托烷司琼复合地塞米松预防腹腔镜胆囊切除术后恶心呕吐的疗效观察

目的观察并比较托烷司琼及复合地塞米松后对预防腹腔镜胆囊切除术后恶心呕吐疗效的影响。方法选择腹腔镜胆囊切除手术患者80例,随机分成托烷司琼组、小剂量托烷司琼复合地塞米松组、小剂量托烷司琼组及对照组,每组20例。监测其围术期血压（BP）、心率（HR）,记录术后有无恶心呕吐及呕吐程度。结果小剂量托烷司琼复合地塞米松组及托烷司琼组与对照组相比,术后6h和24h,恶心呕吐（PONV）发生率显著减少（P〈0.01）;托烷司琼组及小剂量托烷司琼复合地塞米松组与小剂量托烷司琼组相比,PONV发生率明显减少（P〈0.05）;而四组平均动脉压（MAP）、HR相比差异无统计学意义。结论联合使用小剂量托烷司琼与地塞米松对预防腹腔镜胆囊切除术后PONV有较好的效果。     

格拉司琼术前和术后预防性给药对预防术后恶心呕吐效果的比较

目的研究格拉司琼在术前和术后预防性给药预防行腹腔镜胆囊切除术患者术后恶心呕吐(PONV)的效果。方法90例全麻下行腹腔镜胆囊切除术患者随机分为3组,每组30例。Ⅰ组(对照组)不预防性给药;Ⅱ组(术前格拉司琼组)于麻醉诱导前给予格拉司琼3mg;Ⅲ组(术后格拉司琼组)手术结束时给予格拉司琼3mg。记录术后24h内恶心呕吐的发生情况及用药情况。结果Ⅱ组患者在术后24h内恶心呕吐发生率为20.0%,略高于Ⅲ组的16.7%,但无显著性差异(P>0.05);Ⅱ、Ⅲ组与Ⅰ组的46.7%相比,恶心呕吐的发生率和程度明显降低(P<0.05),术后应用止吐药物剂量亦明显低于Ⅰ组(P<0.05)。结论在手术前或手术结束时,应用本研究所用剂量的格拉司琼预防术后恶心呕吐的效果相当。     

地塞米松联合格拉斯琼预防腹腔镜胆囊切除术后恶心呕吐的临床观察

术后恶心呕吐（postoperative nausea and vomiting,PONV）是腹腔镜胆囊切除术后的常见并发症,发生率较高,严重影响患者术后恢复,增加了病人的痛苦。通过运用地塞米松联合格拉斯琼（granisetron）预防腹腔镜胆囊切除术后PONV,观察其临床结果和可行性。     

托烷司琼联合胃复安预防腹腔镜胆囊切除术后恶心呕吐

目的：观察托烷司琼联合胃复安对腹腔镜胆囊切除术后恶心呕吐(PONV)的防治效果。方法择期腹腔镜胆囊切除术患者150例,于麻醉前随机分为三组,各50例,静脉注入各预防性药物, A组：手术结束前静脉注射生理盐水10 ml;B组：手术结束前静脉注射托烷司琼2 mg;C组：手术结束前静脉注射托烷司琼2 mg+胃复安10 mg。观察患者术后24 h恶心呕吐发生率。结果三组术后24 h恶心呕吐总发生率分别为60%、34%、14%,各组间比较差异均有统计学意义(P<0.05)。结论托烷司琼联合胃复安预防腹腔镜胆囊切除术后恶心呕吐的疗效优于单用托烷司琼。     

腹腔镜胆囊切除术后恶心呕吐与药物副作用的关系

目的 探讨腹腔镜切除术后恶心呕吐的原因。方法 选择400例在静吸复合麻醉下腹腔镜切除术的患者。随机分为2组：静滴先锋V组,静滴左氧氟沙星组。结果 后组术后24h内恶心呕吐例数明显少于前组（P〈0．01）。结论 腹腔镜胆囊切除术后恶心呕吐与药物副作用相关。     

格拉司琼和恩丹西酮对腹腔镜胆囊切除术后恶心呕吐的预防作用

术后恶心呕吐(postoperative nausea and vomiting,PONV)是腹腔镜胆囊切除术最常见的并发症之一,是影响患者术后康复及增加痛苦的重要因素.为了有效预防PONV,我们将格拉司琼、恩丹西酮分别用于腹腔镜胆囊切除术患者,对两者预防术后PONV的疗效作一比较.     

HANS穴位神经刺激仪电刺激预防腹腔镜肾癌手术术后恶心呕吐的疗效观察

<正>术后恶心呕吐是最常见的麻醉及手术并发症之一~[1,2]。呕吐可导致严重的并发症,如误吸、脱水、电解质失衡,诱发心律失常等。10%的外科手术患者在术后恢复室发生术后恶心呕吐(PONV),术后24 h内,发生PONV的患者比例可升至30%~[3]。PONV已知的危险因素包括女性、使用阿片类镇痛药物、非吸烟、有PONV史或晕动病史四类~[4]。而腹腔镜手术也是引起PONV的高危因素之一。目前常采用的预防治疗方案     

昂丹司琼、长托宁单次注射用于预防腹腔镜胆囊切除术后恶心呕吐的对照研究

尽管麻醉药品不断更新和麻醉技术也在进展,术后恶心呕吐（postoperative nausea and vomiting,PONV）仍然是常见的术后并发症,据报道平均发生率为20%～30%[1]。腹腔镜胆囊切除术后PONV的发生率在53%～72%[2,3]。     

美施康定直肠给药用于腹腔镜下胆囊切除术后镇痛的临床观察

目的观察美施康定用于腹腔镜下胆囊切除术后镇痛效果。方法ASAⅠ~Ⅱ级静吸复合麻醉下行腹腔镜下胆囊切除术患者64例,按照影响因素匹配来进行分成两组,每组32例,美施康定组,术前30 m in经直肠给予美施康定30 mg(硫酸吗啡控释片);对照组,术前不行镇痛预处理,术后必要时肌肉注射哌替啶。术后4、6、12、24 h分别观察患者的BP、HR、SPO2、镇痛评分(VAS)及恶心呕吐情况。结果两组患者术后生命体征平稳,两组比较无统计学意义(P>0.05);恶心呕吐情况两组比较无统计学意义,术后4、6、12 h VAS评分美施康定组低于对照组(P<0.05或P<0.01)。结论腹腔镜下胆囊切除术的患者,术前30 m in经直肠给予美施康定,可产生良好的术后镇痛效果,不增加恶心呕吐发生率。     

超声引导右侧星状神经节阻滞对腹腔镜胆囊切除术患者术后内脏痛及恶心呕吐的影响

目的 探讨超声引导下右侧星状神经节阻滞（SGB）对腹腔镜胆囊切除术（LC）患者术后内脏痛与恶心呕吐（PONV）的影响。方法 选取择期行LC的患者120例,采用随机数字表法分为SGB组60例和对照组60例。SGB组于术前行超声引导下右侧SGB,注入1%利多卡因6 m L,对照组于相同部位注入等量生理盐水,2组术毕均用1%罗哌卡因10 mL局部浸润腹部切口。记录2组患者麻醉诱导前（T0）、插管即刻（T1）、切皮时（T2）、气腹建立时（T3）、气腹建立后10 min(T4)、术毕（T5）的平均动脉压（MAP）和心率（HR）。记录术后0.5、4、12、24 h的内脏痛数字评价量表（NRS）评分,术后24 h内PONV发生情况及止吐药物使用情况。分别记录2组手术时间、术中丙泊酚和瑞芬太尼用量、拔管时间、术后第1次肛门排气时间、术后第1晚阿森斯失眠量表（AIS）评分、麻醉满意度评分。结果 与对照组比较,SGB组MAP和HR在T1、T4时均明显降低（P<0.05）。与对照组比较,SGB组术后4 h、12 h内脏痛NRS评分明显降低,术后24 h内PONV发生率明显降低且止吐药物使用率降低（P&...     

Efficacy of a single-dose ondansetron for preventing post-operative nausea and vomiting after laparoscopic cholecystectomy with sevoflurane and remifentanil infusion anaesthesia

In this randomized study we compared the efficacy of ondansetron 4 mg with ondansetron 8 mg for the prevention of postoperative nausea and vomiting (PONV) after laparoscopic cholecystectomy with sevoflurane and remifentanil infusion anaesthesia. Sixty patients were randomized to receive ondansetron 8 mg (30 pts) or ondansetron 4 mg (30 pts) before the induction of anaesthesia with thiopental and remifentanil. Anaesthesia was maintained with sevoflurane (0.5 MAC), oxygen and remifentanil infusion (0.25, 0.35, 0.5 microg/kg/min). Postoperative analgesia was provided by intravenous ketorolac 60 mg. The incidence of PONV, the pain score, and the analgesic requirement were recorded for 24 hours. There was no difference among groups in patient characteristics, risk factors for PONV, or side effects. During the first 6 h postoperatively, the incidence of PONV after ondansetron 4 mg and 8 mg were similar (p < 0.001). After 6 h the incidence of PONV increased significantly in patients who had received ondansetron 4 mg (p = 0.01) and was greater than that in patients who had received ondansetron 8 mg (p = 0.001). We conclude that single-dose ondansetron 8 mg is more effective than ondansetron 4 mg in the prevention of PONV after laparoscopic cholecystectomy. This surgery is associated with a high incidence of postoperative nausea and vomiting. A single dose of IV ondansetron 8 mg is well tolerated and decrease the number of nausea and vomiting episodes after surgery.     

地佐辛与曲马多术后早期镇痛效果的比较

目的 比较地佐辛与曲马多单次静脉给药用于腹腔镜胆囊切除术后患者患者早期镇痛的效果及不良反应.方法 选择择期行腹腔镜胆囊切除术患者40例,美国麻醉师协会Ⅰ～Ⅱ,年龄18～65岁,完全随机分为地佐辛组和曲马多组,各20例,均采用气管插管全身静脉麻醉.术中靶控输注异丙酚、瑞芬太尼,间断给予顺式阿曲库铵维持麻醉.地佐辛组关腹前30 min分别静脉注射地佐辛0.1 mg/kg、曲马多组给予曲马多2 mg/kg.记录2组术前(T0)、给药时(T1)、拔管时(T2)、拔管后5 min(T3)、拔管后10 min(T4)、拔管后30 min(T5)、拔管后1 h(T6)患者的HR、SBP、DBP和动脉血氧分压(SpO2),并观测苏醒时间、拔管时间以及T3、T4、T5、T6的视觉模拟评分(VAS),观察拔管后患者的不良反应情况.用警觉/镇静评分评估患者全麻后意识恢复程度.结果 地佐辛组T2、T3时间点心率分别为(105±11)、(96±10)次/min,明显低于曲马多组[分别为(93±6)、(87±6)次/min,P<0.05],SpO2在T2、T3、T4时间点差异无统计学意义,T4时间点地佐辛组VAS评分明显高于曲马多组[(2.06±0.85)分比(2.69±0.93)分,P<0.05].曲马多组呼吸抑制1例,恶心呕吐3例,躁动2例;地佐辛组呼吸抑制1例,躁动1例,头晕1例.2组不良反应发生情况差异无统计学意义.结论 地佐辛在拔管早期对抑制拔管反应的作用和镇痛比曲马多好,不良反应较少.

Abstract：

Objective To study the effect of dezocine versus tramadol for postoperative analgesia and side effects after laparoscopic cholecystectomy. Methods Forty patients with postoperative analgesia, American Society of Anesthesiologists I - II class, were randomly divided into two groups. Target controlled infusion of propofol and remifentanly was used to both groups. Both groups were given intermittent cisatracurium. The single intravenous injections of dezocine(0.1 mg/kg)and tramdol(2 mg/kg) were given before 30 min of operation closure. The analgesic efficacy and side effects was assessed by verbal and visual scales at regular intervals after administration. Hemo-dynamic parameters and SpO2 were recorded, before operation, after administration, extubation time, 5, 10, 30, 60 min after extubation. The visual analogue scale(VAS) pain score and OAA/S score of 5, 10, 30, 60 min after extubation were conducted. Adverse reactions with nausea and vomiting and dysthesia after extubation were obtained. Results There was statistical significance of hemodynamic parameters of extubation(P<0.05). Tramadol group (Group T) has the highest incidence of nausea and vomiting. Dezocine group (Group D)has the highest VAS score after recovery (P<0.05). There were no significant changes in respiratory parameters. Conclusion A single 0. 1 mg intravenous injection of dezocine is safe and effective for postoperative pain after laparoscopic cholecystectomy.     

盐酸格拉司琼预防腹腔镜胆囊切除术后患者恶心呕吐的效应

目的评价盐酸格拉司琼预防腹腔镜胆囊切除术(LC)后患者恶心呕吐的恶心、呕吐反应的预防和治疗方法。方法240例慢性结石性胆囊炎患者,男性120例,女性120例,均在全麻下接受常规LC手术。将其随机分为术前用药组80例、术后用药组80例和对照组80例,分别于麻醉前30分钟静脉注射盐酸格拉司琼3mg(0.9%生理盐水20mL稀释)、麻醉清醒后立即给予静脉注射盐酸格拉司琼3mg(0.9%生理盐水20mL稀释)和仅给予0.9%生理盐水20mL。用药后观察48h,观察恶心、呕吐反应的发生情况和药物的不良反应。若患者出现恶心、呕吐,再给予静脉注射盐酸格拉司琼3mg治疗。结果术前用药组、术后用药组和对照组的恶心、呕吐发生率分别为15%、5%和43.75%,术后用药组的恶心、呕吐发生率明显低于术前用药组和对照组(P<0.05),术前用药组的恶心、呕吐发生率也明显低于对照组(P<0.05);240例患者共有46例发生恶心、呕吐反应,再次静脉注射盐酸格拉司琼3mg后,有41例患者得到控制(89.13%)。未观察到任何药物的不良反应。结论盐酸格拉司琼能安全有效地预防和治疗LC术后恶心、呕吐反应的发生。     

托烷司琼不同时间给药预防术后恶心呕吐的临床观察

目的观察托烷司琼不同时间给药预防术后恶心呕吐的效果。方法将120例择期在全凭静脉麻醉下行腹腔镜胆囊切除术(LC)的病人随机分为3组,每组40例。A组病人麻醉诱导前静脉注射托烷司琼5mg;B组病人手术结束后静脉注射托烷司琼5mg;C组为不给托烷司琼及其他抗呕吐药物的对照组。观察并记录病人术后24h恶心呕吐的发生情况。结果A、B组术后恶心呕吐的发生率明显低于C组(P<0.05),其中A组发生率比B组更低(P<0.05)。结论托烷司琼术前和术后不同时间给药,均能有效减少病人术后恶心呕吐的发生,术前预防性用药效果更佳。     

Evaluation of antiemetic effect of intravenous palonosetron versus intravenous ondansetron in laparoscopic cholecystectomy: A randomized controlled trial

Objectives:

Incidence of postoperative nausea and vomiting (PONV), without active intervention, following laparoscopic cholecystectomy is unacceptably high. We evaluated the effectiveness of intravenous (IV) palonosetron in counteracting PONV during the first 24hrs following laparoscopic cholecystectomy, using ondansetron as the comparator drug.

Materials and Methods:

In a randomized, controlled, single blind, parallel group trial, single pre-induction IV doses of palonosetron (75mcg) or ondansetron (4mg) were administered to adult patients of either sex undergoing elective laparoscopic cholecystectomy. There were 49 subjects per group. The pre-anesthetic regimen, anesthesia procedure and laparoscopic technique were uniform. The primary effectiveness measure was total number of PONV episodes in the 24 hrs period following end of surgery. The frequencies of individual nausea, retching and vomiting episodes, visual analog scale (VAS) score for nausea at 2, 6 and 24hrs, use of rescue antiemetic (metoclopramide), number of complete responders (no PONV or use of rescue in 24 hrs) and adverse events were secondary measures.

Results:

There was no statistically significant difference between the groups in primary outcome. Similarly, the frequencies of nausea, retching and vomiting episodes, when considered individually, did not show significant difference. Nausea score was comparable at all time points. With palonosetron, 14 subjects (28.6%) required rescue medication while 13 (26.5%) did so with ondansetron. The number of complete responders was 14 (28.6%) and 16 (32.7%), respectively. Adverse events were few and mild. QT_c prolongation was not encountered.

Conclusion:

Palonosetron is comparable to ondansetron for PONV prophylaxis in elective laparoscopic cholecystectomy when administered as single pre-induction dose.KEY WORDS: Laparoscopic cholecystectomy, ondansetron, palonosetron, postoperative nausea and vomiting, randomized controlled trial     

阿扎司琼联合地塞米松预防腹腔镜胆囊切除恶心呕吐的疗效观察

目的:观察阿扎司琼联合地塞米松对预防腹腔镜胆囊切除术后恶心呕吐(post-operative nausea and vomiting,PONV)的疗效.方法:选择腹腔镜胆囊切除手术患者80例,随机分为4组,每组20例.A组:麻醉诱导前静脉注射生理盐水2 mL,手术缝皮时静脉注射阿扎司琼10 mg,B组:麻醉诱导前静脉注射地塞米松10 mg,手术缝皮时静脉注射生理盐水2 mL;C组:麻醉诱导前静脉注射地塞米松10 mg,手术缝皮时给予阿扎司琼10 mg;D组:麻醉诱导前和手术缝皮时均给予生理盐水4 mL.观察并记录四组患者术后24小时恶心呕吐发生的例数、程度与不良反应.结果:术后24小时内,A、B、C三组恶心呕吐发生率较D组低,差异有统计学意义(P<0.05),A B两组问的恶心呕吐发生率差异无显著性(P>0.05),C组术后恶心呕吐发生率较A、B两组低,差异有显著性(P<0.05).结论:阿扎司琼联合地塞米松能有效预防腹腔镜胆囊切除术患者术后恶心呕吐,效果较单用阿扎司琼或地塞米松更佳.     

穴位按摩对经脐腹腔镜胆囊切除术后促进康复的疗效分析

目的探讨穴位按摩在经脐单孔腹腔镜胆囊切除术后促进康复中的作用。方法选取50例经脐单孔腹腔镜胆囊切除术后患者,采用随机数字表方法分为实验组和对照组。对照组按外科一般常规护理;实验组除按一般外科常规护理外,对特定的穴位进行按摩。结果与对照组相比,实验组恶心、呕吐、头痛、肩背痛、使用镇痛剂例数明显减少,排气时间、排便时间、住院天数缩短,差异有统计学意义(P<0.05)。结论穴位按摩对促进经脐单孔腹腔镜胆囊切除术后康复有一定效果。     

地塞米松联合肋间神经阻滞对腹腔镜胆囊切除术患者术后疼痛及恢复的影响

目的:观察静脉注射地塞米松复合肋间神经阻滞对腹腔镜胆囊切除术患者术后疼痛、恶心呕吐及预后的影响.方法:择期行腹腔镜胆囊切除术患者72例,随机分为3组:地塞米松+肋间神经阻滞组,肋间神经阻滞组和对照组,每组24例.记录术中丙泊酚和瑞芬太尼的使用量;采用vAs量表对术后患者1、4、12、24 h进行疲乏、静息和咳嗽时疼痛评分;记录发生恶心呕吐例数,首次肠蠕动、肠排气和出院时间.结果:地基米松+肋间神经阻滞组和肋间神经阻滞组丙泊酚和瑞芬太尼用量、术后疼痛和术后4、12、24 h疲乏评分、恶心呕吐发生率、首次肠蠕动、肠排气时间和住院时间明显少于对照组(P＜0.01,P＜0.05);与地塞米松+肋间神经阻滞组比较,肋间神经阻滞组瑞芬太尼用量、术后1、4、12 h咳嗽时疼痛评分、首次肠蠕动、肠排气时间明显多于地塞米松+肋间神经阻滞组(P＜0.05,P＜0.01).结论:肋间神经阻滞能有效地减轻腹腔镜胆囊切除术患者术后疼痛,地塞米松能有效地减少恶心呕吐发生;地塞米松联合应用肋间神经阻滞镇痛效果更确切,有助于患者术后早期恢复.     

右美托咪定对腹腔镜下胆囊切除术患者血流动力学的影响

目的观察全麻诱导前给予右美托咪定对于腹腔镜下胆囊切除术（LC）患者血流动力学的影响。方法40例ASAI～II级择期行Lc的患者,完全随机分为右美托咪定组和生理盐水组,各20例。右美托咪定组于全麻诱导前静脉泵注右美托咪定1μg/kg,泵注时间为10min,生理盐水组以同样的速率静脉泵注相同容量的生理盐水,2组全麻诱导均使用咪达唑仑0．05mg／kg、丙泊酚1mg／kg、芬太尼4μg/kg、顺苯磺酸阿曲库铵0．2mg／kg,术中以七氟醚吸入维持麻醉,观察记录静脉泵注开始前（T0）、静脉泵注10min后（T1）、气管插管后即刻（T2）、手术结束时（T3）、气管拔管即刻（T4）、气管拔管后5min（T5）气管拔管后10min（T6）7个时间点的脑电双频指数（BIS）、MAP、HR,并记录苏醒时间、拔管时间,拔管后进行Ramsay镇静评分,观察有无呛咳、恶心、呕吐等不良反应。结果右美托咪定组患者行气管插管、气管拔管时血流动力学更平稳（P〈0．05）。有美托咪定组苏醒时间（19±5）min,拔管时间（22±4）min,生理盐水组分别为（18±4）min、（22±4）min,2组比较差异均无统计学意义（均P〉0．05）。术后右美托咪定组无躁动、寒战、恶心、呕吐发生,生理盐水组有1例躁动,2例寒战。结论术前预给右美托咪定可以使腹腔镜下胆囊切除术患者气管插管和拔管期间血流动力学更平稳,不影响麻醉苏醒和拔管时间,术后躁动、寒战、恶心、呕吐发生率更低。     

瑞芬太尼与沙菲在腹腔镜胆囊切除术患者呕吐防治中的作用

目的：探讨瑞芬太尼术中、沙菲术后镇痛在腹腔镜胆囊切除术（LC）患者,用氟哌利多、地塞米松预防术后恶心呕吐（PONV）中的作用。方法：收集非吸烟、中青年女性LC患者,即PPONV的高危人群。全组氟哌利多、地塞米松预防性给药。Ⅰ组术中瑞芬太尼镇痛,术后沙菲镇痛;Ⅱ组术中、术后都用芬太尼镇痛。结果：两组异氟醚吸入,24hPONV的VAS评分（3．6±1．0）分与（6．4±1．2）分;麻醉满意度评分（8．8±1．1）分与（6．8＋1．3）分。差异均有显著性（P〈0．01）。结论：在LC恶心呕吐的高危人群,采用氟哌利多、地塞米松预防PONV时,瑞芬太尼、沙菲术中、术后镇痛较芬太尼术中术后镇痛,在预防PONV中更具有优势。