体会护理全麻术后恶心呕吐症

体会护理全麻术后恶心呕吐症的疗效.方法 选择全麻术后386例,主要术前、术后心理沟通,生姜、柠檬、合谷穴配伍灵活运用.结论 疗效满意、简便、节约、快捷.     

地塞米松对布比卡因术后镇痛时效的影响

布比卡因以其强效和长效等特点,临床上常用于硬膜外术后镇痛,本院将布比卡因与地塞米松配伍用于硬膜外手术后镇痛,并对其镇痛时间进行了观察,现报告如下.     

顺铂化疗后程加用地塞米松对迟发性恶心呕吐的防治作用观察

目的评价顺铂化疗后程加用地塞米松防治迟发性恶心呕吐的效果。方法我院50例采用DDP为基础化疗恶性肿瘤患者为研究对象，按照入院顺序随机分为两组：对照组患者给予阿扎司琼，观察组在此基础上加用地塞米松。观察两组患者化疗第2、3、4d内恶心呕吐的情况及不良反应。结果观察组治疗有效率相比，差异具有显著性（P<0.05）；观察组不良反应率显著低于对照组（P<0.05）。结论 DDP化疗后程短期加用地塞米松可有效防治迟发性恶心呕吐的发生，降低不良反应发生率。     

右美托咪定替代瑞芬太尼对甲状腺手术 全麻患者术后恶心呕吐的影响

目的 观察右美托咪定对甲状腺手术全麻患者术后恶心呕吐的影响。方法 选取我院2016年1月～2017年2月择期全麻甲状腺患者80例,随机分为两组,每组40例。D组给予右美托咪定,R组给予瑞芬太尼。观察患者入室时、插管前、插管后5 min、手术开始后5 min、手术开始后30 min、缝皮时、拔管后5 min的平均动脉压和心率。记录麻醉时间、手术时间、睁眼时间、拔管时间、及入PACU时的警觉镇静评分、术后疼痛评分、补救止吐和镇痛药物的使用。观察患者0～2 h、2～24 h内恶心呕吐发生情况。结果 T2～T7时D组HR低于R组（P＜0.05）,两组间MAP差异无统计学意义（P＞0.05）。R组和D组患者手术时间、麻醉时间对比,差异无统计学意义（P＞0.05）。D组睁眼时间、拔管时间长于R组,D组OAA/S镇静评分低于R组（P＜0.05）;后2个时段,D组恶心发生率低于R组（P＜0.05）;止吐药使用率低于R组（P＜0.05）;两组术后呕吐发生率,差异无统计学意义（P＞0.05）。术后0～2 h疼痛VAS评分,两组差异无统计学意义（P＞0.05）;术后2～24 h,D组VAS评分低于R组;两组补救镇痛率无统计学意义（P＞0.05）。结论 对于甲状腺手术患者,麻醉诱导前右美托咪定负荷量1 μg,维持量0.3～0.5 μg/（kg·h）可有效降低术后恶心呕吐的症状,减少止吐药物的使用,改善术后镇痛效果。     

胸科患者术后24h内非计划停止自控静脉镇痛的原因分析

目的 分析胸科术后24 h内非计划停止使用患者自控静脉镇痛(PCIA)的影响因素,优化围术期镇痛方案,减少医疗资源浪费。方法 回顾性分析2018-04-01至2019-03-31在北京协和医院行胸科手术患者的临床资料。依据PCIA开始启用至结束时间将患者分为A组(≤24 h)及B组(>24 h)。采用单因素分析及多因素Logistic回归分析对比两组患者一般临床资料、麻醉/手术类型、PCIA配置方案及不良反应。结果 本研究共纳入371例患者。单因素分析中发现女性较男性患者24 h内停止术后PCIA比例更高(16.8%/39.4%);胸腔镜手术较开胸术后的患者24 h内停止术后PCIA的比例更高(31.4%/19.7%);PCIA中使用吗啡较羟考酮和舒芬太尼的患者更容易24 h内停止使用术后PCIA,而使用羟考酮较使用舒芬太尼的患者更容易24 h内停止使用PCIA(60%/40.5%/25.3%);PCIA中加入5-HT3受体阻断剂比未加入的患者24 h内停止使用术后PCIA的比例低(14.9%/30.6%);随访时患者呈镇静状态的患者比未存在镇静状态的24 h内停止使用PCIA的...     

甲氧氯普胺预防腹腔镜胆囊切除术后呕吐的临床观察（摘要）

我们将105名进行腹腔镜胆囊切除术的患者采用随机分组方法分为3组,A组为未用甲氧氯普胺组,B组患者干麻醉苏醒后立即肌注10mg甲氧氯普胺,术后4小时再次肌注10mg该药,C组于麻醉苏醒后立即肌注20mg甲氧氯普胺,术后6小时再次肌注10mg该药,结果发现,A、B、C 3组术后24小时内呕吐发生率分别为74.3％、48.6％和34.3％,B、C两组术后呕吐发生率明显低于A组(P<0.05),且呕吐的严重程度也较A组减轻,表明甲氧氯普胺预防腹腔镜胆囊切除术后呕吐具有良好的效果。     

单髁关节置换前静脉应用地塞米松对置换后患者疼痛及并发症的影响

背景:目前地塞米松在髋、膝关节置换手术中获得了较为广泛的应用,发挥了减少术后疼痛和恶心呕吐及加速患者康复的作用,但国内外对于术前静脉应用地塞米松对膝关节单髁置换后患者的影响尚未见相关报道.目的:探讨术前静脉应用地塞米松对单髁置换后患者的影响.方法:纳入苏州大学附属第一医院骨科2020年1月至2021年5月收治的膝关节骨...     

昂丹司琼预防腰麻-硬膜外联合麻醉后恶心、呕吐的观察

目的观察中枢性镇吐药昂丹司琼预防腰麻-硬膜外联合麻醉术后恶心、呕吐的疗效。方法选择ASAⅠ~Ⅱ级择期在腰麻-硬膜外联合麻醉下行子宫切除术的患者20例,分为Ⅰ组和Ⅱ组,每组10例,Ⅰ组手术结束前10min给昂丹司琼6mg(6ml),Ⅱ组给生理盐水6ml,记录术后24h恶心、呕吐及其它并发症的发生情况。结果两组患者一般资料无显著性差异。术后24h随访恶心、呕吐发生率Ⅰ组明显低于Ⅱ组(P<0.05)。结论昂丹司琼6mg可以明显降低术后恶心、呕吐发生率。     

妇科病人术中术后恶心呕吐的观察分析

妇科病人术中术后发生的恶习呕吐是较常见的并发症之一,术中发生的恶心呕吐增加手术难度,也增加术中麻醉管理的难度.     

地塞米松对Graves病甲状腺细胞的影响

为进一步探讨地塞米松(DEX)治疗Graves病(GD)的机制, 以不同浓度DEX作用单层培养的GD甲状腺上皮细胞(TEC), 应用MTT法检测TEC的增殖抑制情况.用Tunnel法、S-P法检测DEX刺激前、后TEC的凋亡率及Fas表达阳性率. 结果表明: ①10-6-10-2mol/L的DEX可直接杀伤TEC, 对TEC具有明显的增殖抑制作用; ②DEX可时间依赖性地促进TEC Fas表达并诱导TEC凋亡; ③Fas阳性细胞百分率与凋亡细胞百分率呈正相关. 提示DEX可直接杀伤TEC及促进TEC表达Fas, 进而诱导其凋亡.     

Incidence and Risk Factors of Postoperative Nausea and Vomiting in Patients with Fentanyl-Based Intravenous Patient-Controlled Analgesia and Single Antiemetic Prophylaxis

Purpose

We evaluated the incidence and risk factors of postoperative nausea and vomiting (PONV) in patients with fentanyl-based intravenous patient-controlled analgesia (IV-PCA) and single antiemetic prophylaxis of 5-hydroxytryptamine type 3 (5 HT₃)-receptor antagonist after the general anesthesia.

Materials and Methods

In this retrospective study, incidence and risk factors for PONV were evaluated with fentanyl IV-PCA during postoperative 48 hours after various surgeries.

Results

Four hundred-forty patients (23%) of 1878 had showed PONV. PCA was discontinued temporarily in 268 patients (14%), mostly due to PONV (88% of 268 patients). In multivariate analysis, female, non-smoker, history of motion sickness or PONV, long duration of anesthesia (>180 min), use of desflurane and intraoperative remifentanil infusion were independent risk factors for PONV. If one, two, three, four, five, or six of these risk factors were present, the incidences of PONV were 18%, 19%, 22%, 31%, 42%, or 50%. Laparoscopic surgery and higher dose of fentanyl were not risk factors for PONV.

Conclusion

Despite antiemetic prophylaxis with 5 HT₃-receptor antagonist, 23% of patients with fentanyl-based IV-PCA after general anesthesia showed PONV. Long duration of anesthesia and use of desflurane were identified as risk factors, in addition to risk factors of Apfel''s score (female, non-smoker, history of motion sickness or PONV). Also, intraoperative remifentanil infusion was risk factor independent of postoperative opioid use. As the incidence of PONV was up to 50% according to the number of risk factors, risk-adapted, multimodal or combination therapy should be applied.     

Association of 5-HT3B Receptor Gene Polymorphisms with the Efficacy of Ondansetron for Postoperative Nausea and Vomiting

Purpose

Postoperative nausea and vomiting (PONV) is a common problem after general anesthesia. Although 5-hydroxytryptamine type 3 (5-HT3) receptor antagonists have significantly reduced PONV, over 35% of patients treated with ondansetron can experience PONV. In this study, we investigated whether the Y129S and -100_-102AAG deletion polymorphisms of the 5-HT3B receptor gene affect the efficacy of ondansetron in preventing PONV.

Materials and Methods

Two hundred and forty-five adult patients who underwent laparoscopic cholecystectomy were enrolled. Ondansetron 0.1 mg/kg was intravenously administered 30 minutes before the end of surgery. Genomic DNA was prepared from blood samples using a nucleic acid isolation device. Both the Y129S variant and the -100_-102AAG deletion variant were screened for using a single base primer extension assay and a DNA direct sequencing method, respectively. The relationship between genetic polymorphisms and clinical outcomes of ondansetron treatment was investigated.

Results

Among the 5-HT3B AAG deletion genotypes, the incidence of PONV was higher in patients with the homomutant than with other genotypes during the first 2 hours after surgery (p=0.02). There were no significant differences in the incidence of PONV among genotypes at 2-24 hours after surgery. In the Y129S variants of the 5-HT3B receptor gene, there were no significant differences in the incidence of PONV among genotypes during the first 2 hours and at 2-24 hours after surgery.

Conclusion

The response to ondansetron for PONV was significantly influenced by the -100_-102AAG deletion polymorphisms of the 5-HT3B gene. Thus, the -100_-102AAG deletion variants may be a pharmacogenetic predictor for responsiveness to ondansetron for PONV.     

Total Intravenous Anesthesia with Propofol Reduces Postoperative Nausea and Vomiting in Patients Undergoing Robot-Assisted Laparoscopic Radical Prostatectomy: A Prospective Randomized Trial

Purpose

We investigated the effect of total intravenous anesthesia (TIVA) with propofol on postoperative nausea and vomiting (PONV) after robot-assisted laparoscopic radical prostatectomy (RLRP) in patients at low risk of developing PONV, in comparison to balanced anesthesia with desflurane.

Materials and Methods

Sixty two patients were randomly assigned to the Des or TIVA group. Propofol and remifentanil were used for induction of anesthesia in both groups and for maintenance of the anesthesia in the TIVA group. In the Des group, anesthesia was maintained with desflurane and remifentanil. In both groups, postoperative pain was controlled using fentanyl-based intravenous patient controlled analgesia, and ramosetron 0.3 mg was administered at the end of surgery. The incidence of PONV, severity of nausea and pain, and requirements of rescue antiemetics and analgesics were recorded.

Results

The incidence of nausea in the post-anesthetic care unit was 22.6% in the Des group and 6.5% in the TIVA (p=0.001) group. The incidence of nausea at postoperative 1-6 hours was 54.8% in the Des group and 16.1% in the TIVA group (p=0.001). At postoperative 6-48 hours, there were no significant differences in the incidence of nausea between groups.

Conclusion

In order to prevent PONV after RLRP in the early postoperative period, anesthesia using TIVA with propofol is required regardless of patient-related risk factors.     

Comparison of Azasetron and Ondansetron for Preventing Postoperative Nausea and Vomiting in Patients Undergoing Gynecological Laparoscopic Surgery

Purpose

We compared the prophylactic effects of intravenously administered azasetron (10 mg) and ondansetron (8 mg) on postoperative nausea and vomiting (PONV) in patients undergoing gynecological laparoscopic surgery under general anesthesia.

Materials and Methods

We studied 98 ASA physical status I or II 20-65 years old, female patients, in this prospective, randomized, double blind study. Patients were randomly divided into two groups and received ondansetron 8 mg (group O) or azasetron 10 mg (group A) 5 min before the end of surgery. The incidence of PONV, Visual Analogue Scale (VAS) for pain, need for rescue antiemetic and analgesics, and adverse effects were checked at 1, 6, 12, 24, and 48 h postoperatively.

Results

The overall incidence of PONV was 65% in group O and 49% in group A. The incidence of PONV was significantly higher in group O than in group A at 12-24 h postoperatively (nausea; 24% vs. 45%, p = 0.035, vomiting; 2% vs. 18%, p = 0.008), but there were no significant differences at 0-1, 1-6, 6-12 or 24-48 h.

Conclusion

In conclusion, azasetron (10 mg) produced same incidence of PONV as ondansetron (8 mg) in patients undergoing general anesthesia for gynecological laparoscopic surgery. Azasetron was more effective, in the intermediate post-operative period, between 12 and 24 h.     

癌症患者预期性恶心和呕吐的不良情绪与应激

目的:观察不良情绪与预期性恶心和呕吐(Anticipatory nausea and vomiting,ANV)发生之间的关系及预期性恶心和呕吐发生患者的交感神经兴奋性和肾上腺皮质激素的变化情况。方法:采用恶心、呕吐情况调查表及ZUNG氏焦虑自评量表(SAS)、抑郁自评量表(SDS)对87例经历过一或两个化疗周期的癌症患者进行调查,以皮肤电测试仪测量其皮肤电阻水平,以放射免疫法测其唾液中皮质醇含量。结果:预期性恶心和呕吐发生组患者(n=35)恶心问卷总分(0.3±0.2)及三因子躯体不适(0.3±0.2)、消化道反应(0.5±0.3)、情绪痛苦(0.2±0.2)均高于未发生预期性恶心和呕吐组(n=52)(0.1±0.1、0.1±0.1、0.1±0.1、0.1±0.1,P<0.05或0.01)。发生组焦虑(38.0±8.7)、抑郁(38.3±10.8)、唾液皮质醇含量(6.8±2.9)的得分均高于未发生组(31.6±6.0,P<0.01)、(33.1±7.3,P<0.05)、(5.14±2.45,P<0.05)。发生组皮肤电阻(0.60±0.37)低于未发生组(1.44±1.01,P<0.01)。相关分析结果显示,发生组恶心问卷总分及其三因子分与焦虑正相关(r=0.49~0.62,P<0.01),与抑郁正相关(r=0.26~0.40,P<0.05或0.01)。结论:发生期待性恶心和呕吐的癌症患者具有较重的应激反应,焦虑、抑郁是伴随期待性恶心和呕吐发生的重要因素。     

Risk Assessment of Postoperative Nausea and Vomiting in the Intravenous Patient-Controlled Analgesia Environment: Predictive Values of the Apfel's Simplified Risk Score for Identification of High-Risk Patients

Purpose

Opioid-based intravenous patient-controlled analgesia (IV PCA) is popular method of postoperative pain control, but many patients suffer from IV PCA-related postoperative nausea and vomiting (PONV). In this retrospective observational study, we have determined independent predictors of IV PCA-related PONV and predictive values of the Apfel''s simplified risk score in pursuance of identifying high-risk patients.

Materials and Methods

We analyzed 7000 patients who received IV PCA with background infusion after elective surgery. Patients who maintained IV PCA for a postoperative period of 48 hr (completion group, n=6128) were compared with those who have discontinued IV PCA within 48 hr of surgery due to intractable PONV (cessation group, n=872). Patients, anesthetics, and surgical factors known for predicting PONV were evaluated by logistic regression analysis to identify independent predictors of IV PCA related intractable PONV.

Results

In a stepwise multivariate analysis, weight, background infusion dose of fentanyl, addition of ketolorac to PCA, duration of anesthesia, general anesthesia, head and neck surgery, and Apfel''s simplified risk score were revealed as independent risk factors for intractable PONV followed by the cessation of IV PCA. In addition, Apfel''s simplified risk score, which demonstrated the highest odds ratio among the predictors, was strongly correlated with the cessation rate of IV PCA.

Conclusion

Multimodal prophylactic antiemetic strategies and dose reduction of opioids may be considered as strategies for the prevention of PONV with the use of IV PCA, especially in patients with high Apfel''s simplified risk scores.     

Comparison of remifentanil and fentanyl for postoperative pain control after abdominal hysterectomy

PURPOSE: In this randomized, double-blind study, we investigated the analgesic efficacy and side effects of continuous constant-dose infusions of remifentanil after total abdominal hysterectomy and compared it to fentanyl. MATERIALS AND METHODS: Fifty-six adult female patients scheduled for elective total abdominal hysterectomy were enrolled in this study. Patients were randomly assigned to two groups according to fentanyl (group F, n=28) or remifentanil (group R, n=28) for postoperative analgesia. Patients in group F were given fentanyl intravenously with an infusion rate of fentanyl 0.5 microg/kg/hr; group R was given remifentanil with an infusion rate of remifentanil 0.05 microg/kg/min for 2 days. Pain intensity at rest, occurrence of postoperative nausea and vomiting (PONV), dizziness, pruritus, and respiratory depression were assessed 1 hr after arrival at the post-anesthesia care unit, at 6; 12; 24; and 48 hr post-operation and 6 hr post-infusion of the study drug. Pain was evaluated by using visual analogue scale (VAS; 0-10). The time that patients first requested analgesics was recorded as well as additional analgesics and antiemetics. RESULTS: There were no significant differences in VAS, time to first postoperative analgesics, and additional analgesics between the 2 groups. The incidences and severities of PONV and opioid related side effects were not different between the groups; however, there were 3 episodes (10.7%) of serious respiratory depression in group R. CONCLUSION: Continuous infusion technique of remifentanil did not reveal any benefits compared to fentanyl. Furthermore, it is not safe for postoperative analgesia in the general ward.     

Ondansetron Does Not Attenuate the Analgesic Efficacy of Nefopam

Objectives: The aim of this study was to investigate if there is any interaction between ondansetron and nefopam when they are continuously co-administrated during patient-controlled intravenous analgesia (PCIA).Methods: The study was a prospective, randomized, controlled, non-inferiority clinical trial comparing nefopam-plus-ondansetron to nefopam alone. A total of 230 postoperative patients using nefopam for PCIA, were randomly assigned either to a group receiving continuous infusion of ondansetron (Group O) or to the other group receiving the same volume of normal saline continuously (Group N). Postoperative pain intensity scores, the sum of pain intensity difference over 24 hours postoperatively (SPID_24hr), the incidence of adverse events, and the total consumption of nefopam were evaluated respectively.Results: Postoperative pain was treated successfully in both groups. The mean SPID_24hr scores were 95.6 mm in Group N and 109.3mm in Group O [95% confidence interval (CI) -14.28, 24.32]. The lower margin of the 95% CI was above the pre-determined non-inferiority margin (-30mm) for SPID_24hr, which indicated that nefopam-plus-ondansetron was not worse than the nefopam alone in term of analgesic efficacy. In addition, there was no statistical difference between the two groups in term of cumulative consumption of nefopam. Compared with Group N, postoperative vomiting was significantly reduced in Group O during the postoperative 24 hours (P < 0.05). Less rescue antiemetics were given to patients in Group O than those receiving nefopam alone (P < 0.05). There were no differences in postoperative nausea between the two groups.Conclusion: Nefopam-plus-ondansetron is not inferior to nefopam alone in relieving the pain in PCIA after minimally invasive surgery. In addition, adverse events are reduced without compromising analgesic efficacy.     

Physico-Chemistry of Geophagic Soils Ingested to Relief Nausea and Vomiting During Pregnancy

Background

Nausea and vomiting during pregnancy (NVP) is one of the most common symptoms experienced by most women during their first trimester of pregnancy. For some of these women, especially the more tribally and culturally oriented ones, soil ingestion is one of the remedies used to curb NVP. The aim of this study was to physico-chemically characterise selected geophagic soils from Cameroon and South Africa, ingested for the relief of NVP and to appraise their ability to meet the needs of geophagic individuals.

Materials and Methods

Thirteen geophagic soil samples (6 from Cameroon and 7 from South Africa) were obtained from traditional mine sites and physico-chemically characterized. The following tests were conducted; particle size distribution (PSD), liquid limit (LL), plastic limit (PL), plasticity index, soil pH and electrical conductivity (EC).

Results

The samples were texturally classified as silt loam, of medium to high plasticity with normal to active swelling potentials. The samples were generally acidic (pH of 3.1 – 6.1) with low EC (average of 92.71µS/cm).

Conclusion

Based on soil consistency limits and pH, the samples were found to be suitable for use as remedy for NVP with soils from Cameroon displaying the most optimum properties.