地塞米松和昂丹司琼预防腹腔镜胆囊切除术后恶心呕吐的效果及卫生经济学分析

目的比较地塞米松和昂丹司琼预防全麻下腹腔镜胆囊切除(LC)术后恶心呕吐的效果及卫生经济学分析。方法将美国麻醉师协会分级Ⅰ～Ⅱ级且全麻下行LC患者90例随机分成三组(n=30):Ⅰ组:麻醉诱导前1min静注地塞米松针10mg;Ⅱ组:关腹时立即给予静注昂丹司琼针4mg;Ⅲ组:关腹时立即给予静注0.9%氯化钠注射液2ml。观察三组术后24h内的恶心呕吐的情况及住院费用等指标。结果Ⅰ组、Ⅱ组和Ⅲ组患者的恶心呕吐的发生率分别为20.00%、23.33%和50.00%,Ⅰ组、Ⅱ组的恶心呕吐发生率低于Ⅲ组,差异均有统计学意义(χ2分别=5.93、4.59,P均<0.05);Ⅰ组与Ⅱ组间的恶心呕吐发生率比较,差异无统计学意义(χ2=0.98,P>0.05)。与Ⅰ组与Ⅲ组比较,Ⅱ组麻醉费用较高,差异均有统计学意义(t分别=6.73、6.80,P均<0.05)。三组患者平均住院天数和住院费用比较,差异均无统计学意义(F分别=2.12、2.19,P均>0.05)。结论地塞米松和昂丹司琼均能安全有效地降低LC术后恶心、呕吐的发生率,但地塞米松相比与昂丹司琼,价格上更低廉。

Health economics analysis and clinical prophylactic effect of dexamethasone and ondansetron on postoperative nausea and vomiting after laparoscopic cholecystectomy

Objective To compare the clinical prophylactic effect of dexamethasone and ondansetronon postoperative nausea and vomiting after laparoscopic cholecystectomy and the health economics analysis. Methods A total of 90 pa-tients ASAⅠ~Ⅱlevel scheduled for laparoscopic cholecystectomy were randomly divided into 3 groups（n=30）. GroupⅠ：intravenous injection dexamethasone 10 mg 1 minute before inducing general anesthesia. GroupⅡ：intravenous ondansetron 4 mg when closed abdomen. GroupⅢ：intravenous saline 2 ml when closed abdominal. The postoperative nausea and vom-iting ocurring within 24 hours of the three groups were observed. Results The incidence of nausea and vomiting ofⅠ, Ⅱand Ⅲ groups were 20.00%, 23.33% and 50.00% respectively. Compared with group Ⅲ, the incidences of nausea and vomiting of groupⅠand Ⅱ were significantly lower （χ^25.93,4.59,P〈0.05）. The differences of incidence of nausea and vomiting between groupⅠandⅡ were not statistically significant （χ^20.98,P〉0.05）. Compared with group I and Ⅲ, the cost of anesthe of group Ⅱ were significantly higher （t=6.73,6.80,P〈0.05）. There were no statistically significant differ-ences in the average length of stay and hospitalization expenses among three groups （F=2.12,2.19,P〉0.05）. Conclusions Dexamethasone and ondansetron can reduce the incidence of nausea and vomiting safely and effectively after laparoscopic cholecystectomy;the price of dexamethasone is cheaper than ondansetron.