帕洛诺司琼联合地塞米松在预防老年患者术后恶心呕吐的分析

目的观察老年患者应用帕洛诺司琼联合地塞米松预防全身麻醉后妇科手术后恶心呕吐的效果。方法选择老年患者全身麻醉后妇科手术120例,随机分为A、B、C3组,各40例。在手术结束前静脉注射预防恶心呕吐的药物。A组:帕洛诺司琼0.075mg,复合地塞米松5mg。B组:帕洛诺司琼。C组:生理盐水10 m L。观察术后48h恶心呕吐的发生率。结果 A、B两组术后恶心呕吐的发生率比C显著降低,其中A组患者术后恶心呕吐发生率比B显著降低。差异均有统计学意义(P0.05)。结论应用帕洛诺司琼联合地塞米松用于预防妇科老年患者手术后恶心呕吐,效果确切,安全性高。     

福沙匹坦双葡甲胺联合帕洛诺司琼预防及治疗妇科腹腔镜手术术后恶心呕吐的疗效研究

目的观察与评价注射用福沙匹坦双葡甲胺联合帕洛诺司琼预防治疗妇科腹腔镜手术术后恶心呕吐(PONV)的可行性与安全性。方法选取妇科腹腔镜手术患者180例, 按随机数字表法分为3组(每组60例):帕洛诺司琼组(A组), 福沙匹坦双葡甲胺组(B组), 福沙匹坦双葡甲胺联合帕洛诺司琼组(C组)。A组用药帕洛诺司琼0.075 mg, B组用药福沙匹坦双葡甲胺150 mg, C组用药福沙匹坦双葡甲胺150 mg加帕洛诺司琼0.075 mg。观察患者术后2 h、术后第1天和术后第2天PONV发生情况, 术后第1天和术后第2天视觉模拟评分法(VAS)疼痛评分、镇痛满意度评分, 术后2 d内因呕吐不耐受需追加紧急补救止吐药物(甲氧氯普胺/地塞米松)(PONV补救)的例数和镇痛补救的例数。记录患者手术时间、瑞芬太尼用量、出血量、输液量以及药物相关不良反应事件的发生情况。结果术后2 h, 与A组比较, C组PONV 0级患者例数增加, PONV 1、2、3级患者例数降低(均P<0.05)。术后第1天和第2天, 与A组和B组比较, C组患者PONV 0级患者例数增加, PONV 1、2、3级患者例数降低(...     

帕洛诺司琼静脉注射联合地塞米松足三里穴位注射预防术后恶心呕吐的效果

目的观察帕洛诺司琼静脉注射联合地塞米松足三里穴位注射对术后恶心呕吐(PONV)发生率的影响。方法选择全身麻醉下行开腹胃肠道手术的女性患者320例,年龄18～75岁,BMI 21.5～27.1 kg/m~2,ASAⅠ—Ⅲ级。所有患者在术前均进行Apfel危险分级。采用随机数字表法将患者随机分为四组:帕洛诺司琼静脉注射联合地塞米松足三里穴位注射组(PD组),帕洛诺司琼静脉注射组(P组),地塞米松足三里穴位注射组(D组)和空白对照组(C组),每组80例。PD组麻醉前静脉注射帕洛诺司琼0.25 mg,足三里穴位注射地塞米松5 mg;P组麻醉前静脉注射帕洛诺司琼0.25 mg;D组麻醉前足三里穴位注射地塞米松5 mg;C组麻醉前静脉注射生理盐水2 ml。所有患者均行静-吸复合麻醉,术后所有患者均使用静脉自控镇痛泵,镇痛泵的配方为舒芬太尼3μg/kg。记录术后48 h内恶心、呕吐的发生情况。麻醉诱导前和术后4 h检测血清胃动素(MTL)浓度。记录术后48 h内头痛、眩晕和疲乏等不良反应的发生情况。结果术后0～8 h PD组恶心发生率明显低于P组(P0.05)。术后0～8 h和8～24 h PD组呕吐发生率明显低于P组(P0.05),P组、D组和C组术后4 h血清MTL浓度明显高于麻醉诱导前(P0.05)。P组术后头痛和眩晕发生率均明显高于PD组、D组和C组(P0.05),而疲乏发生率明显低于PD组、D组和C组(P0.05)。结论帕洛诺司琼静脉注射联合地塞米松足三里穴位注射预处理,在PONV高风险女性患者开腹术后能够有效降低恶心呕吐的发生率,且不良反应更少。     

地塞米松联合帕洛诺司琼预防泌尿外科腹腔镜手术后恶心呕吐的研究

目的比较地塞米松和(或)帕洛诺司琼预防泌尿外科腹腔镜手术后恶心呕吐的效果。方法采用前瞻随机对照研究法,纳入2015年7月至2015年10月择期行泌尿外科腹腔镜手术患者320例,随机分为四组:地塞米松组(D组),麻醉诱导后给予地塞米松10 mg静推;帕洛诺司琼组(P组),麻醉诱导后给予帕诺洛司琼0.25 mg静推;联合给药组(L组),麻醉诱导后给予地塞米松10 mg+帕洛诺司琼0.25 mg静推;对照组(C组),诱导后给予生理盐水5 ml静推。手术后24h评价四组患者术后恶心呕吐(PONV)的发生率。结果四组患者PONV发生率分别为25%(D组)、27.5%(P组)、11.3%(L组)和40%(C组),组间比较差异有统计学意义(P=0.001)。以校正检验水准(0.05/6)两两比较时只有L组与C组PONV发生率差异具有统计学意义(P0.001)。结论联合使用地塞米松和帕诺洛司琼能够更有效降低泌尿外科腹腔镜手术PONV的发生。     

帕洛诺司琼预防妇科手术术后恶心呕吐的临床效果

目的比较术前单次注射帕洛诺司琼或托烷司琼对预防妇科手术术后恶心呕吐(PONV)的效果。方法选择Apfel评分≥3分,择期全麻下行妇科大手术的患者60例,随机分为帕洛诺司琼组(P组)和托烷司琼组(T组),每组30例。麻醉采用气管插管全麻,术前分别单次静脉注射帕洛诺司琼0.25 mg或托烷司琼5 mg,术后使用氢吗啡酮自控镇痛,随访72 h。记录患者术后恶心呕吐程度,并计算完全有效率(CR)和完全控制率(CC)。结果 P组患者术后0~24 h及24~48 h恶心呕吐程度均明显低于T组(P0.05),48~72 h恶心呕吐程度两组差异无统计学意义。P组共5例(17%)发生呕吐,治疗失效时间为(19.6±9.4)h,无一例补救治疗;T组共19例(63%)发生呕吐,治疗失效时间(20.6±4.5)h,补救治疗3例次。术后0~24 h、24~48 h和0~72 h P组CR和CC明显高于T组(P0.05),而术后48~72 h两组CR和CC差异无统计学意义。结论术前单次静脉注射帕洛诺司琼0.25 mg预防妇科手术PONV的疗效在术后48 h内明显优于单次注射托烷司琼5 mg。     

联合用药对全麻术后自控镇痛患者恶心呕吐的随机对照研究

目的探讨联合用药对术后自控镇痛患者恶心呕吐的疗效。方法 176例手术后应用患者自控镇痛(patient controlled analgesia,PCA)随机分为4组:A组,分别在术中、PCA泵中给予昂丹司琼8mg;B组,在PCA泵中给予地塞米松5mg、氟哌利多2.5mg;C组,在术中给予昂丹司琼8mg、PCA泵中给予地塞米松5mg、氟哌利多2.5mg及昂丹司琼8mg;D组,分别在术中给予昂丹司琼8mg、在PCA泵中给予地塞米松5mg及氟哌利多2.5mg。术后48h回访患者术后恶心呕吐(postoperative nausea and vomiting,PONV)的发生情况。结果 4组PONV发生率分别为A组29.5%(13/44)、B组34.1%(15/44)、C组7.0%(3/43),D组11.4%(5/44),联合用药组即C组和D组PONV发生率明显低于单一用药组A组和B组(P0.05);A、B2组PONV发生率差异无显著性(χ2=0.210,P=0.647),C组PONV发生率与D组间差异无显著性(χ2=0.114,P=0.736)。结论联合应用昂丹司琼、地塞米松及氟哌利多3种止吐药可以显著减少术后自控镇痛患者的恶心呕吐的发生率。     

昂丹司琼预防剖宫产术后曲马多持续镇痛所致的恶心呕吐

目的 探讨昂丹司琼不同给药方式对剖宫产术后曲马多持续镇痛所致术后恶心呕吐(PONV)的防治效果.方法 80例腰-硬联合麻醉下行剖宫产手术的产妇随机均分为四组:A组昂丹司琼8 mg加入曲马多镇痛泵持续输注;B组昂丹司琼8 mg在胎儿娩出后缓慢静注;C组昂丹司琼4 mg胎儿娩出后单次静注并4 mg镇痛泵持续输注;D组胎儿娩出后静注生理盐水4 ml,所有患者均行术后曲马多静脉自控镇痛(PCIA).观察并记录四组术后1、6、8、12、24 h时PONV评分及疼痛VAS评分.结果 四组间不同时点疼痛VAS评分差异无统计学意义.术后1、6、8、12、24 PONV评分A、B、C组明显低于D组(P＜0.01),C组明显低于A、B组(P＜0.05);A、B组间差异无统计学意义,与术后6h比较,术后1hA组及术后12、24hA、B后PONV评分明显降低(P＜0.05).结论 昂丹司琼可有效预防曲马多术后镇痛引起的恶心呕吐,但在胎儿娩出后单次静注昂丹司琼4mg,并4mg于PCA中持续输注,其预防效果更佳.     

耳针联合阿扎司琼防治静脉全麻乳腺癌术后恶心呕吐

目的：比较耳针联合阿扎司琼与阿扎司琼或单独耳针治疗对静脉全麻乳腺癌术后恶心呕吐的防治效果。方法：选择择期全麻下行乳腺癌改良根治术患者150例,随机分成3组,A组在手术结束前20 min静脉滴注阿扎司琼10 mg;B组在手术前24 h给予耳针治疗,并在手术结束前20 min静脉滴注阿扎司琼10mg;C组在手术前24h给予耳针治疗。结果：术后24 h内恶心呕吐VAS评分、恶心呕吐发生率、疗效满意率等方面,B组均优于A、C组,差异均有统计学意义,而A、C两组之间差异无统计意义。A、B、C组在PONV的级别上差异均有统计意义。结论：耳针联合阿扎司琼能有效防治静脉全麻后乳腺癌改良根治术后恶心呕吐。     

盐酸帕洛诺司琼预防上腹部手术后硬膜外吗啡镇痛所致的恶心呕吐

目的 观察和评价帕洛诺司琼对上腹部手术后硬膜外吗啡镇痛引起的恶心呕吐的预防效果和安全性.方法 择期行上腹部手术并术后接受硬膜外吗啡镇痛患者60例,随机分为帕洛诺司琼组（P组）和托烷司琼组（T组）.手术结束前30 min,P组患者缓慢静注帕洛诺司琼0.25 mg,T组患者缓慢静注托烷司琼6 mg.观察记录两组患者术后24 h、48 h VAS及Ramsay评分、恶心呕吐的程度,计算恶心呕吐有效控制率.同时记录患者腹胀、头痛、椎体外系症状等不良反应.结果 两组患者术后24 h及48 h的VAS及Ramsay评分差异无统计学意义.P组患者术后24 h的恶心及呕吐有效控制率分别为80.0%和73.3%,T组分别为63.3%和60.0%;P组患者术后48 h的恶心及呕吐有效控制率分别为90.0%和93.3%,T组分别为66.6%和63.3%.两组患者术后24 h恶心、呕吐有效控制率差异无统计学意义.P组患者术后48 h恶心、呕吐有效控制率明显优于T组患者（P 〈 0.05）.帕洛诺司琼的不良反应主要为头痛.结论 腹部手术后24 h内,帕洛诺司琼预防吗啡硬膜外镇痛所致的恶心呕吐的效果与托烷司琼相当,但术后48 h预防恶心呕吐的效果优于托烷司琼,且不良反应发生率低,程度较轻,安全性好.     

甘露醇复合多模式镇吐措施预防甲状腺术后恶心呕吐的观察

目的观察甘露醇复合多模式镇吐措施预防甲状腺术后头晕头痛及术后恶心呕吐(PONV)的临床效果。方法择期行甲状腺切除术患者100例,男39例,女61例,ASAⅠ或Ⅱ级,按照随机数字表随机均分为两组:对照组(C组)和甘露醇复合多模式镇吐组(M组)。两组患者均采用丙泊酚和瑞芬太尼全凭静脉麻醉(TIVA)方法。麻醉诱导后静脉注射地塞米松10 mg,手术结束前30min给予盐酸帕洛诺司琼注射液0.25 mg。M组在手术结束前30 min快速静注甘露醇2ml/kg,C组给予等量的生理盐水。观察术后24h内两组患者头晕头痛及PONV的发生率。结果M组术后24h内头晕头痛发生率为5例(10%),PONV发生率5例(10%),明显低于C组的15例(30%)和12例(24%)(P0.05),术后24h内额外使用止吐药M组为2例(4%),明显少于C组的9例(18%)(P0.05)。结论术前给予地塞米松、术毕前30min给予强效止吐剂帕洛诺司琼并复合脱水药甘露醇进行多模式镇吐可显著降低甲状腺术后头晕头痛及PONV的发生率。     

盐酸帕洛诺司琼预防硬膜外自控镇痛所致恶心呕吐的分析

【摘要】　目的 观察盐酸帕洛诺司琼预防术后硬膜外腔自控镇痛引起恶心呕吐副作用的效果。方法 选取择期硬膜外麻醉下开腹胆囊切除术后施行硬膜外腔自控镇痛(PCEA)的患者60例,PCEA采用吗啡6 mg+0.125%布比卡因混合液(100 mL)。将患者分为盐酸帕洛诺司琼组,氟哌啶组和对照组(每20例),在术前静脉给予盐酸帕洛诺司琼0.25 mg,氟哌啶2.5 mg和生理盐水100 mL。术后记录使用PCEA镇痛期间的恶心例数及其严重程度;呕吐例数及次数;出现呕吐后给予胃复安,非那根,地塞米松等药物止吐的控制率。结果 对照组13例出现Ⅰ~Ⅲ级恶心呕吐的不良反应,盐酸帕洛诺司琼组患者1例1级恶心呕吐的发生,与其他两组相比P<0.001;氟哌啶组出现5例Ⅰ~Ⅱ级恶心呕吐的,与对照组相比P=0.022。结论 术前预防性给予盐酸帕洛诺司琼可显著降低胆囊切除术后PCEA引起恶心呕吐副作用的发生。     

地塞米松联合恩丹西酮对手术后病人自控镇痛相关恶心呕吐的影响

目的　观察地塞米松联合恩丹西酮对手术后病人自控镇痛 (PCA)所致恶心呕吐的防治效果。方法　随机将 2 0 0例在连续硬膜外麻醉下行下肢手术的患者分为四组 :对照 (C)组于手术切皮前 (T1)和手术结束时 (T2 )分别静脉注射生理盐水 2ml;地塞米松 (D)组于T1、T2 时分别注射地塞米松 10mg和生理盐水 2ml;恩丹西酮 (O)组于T1、T2 时分别注射生理盐水 2ml和恩丹西酮4mg ;地塞米松 +恩丹西酮 (D +O)组于T1、T2 时分别注射地塞米松 10mg和恩丹西酮 4mg。术毕均行病人自控静脉芬太尼镇痛 (PCIFA)。观察术后 2 4h内病人镇痛效果、镇静评分和恶心呕吐发生情况。结果　 5例患者因故退出此观察。组间镇痛效果、镇静评分无明显差异。C组恶心呕吐发生率为 5 2 1% ,明显高于D组 (33 3% )和O组 (32 7% ) ,P <0 0 5 ;D +O组恶心呕吐发生率为16 0 % ,与C组比较 ,P <0 0 1,与D组和O组比较 ,P <0 0 5 ;各处理组恶心程度均小于对照组 ,P <0 0 5 ;D +O组呕吐程度低于C组 ,P <0 0 5。结论　地塞米松与恩丹西酮单独应用均能有效地减少手术后PCIFA相关的恶心呕吐 ,减轻恶心程度 ;两药联合应用进一步降低患者的恶心呕吐发生率和呕吐的程度     

Supplemental oxygen does not reduce the incidence of postoperative nausea and vomiting after ambulatory gynecologic laparoscopy

Supplemental 80% oxygen administration halves the incidence of postoperative nausea and vomiting (PONV) in inpatients. Whether it prevents PONV after ambulatory surgery is unknown. We tested the efficacy of supplemental 80% oxygen in decreasing the incidence of PONV after ambulatory gynecologic laparoscopy. One hundred patients were given a standardized sevoflurane anesthetic. They were randomly assigned to two groups: routine oxygen administration with 30% oxygen, balance nitrogen (Group A); and supplemental oxygen with 80% oxygen, balance nitrogen (Group B). Oxygen was administered during surgery and up to 1 h after surgery. The incidence of nausea and vomiting and the need for rescue antiemetics did not differ between the groups in the postanesthesia care unit, in the Phase II unit, or during the 24-h follow-up. The overall incidence of nausea and vomiting during the first postoperative 24 h was 62% in Group A and 55% in Group B (P = 0.486). There were no differences in the recovery profiles and patient satisfaction between the groups. In this study, supplemental oxygen did not prevent PONV in patients undergoing ambulatory gynecologic laparoscopy. IMPLICATIONS: Supplemental 80% oxygen administration during surgery and until 1 h after surgery compared with 30% oxygen administration did not prevent postoperative nausea and vomiting after ambulatory gynecologic laparoscopy.     

Evaluierung der Applikationszeit von Ondansetron Ein Prophylaktikum für postoperative Übel- keit und Erbrechen: Prospektive, randomisierte Doppelblindstudie an 120 Patienten

Objective: To investigate the incidence of postoperative nausea and vomiting (PONV) depending on the administration time of ondansetron. Methods: In this prospective, double-blind, parallel-group study we compared the prevention of PONV with ondansetron at two administration times versus placebo in 120 patients undergoing balanced general anaesthesia. The patients were stratified according to the type of surgey and randomly allocated to three treatment groups: 40 patients (Group A) received ondansetron 4?mg i.v. 10?min before the induction of anaesthesia and placebo 10?min before the end of surgery; 40 (Group B) received placebo 10?min before the induction of anaesthesia and ondansetron 4?mg i.v. 10?min before the end of surgery; and 40 (Group C) received placebo at both of the administrations. Data were analysed by Student’s t-test and chi-square test; significance was taken at P<0.05. Results: The analyses of the results showed a significantly lower incidence of PONV in treated patients (Groups A and B) than in the control group (Group C): postoperative nausea occurred in 12.5%, 27.5%, and 65% of patients in Groups A, B, and C, respectively, and was associated with vomiting in Group A in 2.5% Group B in 5%, and Group C in 55% of patients. Although the patients in Group A showed a lower incidence of PONV in comparison to those in Group B, the difference was not statistically significant. Conclusion: The incidence of PONV was significantly lower in the groups with administration of 4?mg ondansetron. Ondansetron is therefore safe and affective in preventing PONV in surgical patients. The administration time does not influence the occurrence of PONV.     

Dexamethasone is as effective as ondansetron for the prevention of postoperative nausea and vomiting following breast surgery

INTRODUCTION: Postoperative nausea and vomiting remain a common problem following breast surgery. This study assesses whether dexamethasone is as effective as ondansetron in the control of postoperative nausea and vomiting (PONV). METHODS: Eighty ASA I-III patients undergoing breast surgery for carcinoma of the breast were included in the study. Following premedication with diazepam 5-10 mg, patients were induced with fentanyl 50 micro g and propofol 2-2.5 mg kg-1. A larynx mask was inserted and anesthesia maintained with sevoflurane in oxygen and nitrous oxide. Patients were then randomly divided into two groups: Group D (dexamethasone) was given 4 mg dexamethasone i.v. after induction and Group O (ondansetron) was given 4 mg ondansetron at the same time point. Postoperatively, nausea, vomiting and pain were recorded at 1-h intervals during 4 h, and thereafter every 4 h during 24 h. RESULTS: The incidence of PONV during 24 h was 37% and 33% in Group D and Group O, respectively (NS). No differences were found between the groups in the incidence of postoperative nausea, vomiting or pain at the different time intervals. No differences were found in the incidence of PONV in smokers vs. non-smokers. No side-effects of these drugs were observed. CONCLUSIONS: Ondansetron 4 mg or dexamethasone 4 mg are equally effective in the prevention of postoperative nausea and vomiting following breast surgery. Other factors being similar, the difference in cost between these drugs would favor the use of dexamethasone instead of ondansetron when monotherapy against PONV is used.     

Betamethasone in prevention of postoperative nausea and vomiting following breast surgery

Study ObjectiveTo investigate whether betamethasone decreases the incidence of postoperative nausea/vomiting (PONV) and reduces postoperative pain following partial mastectomy.DesignProspective randomized, double-blinded study.SettingOperating room and Postanesthesia Care Unit of a university hospital.Patients80 ASA physical status 1 and 2 women scheduled for elective breast cancer surgery.InterventionsPatients were randomly allocated to two groups in double-blinded fashion: Group B (betamethasone; 37 pts) and Group C (control; 38 pts). Group B received 8 mg of betamethasone intravenously before the start of surgery.MeasurementsThe rate of PONV and pain were recorded using a numeric rating scale (NRS; 0–10), as well as rescue doses of antiemetics (ondansetron) and analgesics (ketobemidone).Main ResultsThere was a significant lower incidence of postoperative nausea (PON) scoring NRS ≥ 1 in Group B in the 4 to 12-hour period compared with Group C (P = 0.02). The cumulative incidence of PON was 57% in Group B versus 68% in Group C (P = 0.27). The overall incidence of postoperative vomiting (POV) was 18% and 20% in Groups B and C, respectively. Postoperative pain was reduced by 40% in Group B in the 4 to 12-hour period, but the mean dose of postoperative rescue analgesic did not differ between the groups.ConclusionsPreoperative betamethasone reduces the severity of PONV and pain in patients undergoing elective breast surgery.     

Comparison of ramosetron and granisetron for preventing postoperative nausea and vomiting after gynecologic surgery.

In a prospective, randomized, double-blinded study, we evaluated the efficacy of granisetron and ramosetron for preventing postoperative nausea and vomiting (PONV) in major gynecologic surgery. One hundred twenty patients, ASA physical status I or II, aged 23-65 yr, received i.v. granisetron 2.5 mg or ramosetron 0.3 mg (n = 60 each) at the end of surgery. A standard general anesthetic technique and postoperative analgesia were used. The incidence of a complete response, defined as no PONV and no need for another rescue medication, 0-3 h after anesthesia was 87% with granisetron and 90% with ramosetron; the corresponding incidence 3-24 h after anesthesia was 85% and 90%; the corresponding incidence 24-48 h after anesthesia was 70% and 92% (P < 0.05). No clinically serious adverse events due to the drugs were observed in any of the groups. In conclusion, prophylactic therapy with ramosetron is more effective than granisetron for the longterm prevention of PONV after major gynecologic surgery. Implications: We compared the efficacy of granisetron and ramosetron for preventing postoperative nausea and vomiting in major gynecologic surgery. Prophylactic therapy with ramosetron was more effective than granisetron for preventing postoperative nausea and vomiting 24-48 h after anesthesia.     

A comparison of total intravenous with balanced anaesthesia for middle ear surgery: effects on postoperative nausea and vomiting,pain, and conditions of surgery

We compared postoperative nausea and vomiting (PONV), pain and conditions for surgery in patients scheduled for middle ear surgery. In a double-blind study, 100 patients were randomly allocated to receive either balanced anaesthesia (group A) using fentanyl, propofol and isoflurane, or total intravenous anaesthesia (group B) using propofol and remifentanil infusions. Pain scores, nausea/vomiting scores, conditions for surgery and analgesic requirements were recorded for 18 h post operatively. In the recovery ward, patients in group B suffered significantly less PONV (p = 0.026) with a reduced requirement for anti-emetic medication (p = 0.023); however, this difference was not maintained on the ward. The overall incidence of PONV was 34% and 17% in groups A and B, respectively. Initial pain scores were higher in group B in the recovery ward (p = 0.003) and patients required more morphine administration (p = 0.002); however, pain scores were similar on the ward. Conditions for surgery were found to be better in group B.