地塞米松预防腹腔镜胆囊切除术后恶心呕吐的临床观察

目的 :总结地塞米松预防腹腔镜胆囊手术全麻后恶心、呕吐的效果。方法 :腹腔镜胆囊切除术2 0 0例ASAⅠ～Ⅱ级 ,2 2～ 79岁。随机分为研究组和对照组各 10 0例。研究组静注地塞米松 10mg ,对照组未用地塞米松。两组麻醉给药一样 ,观察 2 4h心率、血压、呼吸频率及恶心、呕吐发生率。结果 :地塞米松组发生恶心 11例 ,呕吐 6例。未用地塞米松组发生恶心 38例、呕吐 33例 ,两组恶心呕吐总发生率分别为 17%和71% (P <0 0 1)。结论 :地塞米松 10mg能减少腹腔镜胆囊切除术后恶心、呕吐的发生率 ,无副作用     

地塞米松减少手术后硬膜外吗啡镇痛引起的恶心呕吐

目的　观察静脉注射地塞米松 (Dex)对减少手术后与硬膜外吗啡镇痛有关的恶心呕吐发生率的作用。方法　随机双盲选择 87例在硬膜外麻醉下行腹部手术的女性病人进行观察。所有病人在手术后均接受硬膜外吗啡镇痛。Dex组病人 (n =41)在手术后静注Dex 8mg ,对照组病人 (n=46 )则给予等量生理盐水。结果　在手术后 2 4小时内 ,Dex组病人手术后总的恶心呕吐发生率为2 6 8% ,明显低于对照组病人的 43 5 % (P <0 0 1)。两组病人之间手术后皮肤瘙痒的发生率无明显差异 ,Dex也不影响手术后硬膜外吗啡的镇痛作用。结论　预防性静脉注射Dex是一种减少与硬膜外吗啡镇痛有关的恶心呕吐并发症的有效方法     

Postoperative nausea and vomiting prophylaxis: The efficacy of a novel antiemetic drug (palonosetron) combined with dexamethasone

BackgroundPalonosetron is a new, potent, and long-acting 5HT3-receptors antagonist that had been approved by the FDA for use in postoperative nausea and vomiting (PONV) prophylaxis. This study is designed to evaluate its efficacy combined with dexamethasone in PONV prophylaxis in highrisk patients scheduled for laparoscopic surgeries.MethodsIn this double-blind, active-controlled study, 150 patients aged 20–55 years, ASA I–II, and with Apfel’s PONV score 2–4 were equally randomized to receive dexamethasone 8 mg before anesthesia induction and saline 30 min before the end of surgery (group D + S), dexamethasone 8 mg before anesthesia induction and metoclopramide 25 mg 30 min before the end of surgery (group D + M), or dexamethasone 8 mg combined with palonosetron 0.075 mg before anesthesia induction and saline 30 min before the end of surgery (group D + P). Incidences of early and late PONV, complete response, adverse events from antiemetics used, and overall patients’ satisfaction were recorded.ResultsThe incidence of PONV was comparable in the three groups 0–6 h postoperatively. Palonosetron–dexamethasone and dexamethasone–metoclopramide combination therapies significantly reduced the incidence of PONV at 6–12 h postoperatively compared to dexamethasone monotherapy (12% and 16%, vs. 36%, respectively, with P < 0.05). Moreover, palonosetron–dexamethasone combination therapy significantly reduced the incidence of PONV at 12–24 h postoperatively compared to both dexamethasone monotherapy (16% vs. 48%, P < 0.01), and dexamethasone–metoclopramide combination therapy (16% vs. 40%, P < 0.05). The incidence of adverse drug effects was comparable in the three groups. The overall patients’ satisfaction was significantly higher in palonosetron–dexamethasone combination therapy compared to other groups.ConclusionPalonosetron–dexamethasone combination is effective and safe in PONV (early and late) prophylaxis in high-risk patients undergoing laparoscopic surgeries with known high-risk of PONV.     

Prevention of postoperative nausea and vomiting with metoclopramide, droperidol and ondansetron: a randomized, double-blind comparison with placebo in ambulatory surgery

In order to compare the efficacy of metoclopramide, droperidol and two different doses of ondansetron in the prevention of postoperative nausea and vomiting (PONV) after ambulatory surgery, a prospective, randomized, double-blind, placebo-controlled study was performed in 264 patients. The incidence of PONV was 6% and no antiemetic was more effective than placebo in preventing this complication during the 24 h after surgery.     

Effect of premedication with mirtazapine versus ondansetron on postoperative nausea and vomiting in breast surgery

Background

Mirtazapine is a specific serotonergic antidepressant drug. The aim of this study was to compare the efficacy of mirtazapine as PONV prophylaxis with a classic 5HT3 receptor antagonist; ondansetron.

Methods

Eighty female patients with high PONV risk undergoing prophylactic mastectomy with a standardized anesthetic were randomized to receive either an oral disintegrating tablet (ODT) of mirtazapine 30 mg (group M) or ondansetron 16 mg (group O) 1 h before surgery. Preoperative anxiety level was assessed by state and trait anxiety inventory before taking the study drug and 1 h after. Vital sign variables, the incidence of PONV, the use of rescue antiemetic, complete response, postoperative VAS pain scores, the inverted observer’s assessment of alertness/sedation scale and side effects were compared.

Results

Mirtazapine premedication reduced preoperative state anxiety inventory scores (P < 0.01) and the incidence of early nausea and late vomiting (P < 0.05). The percentage of patient having complete responses during the first 24 h after anesthesia was 75% after mirtazapine and 65% after ondansetron prophylaxis. Anesthetic requirements, postoperative pain, sedation scores, and side effects were similar between the two groups.

Conclusion

Mirtazapine prophylaxis reduces preoperative anxiety and the incidence of postoperative early nausea and late vomiting compared with ondansetron, without untoward sedative or cardiovascular effects.     

乳房肿瘤切除术后恶心呕吐的原因分析及预防

目的：探讨乳房肿瘤切除术后恶心呕吐的原因及各种止吐药的预防效果。方法：选择123例在氯胺酮静脉复合麻醉下行乳房肿瘤切除的女性患者，随机分为Ⅰ组(静注恩丹西酮8 mg)，Ⅱ组(静注氟哌利多2．5 mg)，Ⅲ组(静注甲氧氯普胺10 mg)。结果：Ⅰ组术后24 h恶心呕吐评为1级病例数明显少于其他两组。结论：与氟哌利多、甲氧氯普胺比较，恩丹西酮能更有效地防止乳房肿瘤切除术后恶心呕吐。     

Comparison of dexamethasone,metoclopramide, and their combination in the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy

Background Postoperative nausea and vomiting (PONV) are one of the most common complaints following anesthesia and surgery. This study was designed to evaluate the efficacy of dexamethasone, metoclopramide, and their combination to prevent PONV in patients undergoing laparoscopic cholecystectomy. Methods A total of 160 ASA physical status I and II patients were included in this randomized, double blind, placebo-controlled study. Patients were randomly assigned to 4 groups (n = 40 each): group 1 consisting of control patients administered 0.9% NaCl; group 2 patients received metoclopramide 10 mg just before the end of anesthesia; group 3 patients received dexamethasone 8 mg after the induction of anesthesia; and group 4 patients received dexamethasone 8 mg after the induction of anesthesia and metoclopramide 10 mg before the end of anesthesia. The incidence of PONV, mean visual analog pain scores at rest and on movement, time to the first request for analgesia, side effects, and well-being score were recorded during the first 24 h postoperatively. Results Data were analyzed using one-way analysis of variance (ANOVA) and the χ² test, with p < 0.05 considered statistically significant. The total incidence of PONV was 60% with placebo, 45% with metoclopramide, 23% with dexamethasone, and 13% with the combination of dexamethasone plus metoclopramide. None of the dexamethasone plus metoclopramide group patients (p < 0.05 versus groups 1 and 2) and one dexamethasone group patient (p < 0.05 versus group 1) required antiemetic rescue, as compared with four patients in the metoclopramide group and six patients in the placebo group. Pain scores, the time to the first request for analgesia, and side effects were similar across the study groups. Conclusions Dexamethasone and the combination of dexamethasone plus metoclopramide were more effective in preventing PONV than metoclopramide and placebo.     

Nausea, vomiting, and hiccups: a review of mechanisms and treatment

Nausea, vomiting, and hiccups are troubling complications associated with sedation and general anesthesia. This article will review the basic pathophysiology of these events and current recommendations for their prevention and management.     

Dexamethasone or combined with others for postoperative nausea and vomiting in children: A systematic review

Postoperative nausea and vomiting (PONV) is one of the most common and unpleasant postoperative complications in children. This study aims to evaluate the efficacy and safety of using dexamethasone alone or combined other drugs on the incidence of PONV in children. A systematic search of the literature was conducted from inception until March, 2019. Literature selection and data extraction were conducted by two independent reviewers. Statistical analysis was performed using the software package Review Manager Version 5.3.3. Twenty studies with total 2505 participants were included. The pooled analysis used a random-effect model showed that dexamethasone had significantly greater efficacy in incidence of POV and PON in postoperative 24 h than control. Subgroup analysis indicated the RR of dexamethasone ≥0.5 mg/kg group was the lowest compared subgroup dexamethasone ≤0.3 mg/kg and 0.3–0.5 mg/kg. There was no difference for early POV between dexamethasone and placebo groups. Dexamethasone combined with others also could significantly reduce the incidence of POV in postoperative 24 h. Few adverse effects were reported. This study indicates that dexamethasone is effective for preventing incidence of PONV in children. And multimodal approaches have shown more effectively to prevent the incidence of POV.     

针灸预防术后恶心呕吐的研究进展

术后恶心呕吐（PONV）,是术后最常见和最主要的并发症。针灸预防PONV是一种有效安全的非药物疗法。本文就从穴位．针灸方式．干预时间的选择及针灸治疗的副作用等方面综述近年来针灸预防PONV的研究进展。     

围手术期地塞米松对全膝关节置换术后恶心呕吐和疼痛的影响

目的:探讨围手术期应用地塞米松对于单侧全膝关节置换术后恶心呕吐和疼痛的影响及安全性评估。方法:2014年2月至2016年6月采用全膝关节置换治疗的单侧晚期骨性关节炎患者100例,分为2组,每组50例:其中地塞米松组,男27例,女23例,年龄(72.30±7.02)岁,术前给予地塞米松10 mg静脉滴注;生理盐水组,男26例,女24例,年龄(71.30±6.08)岁,相应时间给予等量生理盐水静滴。观察记录术后2、4、6、8、12、24、36、48 h时休息时和屈膝45°时疼痛VAS评分,记录术后0～24 h和24～48 h发生呕吐情况、使用止吐药及阿片类药情况。并记录术后患者药物副作用及并发症。结果:100例患者均获得随访,平均随访时间14.5个月。休息时疼痛VAS评分地塞米松组术后8、24、48 h时低于生理盐水组(P0.05);屈膝45°时VAS评分地塞米松组术后8、48 h时低于生理盐水组(P0.05);地塞米松组休息时和屈膝45°时VAS评分总体低于生理盐水组(P0.05)。术后0～24 h、24～48 h阿片类药用量及总阿片类药用量地塞米松组均低于生理盐水组(P0.05)。两组患者术后0～24 h和24～48 h发生恶心呕吐比例,术后0～24 h要求使用止吐药比例差异均有统计学意义(P0.05)。总止吐药用量地塞米松组少于生理盐水组(P0.05)。截止末次随访,两组患者未出现术后感染、消化道溃疡、出血等并发症。结论:术前全身应用地塞米松可有效减少TKA术后疼痛和恶心呕吐,且并不增加术后并发症。     

全麻诱导中地塞米松联合氟哌啶预防腹腔镜胆囊切除术后的恶心呕吐

目的：探讨全麻诱导中地塞米松联合氟哌啶预防腹腔镜胆囊切除术后恶心、呕吐的效果。方法：随机将240例ASAⅠ～Ⅱ腹腔镜胆囊切除术患者分为3组（各80例）。Ⅰ组（对照组）全麻诱导中不用地塞米松、氟哌啶;Ⅱ组全麻诱导中用地塞米松10mg;Ⅲ组全麻诱导中用地塞米松10mg和氟哌啶40μg/kg,观察术后48h患者的恶心、呕吐情况。结果：Ⅰ组患者恶心、呕吐的发生率为72.5%;Ⅱ、Ⅲ组恶心、呕吐的发生率分别为32.5%和7.5%,组间比较差异有统计学意义（P〈0.05）。结论：全麻诱导中用地塞米松联合小剂量氟哌啶能预防腹腔镜胆囊切除术后的恶心、呕吐。     

Impact of a prophylactic strategy on the incidence of nausea and vomiting after general surgery

Background

This study aimed to evaluate the implementation of a strategy to prevent postoperative nausea and vomiting (PONV) in patients undergoing general surgery.

Study design

Prospective observational study.

Methods

A first period was observational. During a second period, a strategy to prevent PONV was based on five risk factors (RF) identified after the first phase. From two RF, antiemetic treatment was given according to the number of RF. The incidence of PONV was recorded in postoperative anaesthesic care unit (PACU) and at the 24th postoperative hour (24 h).

Results

We prospectively enrolled 823 patients. Implementation of a prophylactic PONV strategy was associated with a decrease of nausea in PACU from 29.9 to 9.8% (P < 0.001) and at 24 h from 19 to 10.3% (P < 0.001). Vomiting decreased from 12.4 to 2.3% (P < 0.001) in PACU and from 5.6 to 3.7% at 24 h (non-significant).

Conclusion

Prophylaxis of PONV by the administration of antiemetic treatment according to a strategy based on a local risk score was efficient and associated with a significant decrease of PONV.     

Prevention of postoperative nausea and vomiting in children following adenotonsillectomy,using tropisetron with or without low-dose dexamethasone

Purpose Postoperative nausea and vomiting (PONV) after adenotonsillectomy in children is, in spite of the prophylactic administration of tropisetron, still a frequent event. The aim of this study was to evaluate the benefit of the additional systemic administration of low-dose dexamethasone (0.15 mg·kg⁻¹) for the prevention of PONV. Methods With hospital ethics committee approval, we investigated children undergoing adenotonsillectomy receiving tropisetron (0.1 mg·kg⁻¹; maximum dose, 2 mg) or tropisetron (0.1 mg·kg⁻¹; maximum dose, 2 mg) plus dexamethasone (0.15 mg·kg⁻¹; maximum dose, 6 mg) intraoperatively. The incidence of vomiting episodes and the need for postoperative analgesics were recorded. Patient data were analyzed using the t-test and the χ² test (significance level of P = 0.05). Data values are means ± SD. Results Ninety children (39 girls and 51 boys), aged 5.6 ± 2.8 years and weighing 21.9 ± 8.8 kg, were enrolled in the study. The overall incidence of vomiting was 38.9% within the first 24 h (67 vomiting events) and 44.4% within 48 h postoperatively (87 vomiting events). The incidence of vomiting in the tropisetron-only group was 53.3% (24/45) at 24 h and 60% (27/45) at 48 h (24 h: P < 0.001 and 48 h: P = 0.04) and 24.4% (11/45) at 24 h and 28.9% (13/45) at 48 h in the tropisetron-dexamethasone group. The need for postoperative nalbuphine was double in patients treated with tropisetron-dexamethasone (0.61 mg ± 0.36 mg·kg⁻¹·48 h⁻¹) compared to that in patients receiving only tropisetron (0.31 mg ± 0.28 mg·kg⁻¹·48 h⁻¹; P < 0.0001). Conclusion A low-dose bolus of dexamethasone (0.15 mg·kg⁻¹) in combination with tropisetron, compared to tropisetron alone, considerably reduced the incidence of vomiting in children following pediatric adenotonsillectomy.     

托烷司琼不同给药方式对术后镇痛恶心、呕吐的预防作用

目的 比较托烷司琼的不同给药方式对术后曲马多静脉自控镇痛患者恶心、呕吐的预防作用.方法 选择气管内全麻下择期腹部手术患者240例,ASAI或Ⅱ级,随机均分为四组.Ⅰ组术毕静脉连接患者自控镇痛（PCA）泵;Ⅱ组术毕静注5 mg托烷司琼后连接PCA泵;Ⅲ组术毕静注2 mg托烷司琼后连接PCA泵（PCA泵内加托烷司琼3 mg）;Ⅳ组术毕连接PCA泵（PCA泵内加托烷司琼5 mg）.PCA泵药物配制：900 mg曲马多加生理盐水配至总容量为100 ml.分别于术后2、4、8、20、36和48 h观察患者恶心、呕吐的发生情况.结果 （1）与Ⅰ组比较,Ⅱ组和Ⅲ组在术后2、4 h恶心的发生率明显降低（P＜0.05）;与Ⅳ组比较,Ⅱ组和Ⅲ组术后2、4和8 h恶心的发生率明显降低（P＜0.05或P＜0.01）.（2）与Ⅰ组比较,Ⅱ组在术后2、4、8和36 h呕吐的发生率明显降低（P＜0.05）;Ⅲ组在术后2、4、8、36和48 h呕吐的发生率明显降低（P＜0.05）;与Ⅱ组比较,Ⅲ组在术后48h呕吐的发生率明显降低（P＜0.05）;Ⅳ组在术后2、4、8 h呕吐的发生率明显高于Ⅱ组（P＜0.05）;Ⅲ组在术后2、4和48 h呕吐的发生率明显低于Ⅳ组（P＜0.05）.结论 术毕单次注射2 mg托烷司琼,并通过PCA泵持续输注可在术后48 h内有效预防恶心、呕吐的发生;术毕单次注射5 mg托烷司琼,术后短时间内可预防恶心、呕吐,但术后48 h已无此作用;而通过PCA泵中持续输注5mg托烷司琼不能预防恶心、呕吐.     

格拉司琼对腹腔镜胆囊切除术后恶心、呕吐的预防作用--随机双盲对照研究

目的探讨格拉司琼对腹腔镜胆囊切除手术（laparoscopic cholecystectomy，LC）后恶心、呕吐（postoperative nausea and vomiting，PONV）的预防作用。方法选择120例ASAⅠ-Ⅱ级LC，随机分为A、B、C组，双盲法于手术结束后分别静脉注射格拉司琼3mg（A组）、6mg（B组）和生理盐水6ml（C组），观察3组病入手术结束后0～4h、4～8h、8-24h、24～48h恶心、呕吐、头痛、头昏情况。结果A、B组术后各时段恶心、呕吐发生率比C组明显减少（Y=4．021，P=0．045；x^2=4．267，P=0．039），A、B2组之间比较差异无显著性；头痛、头昏发生率B组显著高于A组（x^2=4．021，P=0．045；x^2=4．267，P=0．039），B组头痛发生率与C组比较差异无显著性（x^2=2．813，P=0．094），B组头昏发生率高于C组（x^2=4．267，P=0．039）。结论静注3mg或6mg格拉司琼能明显减少LC术后恶心、呕吐的发生率，但剂量增大会增加副作用。     

Ondansetron, metoclopramid, dexamethason, and their combinations compared for the prevention of postoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy: a prospective randomized study

Background A prospective randomized study was performed to assess the value of some individual risk factors for postoperative nausea and vomiting (PONV), and to compare the efficacy of ondansetron, metoclopramide, dexamethason, and combinations of these antiemetics in preventing PONV in patients after laparoscopic cholecystectomy. Methods The study enrolled 210 patients (157 women and 53 men) scheduled for laparoscopic cholecystectomy. The patients were randomly divided into seven groups. In groups 1 to 6, antiemetic drugs were administered. Group 7, the control group, received no antiemetic. For all the patients, individual risk factors for the incidence of nausea also were analyzed. Both nausea and vomiting were assessed separately 1, 4, 8, and 12 h after the procedure. Results Postoperative nausea and vomiting were significantly less frequent in menopausal women and more frequent in patients with a history of motion sickness. A comparison of mean values for the incidence of nausea and vomiting in groups 1 to 6 with the same values in group 7 showed that the mean PONV incidences were highest in groups 3 and 7, and the difference was significant. Conclusions Administration of antiemetic drugs significantly decreases the incidence of PONV in patients after laparoscopic cholecystectomy. The best decreases were achieved when ondansetron and dexamethason were applied together.     

不同用药方式对昂丹司琼预防术后镇痛后恶心、呕吐疗效的影响

目的比较不同用药方式对中枢性镇吐药昂丹司琼预防术后镇痛治疗后发生恶心、呕吐的疗效差异。方法择期妇科手术患者120例按昂丹司琼用药方式不同分为四组镇痛泵联合静脉用药组(A组)、镇痛泵用药组(B组)、静脉用药组(C组)和对照组(D组),每组30例。记录手术结束后的不同时间点(0、1、3、6、12和24h)疼痛视觉模拟评分(VAS)以及不同时间段内(0~1h、1~3h、3~6h、6~12h、12~24h)恶心、呕吐发生例数。结果不同时间点组内和组间VAS差异无显著意义。恶心、呕吐发生率在A组和C组间以及B组和D组间差别无显著意义。而A组和B组间以及C组和D组间差异有显著意义(P<0·05)。结论术后静脉注射昂丹司琼较其他用药方式可明显减少术后镇痛后恶心、呕吐的发生率。