地塞米松预防术后硬膜外吗啡镇痛引起的恶心呕吐

硬膜外应用吗啡控制手术后疼痛是一种简易安全有效的镇痛方法 ,已广泛应用于临床 ,但其恶心呕吐的发生率较高 (30 %～62 % ) [1],不仅增加了手术病人的不适感 ,影响了术后镇痛的质量和水平 ,还可能造成呕吐、误吸等严重后果。如何在提高镇痛效果的同时 ,减轻其副作用 ,已越来越被临床关注。我们采用预防性应用地塞米松以减少硬膜外吗啡镇痛引起的恶心呕吐 ,取得满意效果 ,现报道如下。1资料与方法1.1一般资料选择ASAⅠ～Ⅱ级择期手术88例 ,男性36例 ,女性52例 ,年龄23～65岁 ,体重40～78kg,手术种类包括盆腔 (子宫、附件 )、胃、胆、脾、…     

地塞米松对术后硬膜外吗啡引起恶心呕吐的预防作用

目的:评价地塞米松对硬膜外吗啡引起恶心呕吐的预防效果。方法:妇科肿瘤择期手术病人120例,随机双盲分为地塞米松(A)组、恩丹西酮(B)组、生理盐水(C)组三组,每组40人。当手术开始时,随机给予地塞米松10 mg或者恩丹西酮8 mg或者生理盐水2 mL。所有病人在手术结束前1 h均接受硬膜外吗啡2 mg,然后以0.125％布比卡因100 mL和吗啡0.12mg/kg维持硬膜外术后止痛48 h,评价镇痛效果、恶心呕吐。结果:A组和B组早期和晚期恶心呕吐发生率低于C组(P<0.05),而A组和B组无差别(P>0.05)。结论:地塞米松和恩丹西酮均能降低硬膜外吗啡引起的恶心呕吐,地塞米松对术后硬膜外吗啡引起的恶心呕吐有预防作用。     

地塞米松、胃复安对预防术后硬膜外吗啡镇痛引起恶心呕吐的临床疗效评价

吗啡已广泛被用于术后硬膜外镇痛，但存在恶心、呕吐、皮肤瘙痒的主要并发症，增加了病人的痛苦，影响术后恢复。我们选择了120例病人的对照分析硬膜外给予地塞米松10mg，胃复安10mg，对恶心、呕吐、皮肤瘙痒的预防作用。     

耳穴注药预防妇科术后吗啡镇痛坐恶心呕吐的效果观察

目的探讨氟哌利多耳穴注射预防姐科手术患者吗啡术后镇痛所致恶心呕吐的临床效果。方法选择拟行硬膜外麻醉与吗啡术后镇痛的妇科手术患者90例,随机分为3组,每组30例。Ⅰ组为氟哌利多耳穴注射,Ⅱ组为氟哌利多肌内注射,Ⅲ组为对照组。观察各组患者术后24h内恶心呕吐的发生次数和程度,按评定标准以计分法进行评定。结果恶心与呕吐发生率Ⅰ组、Ⅱ组与Ⅲ组比较差异均有统计学意义（P〈0．01或P〈0．05）;恶心与呕吐发生率Ⅰ组与Ⅱ组比较差异有统计学意义（P〈0．01）。结论氟哌利多耳穴注射预防妇科手术患者吗啡术后镇痛所致的恶心呕吐,临床效果可靠,无明显并发症。     

枢丹和异丙嗪预防硬膜外吗啡术后镇痛并发恶心呕吐皮肤瘙痒的观察

硬膜外(EP)吗啡术后镇痛并发恶心呕吐(PONV)的发生率为20％～50％，常出现皮肤瘙痒等副作用。本组将枢丹和异丙嗪静注预防其恶心呕吐及皮肤瘙痒获得满意效果，现报告如下：     

地塞米松对吗啡硬膜外镇痛副作用的影响

吗啡硬膜外腔注射术后镇痛的效果在理论与临床上都得到了充分肯定，其副作用相继也有一些报道。但是，对其副作用如尿潴留、恶心呕吐、皮肤瘙痒、骶尾部水疱疹的治疗研究甚少。本旨在观察患应用地塞米松以减少或消除吗啡镇痛副作用的效果，报告如下。     

静注异丙嗪可以预防硬膜外吗啡术后镇痛并发的恶心呕吐

吗啡术后镇痛并发恶心呕吐的发生率约为２０％￣５０％。为提高镇痛质量，本组将硬膜外注入吗啡镇痛的１３０例患者，采用不同的药物或方法，进行预防恶心呕吐的临床效果观察，所有患者硬膜外麻醉成功后，均辅用盐酸异丙嗪０．５ｍｇ／ｋｇ，甲氧氯普胺１０ｍｇ和地塞米松１０ｍｇ静滴。于术毕前３０ｍｉｎ经硬膜外导管精确注入吗啡２￣３ｍｇ。１３０例分三组。Ⅰ组３０例，为对照组，不再用药；Ⅱ组３０例，静滴氟哌啶５ｍｇ；Ⅲ组     

不同时间应用地塞米松对预防腹腔镜术后恶心呕吐的比较

目的：比较不同时间应用地塞米松对预防术后恶心呕吐的影响。方法：120例腹腔镜胆囊切除术患者,随机分为3组,各40例。1组麻醉诱导前给予地塞米松10 mg,2组于手术后给予地塞米松10 mg,3组为对照组。观察三组术后恶心呕吐情况。结果：1、2组术后恶心呕吐数量均显著低于3组,同时1组亦明显低于2组。结论：不同时间应用地塞米松对预防术后恶心呕吐有影响,麻醉前应用效果优于手术后。     

氟比洛芬酯联合地塞米松对甲状腺术后疼痛和恶心、呕吐的治疗作用

目的观察氟比洛芬酯复合地塞米松对甲状腺手术后疼痛和恶心、呕吐的治疗作用。方法100例ASA为Ⅰ～Ⅱ级甲状腺手术病人分为5组,每组20例,各组病人在麻醉诱导后手术开始前15min分别静脉注射生理盐水5mL,氟比洛芬酯50mg,地塞米松5mg和氟比洛芬酯50mg,地塞米松10mg和氟比洛芬酯50mg,地塞米松15mg和氟比洛芬酯50mg。手术结束后2、4、8、12、24和48h应用视觉模拟（VAS）评分法评估切口疼痛程度,观察术后恶心、呕吐的发生率。结果术后2h各组的VAS评分没有明显差别（P〉0．05）,术后4、8、12、24hⅡ组的VAS评分低于Ⅰ组,Ⅲ组低于Ⅱ组,但无统计学意义（P〉0．05）;Ⅲ组低于Ⅰ组（P〈0．05）,Ⅳ和Ⅴ组VAS均明显低于Ⅰ组、Ⅱ组（P〈0．01）和Ⅲ组（P〈0．05）,术后48h各组的VAS评分无明显区别（P〉0．05）。术后0～2h内各组均无恶心、呕吐发生,2～48h内各组发生恶心、呕吐的例数分别为9、8、3、2、3,应用地塞米松组恶心、呕吐明显低于未用地塞米松组（P〈0．05）。结论甲状腺手术开始前给予氟比洛芬酯50mg和地塞米松10mg,可以获得术后较好的镇痛、止吐效果。     

托烷司琼预防术后静脉自控镇痛致恶心呕吐疗效观察

目的观察托烷司琼抑制患者术后静脉自控镇痛（patient controlled intrarenous analgesia,PCIA）所致恶心呕吐的效果。方法选择择期手术需行全身麻醉ASAI-Ⅱ级患者120例,所有患者术前均无明显胃肠道功能异常和恶心呕吐症状,无心、肺、肝、肾功能不全;术前24h未给任何止吐药。术毕将120例患者随机分为3组：①Ⅰ组（生理盐水组,n=40）,术毕静脉注射生理盐水2mL,患者PCIA配方为芬太尼0.6～0.8mg,用生理盐水稀释至100mL。②Ⅱ组（托烷司琼组,n=40）,术毕静脉注射托烷司琼2mg;在Ⅰ组PCIA配方中加托烷司琼4mg。③Ⅲ组（氟哌利多组,n=40）术毕静脉注射氟哌利多2.5mg,在Ⅰ组PCIA配方中加氟哌利多2.5mg。术后连续观察48h,记录术后0、4、8、16、24、32、48h视觉模拟评分（VAS）、舒适评分（BCS）及恶心呕吐等不良反应。结果所有患者术后镇痛及舒适评分均达基本满意水平,各组相比,差异无统计学意义（P〉0.05）。防治恶心、呕吐效果,Ⅱ组效果最好,Ⅱ组、Ⅲ组与Ⅰ组相比差异均有显著性（均P〈0.05）;Ⅱ组与Ⅲ组相比差异无显著性（P〉0.05）。Ⅲ组出现了3例锥体外系症状及5例嗜睡症状,Ⅱ组有3例出现一过性轻微头痛。结论托烷司琼及氟哌利多均能抑制PCIA所致恶心、呕吐,但托烷司琼不良反应少且轻微。     

长托宁结合赛格恩预防妇科肿瘤术后丁丙诺啡PECA所致的恶心呕吐

【目的】观察长托宁术前肌注结合赛格恩术后经患者硬膜外自控镇痛（PECA）泵持续输注对妇科肿瘤术后丁丙诺啡PECA所致的恶心呕吐的影响。【方法】经腹妇科肿瘤手术患者160例随机均分为A、B、C、D四组,A组术前抗胆碱药采用阿托品,B、C、D组采用长托宁,术后PECA均采用丁丙诺啡,术毕A组不用止呕药,B组赛格恩5mg单次静注,C组赛格恩5mg静脉持续泵入,D组赛格恩5mg加入PECA泵中持续泵入。观察各组术后4、24、40h镇痛评分（VAS）;Ramsay镇静评分（RSS）;舒适评分（BCS）;恶心、呕吐例数;因严重恶心、呕吐而要求终止PCA的例数;肛门首次排气时间。【结果】A组VAS术后各时点明显高于D组（P〈0．05）,组B、C术后24、40h明显高于D组（P〈0．05。P〈0．01）;A组各时点RSS明显低于B、C或D组（P〈0．01）;BCSA组术后24、40h明显低于B、C或D组（P〈0．01）;术后恶心、呕吐例数及要求终止PCA的例数组A明显多于B组、C组或D组（P〈0．05,P〈0．01）,恶心、呕吐例数B组亦明显多于C组或D组（P〈0．05）;肛门首次排气时间D组较组A短（P〈0．05）。【结论】长托宁术前肌注结合赛格恩术后经患者PECA泵持续输注能明显减少妇科肿瘤术后丁丙诺啡PECA所致的恶心、呕吐,缩短肛门首次排气时间,且有较高的舒适评分和较好的术后镇痛、镇静效果。     

Prevention and Management of Postoperative Nausea and Vomiting in Adults

In early 2007, patients at our small community hospital's outpatient surgery center experienced postoperative nausea and postoperative nausea and vomiting (PONV) at a rate of 27% to 35%. Many record reviews and a written survey of nurses in the postanesthesia care unit and same day surgery center revealed that little or no risk assessment and no consistent prophylaxis or treatment were in use by nurses, physicians, or anesthesia care providers.After a review of the literature and discussions with anesthesia care providers, we developed and put into practice a risk assessment tool and perioperative care path. A formal evaluation to assess the effectiveness of the plan was performed one year after implementation. We found that the rates of PONV had decreased to 16%. AORN J 90 (September 2009) 391-413. © AORN, Inc, 2009.     

Aprepitant vs. Multimodal Prophylaxis in the Prevention of Nausea and Vomiting following Extended‐Release Epidural Morphine

Background: Extended‐release epidural morphine (EREM) is an effective option for postoperative analgesia following major orthopedic surgery; however, postoperative nausea/vomiting (PONV) is a recognized limitation. The incidence of PONV following prophylactic aprepitant, a neurokinin‐1 antagonist, was compared with prophylactic multimodal antiemetic therapy in patients receiving EREM for postoperative analgesia following unilateral primary total knee arthroplasty (TKA). Methods: Prospectively collected quality assurance data were examined with Institutional Review Board approval. A sequential, open‐label, active matched case‐control study compared PONV following EREM in patients receiving ondansetron and dexamethasone, and either metoclopramide, diphenhydramine, or prochlorperazine every 6 hours for the 48‐hour study period, to patients receiving aprepitant 40 mg given as a single oral dose in the preoperative holding area. Cases were matched for procedure (TKA), age, epidural morphine dose, and known major risk factors for PONV (sex, smoking, previous PONV/motion sickness). Results: Twelve consecutive patients (3 male; 9 female) receiving aprepitant prior to EREM were matched to 12 patients of the same sex of similar age (range 51 to 84 years.) and EREM dose (range 5 to 12.5 mg) receiving the multimodal regime. The incidence of PONV was significantly less for the aprepitant group where 3 of 12 (25%) had PONV compared with 9 of 12 (75%) in the multimodal group (P = 0.039, Fisher's Exact Test; odds ratio = 0.11; 95% CI: 0.018 to 0.706, P = 0.03). Conclusion: While aprepitant significantly reduced the incidence of PONV compared with a multimodal antiemetic regime, used alone it did not eliminate PONV.