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。

Clinical Observation of the Effects of Tropisetron on Prevention of Nausea and Vomiting in Postoperative Patients with PCIA

Objective To study the the effects of tropisetron on prevention of nausea and vomiting in postoperative patients with PCIA（Patient controlled intravenous analgesia）.Methods 120 patients（ASA scoreⅠ-Ⅱ） who underwent elective operations under general anesthesia.All patients before surgery had no significant gastrointestinal dysfunction and symptoms of nausea and vomiting,no heart and lung liver and kidney dysfunction,and 24 hours before surgery did not to any anti-emetics.All patients of operation completed divided randomly into 3 groups：①in Group Ⅰ（n=40） patients intravenous injection of saline 2 mL,when the end of surgery,and received PCIA with Fentanyl 0.6~0.8 mg,normal saline diluted to 100 mL;②in Group Ⅱ（n=40） patients intravenous injection of tropisetron 2 mg,when the end of surgery,and received PCIA with Fentanyl 0.6~0.8 mg and tropisetron 4 mg,normal saline diluted to 100 mL;③in Group Ⅲ（n=40） patients intravenous injection of droperidol 2.5 mg,when the end of surgery,and received PCIA with Fentanyl 0.6~0.8 mg and droperidol 2.5 mg,normal saline diluted to 100 mL.The scores for nausea,vomiting,visual analogue scale （VAS）,bruggrman comfort scale（BCS）,were evaluated at 0,4,8,16,24,32,48 hrs pos-toperatively.Results Postoperative analgesia and comfort of all patients rate the satisfaction level of scientology,no difference among the groups（P〉0.05）.Prevention and control nausea and vomiting effect,groupⅡis the best,compared with groupⅠsignificant difference（P〈0.05）,groupⅢ and groupⅠsignificant difference compared（P〈0.05）.GroupⅡGroupⅢshowed no significant difference between（P〉0.05）.However,group Ⅲ emerged three cases of extrapyramidal symptoms,sleepiness symptoms in five cases,groupⅡemerged three cases of mild headache.Conclusion Tropisetron and droperidol can inhibit PCIA-induced nausea and vomiting.However,minor side effects of tropisetron.