甲氧氯普胺、氟哌利多、枢复宁对术后自控镇痛患者恶心呕吐预防作用的比较

目的 :通过患者自控镇痛 (PCA)泵 ,硬膜外腔注射甲氧氯普胺、氟哌利多、枢复宁三种镇吐药 ,观察对术后PCA患者恶心呕吐的预防作用。方法 :将 10 0例妇科及腹部手术的病人 ,随机分成 4组 ,即甲氧氯普胺组、氟哌利多组、枢复宁组、枢复宁 +氟哌利多组 ,通过PCA泵分别将镇吐药注入硬膜外腔 ,观察术后 72h内恶心呕吐情况。结果 :枢复宁组和联合用药组预防恶心呕吐的效果明显高于甲氧氯普胺组和氟哌利多组 ,术后恶心呕吐 (PONV)发生率分别为 2 6 .8% ,16 % ,6 0 %和 73.7% (P <0 .0 1) ,单用甲氧氯普胺和氟哌利多预防术后PONV的效果不理想 ,联合用药组PONV发生率最低 ,但与枢复宁组之间无显著性差异 (P >0 .0 5 )。结论 :枢复宁单用及与氟哌利多联合用药都能很好地预防术后恶心呕吐的发生。     

6种方法预防低危患者术后恶心呕吐(PONV)的成本效果分析

 目的 比较6种方法预防相对低危患者在腹腔镜胆囊切除术后发生恶心呕吐的成本和效果。方法 180名择期行腹腔镜胆囊切除术并符合入选标准的男性患者,随机分为6组。组1接受异丙酚靶控输注(target-controlled infusion,TCI)+5 mg托烷司琼;组2接受异丙酚TCI+10 mg地塞米松和1.25 mg氟派利多;组3接受异丙酚TCI+生理盐水;组4接受七氟醚+5 mg托烷司琼;组5接受七氟醚+10 mg地塞米松和1.25 mg氟派利多;组6接受七氟醚+生理盐水。研究终点是术后24 h内恶心呕吐发生的次数,采用盲法记录。结果 各组患者的一般情况、麻醉时间、手术时间、拔管时间和术后24 h的痛觉模拟评分差异均无统计学意义。组2术后恶心呕吐的发生率显著低于组3 (P=0.03),组5显著低于组6 (P=0.01)。 接受托烷司琼和异丙酚或七氟醚发生术后恶心呕吐的相对危险度分别为0.51或0.68;接受地塞米松联合氟哌利多和异丙酚或七氟醚发生术后恶心呕吐的相对危险度分别为0.40或0.39;相对于七氟醚,接受异丙酚麻醉发生术后恶心呕吐的相对危险度是0.80。1~6组每分钟的费用-效果比分别为1.07、0.88、1.14、1.05、0.74 和1.06。结论 异丙酚、托烷司琼、地塞米松和氟哌利多发生术后恶心呕吐的相对危险度不同。6种干预措施中,七氟醚结合地塞米松和氟哌利多具有最低的每分钟费用-效果比。     

昂丹司琼和甲氧氯普胺对面神经微血管减压术后舒芬太尼镇痛恶心呕吐的防治

目的：观察昂丹司琼和甲氧氯普胺对面肌痉挛面神经微血管减压术成年患者舒芬太尼静脉自控镇痛恶心呕吐的防治作用。方法选择150例行面神经微血管减压术的成年患者,ASA分级Ⅰ或Ⅱ级,年龄35～65岁,随机分为3组。 A：昂丹司琼组,B：甲氧氯普胺组,C：昂丹司琼联合甲氧氯普胺组。术毕均连接病人静脉自控镇痛泵（ PCIA）。分别于术后的6,12,24,48h记录患者镇痛评分、恶心、呕吐和其他相关并发症的发生情况。结果术后各时间点疼痛评分无统计学差异,镇痛效果相同。术后24h内A,C组恶心的发生率及程度均低于B组（P＜0．01）,A,C两组之间无统计学差异。术后6h和12h呕吐发生率和术后6h呕吐程度C组低于A, B两组（P＜0．01）,且A,B组之间无统计学差异。24h C组呕吐发生率及程度低于B组（P＜0．01）,而A,C之间与A,B之间均无统计学差异。术后48h 3组之间恶心呕吐发生率及严重程度均无统计学差异（P＞0．05）。结论昂丹司琼对于舒芬太尼术后镇痛引起的恶心呕吐效果确切,联合甲氧氯普胺使用对呕吐的效果更佳。     

盐酸托烷司琼预防舒芬太尼自控镇痛所致的恶心呕吐的疗效观察

目的:评价盐酸托烷司琼(tropisetron)在妇科手术后应用舒芬太尼自控静脉镇痛(PCIA)技术致恶心、呕吐(PONV)的预防和疗效。方法:选择术后安装止痛泵ASA分级Ⅰ~Ⅱ级的择期妇科手术患者120例,按照随机双盲对照原则分成三组。A组:舒芬太尼药液中加入盐酸托烷司琼5mg 40例患者,B组:舒芬太尼药液中加入氟哌利多5mg 40例患者,C组:舒芬太尼药液(对照组)。于术后2,12,24,48小时定时观察并记录患者的恶心,呕吐发生率;瘙痒,镇静,锥体外系症状的不良反应发生率。结果:患者的PONV发生率A组显著低于B组,B组与A组比较有统计学意义(P<0.01),A组显著低于C组,C组与A组比较有统计学意义(P<0.01);B组镇静,锥体外系反应发生率高于A,C组,有明显的副作用。结论:应用盐酸托烷司琼可有效降低术后舒芬太尼PCIA治疗中恶心、呕吐的发生率,效果优于氟哌利多,而且无明显的副作用。     

芬太尼联合氟哌利多用于剖宫产术后静脉镇痛效果观察

目的：探讨芬太尼联合氟哌利多用于剖宫产术后患者自控静脉镇痛（Patient-controlled intravenous analgesia,PCIA）的效果及对术后恶心、呕吐（Postoperative nausea and vomit,PONV）不良反应的影响。方法：60例持续硬膜外麻醉下剖宫产术后患者,随机分为观察组和对照组,每组30例,对照组：芬太尼1mg＋生理盐水80ml;观察组：芬太尼1mg＋氟哌利多2.5mg＋生理盐水80ml,分别予自控镇痛泵持续静脉自控泵注2ml/h,观察镇痛、镇静效果及恶心、呕吐不良反应发生率。结果：两组Prince-Henry疼痛评分,在术后1h、2h、4h及8h时间点上,差异无显著性（P〉0.05）。术后16h观察组明显低于对照组,差异有显著性（P〈0.01）。术后24h及48h,观察组低于对照组,差异具有显著性（P〈0.05）;镇静评分,组间比较无显著性差异（P〉0.05）;恶心、呕吐不良反应上,观察组恶心、呕吐发生率明显低于对照组,差异具有统计学意义（P〈0.01）。结论：芬太尼联合氟哌利多用于剖宫产术后自控静脉镇痛效果明显优于单独应用芬太尼,且能有效控制恶心、呕吐等并发症的发生。     

Cyclizine and droperidol have comparable efficacy and side effects during patient-controlled analgesia

Background

Post-operative nausea and vomiting (PONV) is common, especially following gynaecological surgery. Patient-controlled analgesia (PCA) is frequently complicated by nausea. We assessed PONV, pain and sedation in patients receiving cyclizine or droperidol during PCA following abdominal hysterectomy in a double-blind trial.

Methods

Thirty women were randomised to receive either cyclizine 0.7mg/kg or droperidol 0.04mg/kg during surgery followed by PCA containing morphine sulphate with cyclizine 2mg or droperidol 0.05mg per demand. Blinded observers scored levels of nausea, sedation, anxiety and pain.

Results

Pain scores, PCA usage and supplemental antiemetic requirements were comparable. Nausea and sedation scores were similar in both groups. Two patients in each group developed refractory PONV. Pre-operative anxiety scores were similar and decreased comparably over time. Patients developing refractory emetic sequelae had a higher incidence of previous PONV. Previous PONV also predicted lower PCA medication intake despite similar demand rates, suggesting increased usage during lock-out periods.

Conclusion

Prophylactic cyclizine and droperidol have similar efficacy during PCA. Neither is associated with perioperative anxiety. A minority of patients have refractory PONV during PCA. Previous PONV may predict less efficient PCA usage.     

地塞米松联合氟哌利多预防腹腔镜胆囊切除术后恶心、呕吐

目的:探讨地塞米松联合氟哌利多预防腹腔镜胆囊切除(LC)术后恶心呕吐的效果。方法:180例ASAⅠ~Ⅱ级LC术患者,随机分成3组,各60例,A组术前静脉注射生理盐水10 ml,B组、C组术前分别静脉注射地塞米松10 mg、地塞米松10mg和氟哌利多20μg/kg,观察术后48 h患者的恶心、呕吐情况。结果:A组恶心、呕吐的发生率为68.3%,B组、C组恶心呕吐的发生率分别为26.7%和8.3%,各组间比较差异有统计学意义(P<0.005)。结论:地塞米松复合小剂量氟哌利多能减少术后恶心、呕吐。     

地塞米松联合氟哌利多预防术后硬膜外吗啡镇痛所致恶心呕吐

目的观察地塞米松联合氟哌利多预防术后硬膜外吗啡镇痛所致恶心呕吐的效果。方法200例连续硬膜外阻滞下手术患者随机分为4组,每组50例:对照组在手术结束时静脉注射生理盐水2ml;地塞米松组在手术结束时静脉注射地塞米松10mg(2ml);氟哌利多组在镇痛药液中加入氟哌利多5mg;联合组在手术结束时静脉注射氟哌利多2.5mg(1ml)和地塞米松5mg(1ml)。术毕所有患者均行硬膜外镇痛。观察术后24h内患者镇痛效果和恶心呕吐发生率。结果对照组恶心呕吐率(22.4%),明显高于氟哌利多组(10%)、地塞米松组(12%)和联合组(10.2%),P<0.05;处理组三组组间比较恶心呕吐率无明显差异,P>0.05。结论地塞米松与氟哌利多单独或联合应用都能有效减少术后硬膜外吗啡镇痛所致恶心呕吐。     

To add or not to add? An empirical study on droperidol and intravenous patient-controlled analgesia

BackgroundDroperidol is commonly added to intravenous patient-controlled analgesia (IVPCA) regimens as an antiemetic agent. Although some studies have demonstrated its safety and efficacy, it is not clear whether adding droperidol to IVPCA infusate without an extra loading dose can effectively reduce the incidence and severity of postoperative nausea and vomiting (PONV) in real-life clinical settings.MethodsPatients receiving IVPCA in this retrospective survey were classified into two groups based on their IVPCA regimens. The droperidol group used morphine 1 mg/mL with droperidol 50 μg/mL, and the non-droperidol group was given morphine 1 mg/mL alone. The incidence and severity of PONV were compared between the two groups during the 3-day course of IVPCA treatment using logistic regression and ordinal logistic regression. Propensity score methodology was applied to adjust for potential confounders.ResultsAmong the 186 patients enrolled, 94 patients received IVPCA with droperidol, and 92 patients received a pure morphine solution. There was no significant difference in patient attributes between the two groups. On the 1^st postoperative day, there was no significant difference in incidence or severity of PONV between the two groups. From the 2^nd day onward, the patients in the droperidol group had significantly fewer and less severe episodes of PONV (relative risk 0.34 and 0.31, respectively). The overall effects of droperidol on PONV and its severity during the whole IVPCA course were also statistically significant, whether or not adjustment for propensity score was made. However, although a statistically significant decrease in nausea was observed in the droperidol group after the 1^st day, no significant difference in the incidence of vomiting between the two groups was noted during the study.ConclusionA loading dose should be considered on the 1^st postoperative day. Our study suggests just how beneficial droperidol can be to IVPCA users in practical clinical settings, showing that droperidol can reduce with some significance the amount and severity of nausea suffered by patients postoperatively, even if the frequency of patient vomiting remains unchanged.     

昂丹司琼、托烷司琼和格拉司琼预防全身麻醉术后恶心呕吐的随机双盲研究

目的比较5羟色胺3(5HT3)受体拮抗剂昂丹司琼、托烷司琼和格拉司琼预防全身麻醉手术后恶心呕吐的效果。方法360例择期接受气管插管全身麻醉手术的患者,美国麻醉医师协会(ASA)体格情况分级Ⅰ~Ⅱ级,年龄18~75岁。根据随机双盲原则分为3组,每组120例,于麻醉诱导前分别给3组患者缓慢静脉注射昂丹司琼4mg、托烷司琼5mg或格拉司琼3mg,观察术后24h内恶心呕吐发生情况并作比较。结果昂丹司琼组、托烷司琼组和格拉司琼组术后24h内完全抑制恶心呕吐的有效率分别为70.0%、68.6%和72.9%,术后恶心发生率分别为22.5%、25.4%和20.3%,术后呕吐发生率分别为10.0%、13.6%和8.5%,3组间差异均无显著性(P>0.05)。术后24h内均未观察到与抗呕吐药相关的明显不良反应。结论麻醉诱导前缓慢静脉注射昂丹司琼4mg、托烷司琼5mg或格拉司琼3mg,能同样安全有效地预防手术后恶心呕吐的发生。     

不同剂量氟哌利多预防术后PCA恶心、呕吐的临床观察

目的:比较不同剂量氟哌利多用于芬太尼静脉术后镇痛(PCA)中对恶心、呕吐的预防作用,并与万唯(阿扎丝琼)相比较。方法:150例择期行腹部手术患者,ASA-级,接受芬太尼术后自控镇痛,随机、双盲分为五组,PCA用药均为芬太尼(0.02mg/ml)。I组为对照组,、、组分别加入氟哌利多(0.0125mg/ml,0.025mg/ml,0.05mg/ml),V组加入万唯0.1mg/ml。观察记录各组患者镇痛后4、8、12、24h芬太尼用量、疼痛评分、恶心呕吐评分、镇静评分。结果:与对照组相比、、组病人恶心和呕吐发生率明显降低(P<0.05);组病人恶心和呕吐发生率虽然有所降低但与对照组相比无显著性差异(P>0.05);、组的恶心和呕吐发生率较组高,但无显著性差异(P>0.05)。组病人术后24h的镇静评分明显高于其它各组(P<0.05)。各组间疼痛、VAS评分及芬太尼用量无差异(P>0.05)。结论:中等剂量氟哌利多能有效地减少芬太尼术后PCA治疗中的恶心、呕吐,副作用少。     

地塞米松联合氟哌利多对术后吗啡硬膜外镇痛恶心呕吐的影响

目的研究地塞米松静脉给药联合小剂量氟哌利多硬膜外给药对降低术后吗啡硬膜外镇痛恶心呕吐（PONV）的作用。方法随机双盲选择90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联合小剂量氟哌利多镇痛。地塞米松（D）组病人在手术后静注地塞米松10mg，对照组（C）组病人则给予等量生理盐水。结果7例患者因故退出此观察。在手术后48h内D组病人手术后总的恶心呕吐发生率为19．0％，明显低于C组病人的36．6％（P〈0．05）。两组病人之间手术后皮肤瘙痒的发生率无明显差异，组间镇痛效果亦无明显差异。结论地塞米松联合氟哌利多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。     

鼻内镜下鼻窦开放术后恶心呕吐的原因分析及预防

目的：探讨鼻内镜下鼻窦开放术后恶心呕吐的原因及各种止吐药的预防效果。方法：选择120例在气管内全麻下进行鼻内镜下鼻窦开放术的患者,随机分成3组,每组40例。Ⅰ组为静注托烷司琼5mg,Ⅱ组静注甲氧氯普胺10mg,Ⅲ组静注生理盐水5mL。结果：Ⅰ组病人术后24h恶心呕吐的发生率明显少于其他两组。结论：托烷司琼能有效预防各种原因引起的鼻内镜下鼻窦开放术后恶心呕吐。     

Ondansetron in prophylaxis of postoperative nausea and vomiting in patients undergoing breast surgery: a placebo-controlled double blind study

The present study was to evaluate the efficacy of ondansetron, 5-HT3 receptor antagonist, versus placebo in the prevention of postoperative nausea and vomiting (PONV) in a homogenous group of female patients undergoing breast reduction surgery under general anaesthesia. Approximately one hour before skin closure, 70 patients were randomly divided into two groups of 35 each. In a double blind manner each group of patients received either intravenous ondansetron (4mg) or a matching placebo. The overall incidences of PONV during first 24-hour were 60% and 20% in placebo and ondansetron group respectively (p<0.05). However, there was no significant difference after 24-hour postoperatively. In placebo group 42.9% of patients received rescue anti-emetic (metoclopramide) for the treatment of severe PONV (ie, 2 or more episodes of PONV), whereas, only 8.6% patients were administered such intervention in the ondansetron group (p<0.05). It is, therefore, concluded that prophylactic administration of intravenous ondansetron (4mg) one hour before skin closure is safe and effective in preventing PONV in female patients undergoing breast surgery and routine use of ondansetron in the patient population is recommended.     

氟哌利多预防全麻腹腔镜胆囊切除术后恶心呕吐的临床观察

目的 观察小剂量氟哌利多预防全麻腹腔镜胆囊切除术后恶心呕吐的临床效果。方法 选择50例ASAⅠ～Ⅱ级在全麻下行腹腔镜胆囊切除术病人。随机将病人分为预防组(D组)和对照组(C组)，每组各25例。麻醉诱导前5min D组静脉推注氟哌利多1．25mg。麻醉诱导及维持两组相同。所有病人气管插管后均常规置入胃管。观察24h恶心呕吐发生率、镇静情况及不良反应。结果 D组术后恶心呕吐发生率为16％，C组为72％，两组比较差异有显著统计学意义。镇静评分两组问无显著性差异，D组未见不良反应。结论 腹腔镜胆囊切除术麻醉诱导前5min静注小剂量氟哌利多能有效减少术后恶心呕吐的发生率。     

地塞米松对新辅助化疗后乳腺癌患者术后恶心呕吐发生率的影响

目的：评估地塞米松对新辅助化疗（术前化疗）后乳腺癌改良根治术术后恶心呕吐（postoperative nausea and vomiting, PONV）的预防效果。方法：新辅助化疗后行乳腺癌改良根治术的女性乳腺癌患者280例,18~60岁,随机分为两组,每组140例：（1）D组：实验组,术前给予10 mg地塞米松静脉滴注;（2）C组：对照组,术前给予2 mL生理盐水作为安慰剂静脉滴注。每组患者再分为两亚组,每组70例,分别应用丙泊酚全凭静脉麻醉(total intravenous anesthesia, TIVA)（P亚组）和七氟醚维持吸入全身麻醉（S亚组）。所有患者均进行标准的全身麻醉操作,手术结束前30 min静脉滴注昂丹司琼(ondansetron) 8 mg。随访术后24 h内患者恶心呕吐的发生率,并对PONV的影响因素进行Logistic回归分析。检测因素包括年龄、体重指数（body mass index, BMI）、手术时间、术后疼痛程度、晕动病史/既往PONV史、是否应用地塞米松以及麻醉方法。结果：术后24 h内D组患者恶心呕吐的发生率明显低于C组患者（11.4% vs. 20.7%,P=0.034）;术后0~2 h D组患者PONV的发生率低于C组患者（1.4% vs. 6.4%,P=0.031）;术后2~24 h D组患者PONV的发生率与C组患者差异无显统计学意义（10.7% vs. 17.9%,P=0.088）。术后24 h内各时段,D组与C组内丙泊酚全凭静脉麻醉亚组与吸入麻醉亚组PONV的发生率比较差异均无统计学意义（P>0.05）。Logistic回归分析显示地塞米松对新辅助化疗后乳腺癌改良根治术患者术后恶心呕吐有预防效果（OR=0.447,P=0.030）,晕动症/PONV病史是术后恶心呕吐的危险因素（OR=15.730,P＜0.001）。结论：术前应用地塞米松可明显降低新辅助化疗后乳腺癌改良根治术患者术后恶心呕吐的发生率。     

足三里穴位注射预防腹腔镜胆囊切除术后恶心呕吐临床观察

目的观察足三里穴位注射预防腹腔镜胆囊切除术（1aparoscopiccholecystectomy,LC）术后恶心呕吐（postoperativenauseaandvomiting,PONV）的效果。方法将拟行LC治疗的72例患者于麻醉前随机平均分为3组,A组采用10％葡萄糖液3ml加氟哌利多2．5mg和地塞米松10mg行双侧足三里穴位注射,B组采用与A组相同的药物静脉注射,C组采用等容量的9．0g／L氯化钠注射液行双侧足三里穴位注射,观察术后24h3组PONV发生率。结果A组、B组、C组术后24hPONV总发生率分别为12．5％、25．0％、58．3％,A组和B组PONV总发生率显著低于C组（P〈0．01）,但A组和B组PONV总发生率比较,差异无统计学意义。结论穴位注射和静脉注射地塞米松和氟哌利多都有预防LC患者PONV的作用,而穴位注射效果具有优于静脉注射的趋势。     

格拉司琼预防颅脑外科手术后恶心呕吐的临床研究

OBJECTIVE: To observe the prophylactic effect of granisetron on postoperative nausea and vomiting (PONV) after supratentorial craniotomy. METHODS: Seventy ASA I-II patients undergoing elective supratentorial craniotomy were randomly and double-bindly divided into two groups: control group (Group C, n = 35) and granisetron group (Group G, n = 35). All the patients received either 0.9% NS (Group C) or granisetron 3 mg (Group G) via intravenous injection. The incidences of postoperative nausea and vomiting were recorded at 24 h, 48 h, 72 h after supratentorial craniotomy. RESULTS: The incidence of PONV in Group G was lower than that in Group C (25.7% vs 57.1%, P < 0.01). The incidence of server nausea with vomiting or vomiting in Group G was lower than that in Group C (17.2% vs 48.6%, P < 0.01). CONCLUSION: Granisetron can be used effectively and safely to prevent PONV in supratentorial craniotomy.     

吗啡伍用不同抗呕吐药硬膜外自控镇痛对妇科手术后恶心呕吐的影响

目的 探讨和比较甲氧氯普胺、氟哌利多、地塞米松等药物对术后硬膜外自控镇痛（PCEA）所产生恶心、呕吐不良反应的影响。方法 将80例在硬膜外麻醉睛择期妇科手术的患都 胡机分成4组，所有患者均用吗啡作为镇痛药物，但各组所使用的抗呕吐药不同。手术结束后使用PCEA，并分别记录术后24h和48h的视觉模拟评分（VAS）、恶心呕吐的发生率、皮肤瘙痒及呼吸频率等。结果 术后24h内，地塞米松组抗呕吐的作用明显高于其他3组，抗恶心作用与氟哌利多组相似，均明显高于甲氧氯普胺组和对照组。各组间VAS和第术后皮肤瘙痒的发生率差异无显著性。结论 椎管内单次应用地塞米松可显著减少术后硬膜外吗啡镇痛引起的恶心、呕吐，未见明显不良反应，较氟哌利多和甲氧氯普胺更为优越。     

盐酸戊乙奎醚复合托烷司琼对防治中耳手术后恶心呕吐的应用观察

目的评价盐酸戊乙奎醚复合托烷司琼对中耳手术后恶心呕吐（PONV）的防治效果及其安全性。方法选择ASAⅠ～Ⅱ级择期行中耳手术患者80例，均采用静吸复合麻醉。患者随机分为4组，诱导前10min分别静注生理盐水10mL（Ⅰ组）、托烷司琼2mg（Ⅱ组）、盐酸戊乙奎醚1mg（Ⅲ组）、托烷司琼2mg加盐酸戊乙奎醚1mg（Ⅳ组）。记录术前、诱导后、术毕心率、血压的变化；术毕口干程度；术后24h PONV发生情况、严重程度及补救措施。结果各组诱导后MAP均明显降低（P〈0．05），Ⅰ组、Ⅱ组和Ⅲ组术毕MAP均明显增高（P〈0．05）。Ⅰ组和Ⅱ组诱导后和术毕HR明显增加（P〈0．05），Ⅲ组和Ⅳ组HR变化不明显（P〉0．05）。Ⅲ组和Ⅳ组明显口干，气道分泌物明显少于Ⅰ组和Ⅱ组（P〈0．05）。Ⅳ组术后PONV的发生率明显低于Ⅰ组、Ⅱ组和Ⅲ组（P〈0．05）。结论术前应用盐酸戊乙奎醚复合托烷司琼可以稳定术中血液动力学，减少气道分泌物，明显降低中耳术后恶心呕吐的发生率。