexamethasone can more effectively reduce the incidence nausea and vomiting caused by epidural morphine analgesia after cesarean section than individual use. It is worthy of clinical popularization and application.