不同给药方式的托烷司琼预防肝脏手术后曲马朵静脉镇痛恶心呕吐的临床观察

目的观察不同剂量和给药方式的托烷司琼对减轻肝脏手术后曲马朵静脉镇痛（PCA）期间恶心呕吐发生率的比较。方法150例肝脏手术患者，ASAⅠ-Ⅱ级，随机分为5组，术后行曲马朵静脉镇痛（PCIA）。Ⅰ组不用托烷司琼；Ⅱ组术毕静注5mg托烷司琼；Ⅲ组术毕静注2.5mg托烷司琼，PCA泵内加托烷司琼2.5mg；Ⅳ组术毕PCA泵内加托烷司琼5mg；V组术毕PCA泵内加托烷司琼10mg。观察术后2、24、48h患者恶心呕吐的发生率。结果Ⅱ组-V组和I组比较，2、24h和48h时恶心呕吐发生率显著低于I组（P〈0.05）；Ⅲ组-V组和Ⅱ组比较，术后48h时的恶心呕吐发生率显著低于Ⅱ组（P〈0.05）；Ⅲ组、Ⅳ组和V组之间比较无统计学差异（P〉0.05）。结论不同剂量和给药方式的托烷司琼都能显著地减轻肝脏手术后曲马朵静脉镇痛的恶心呕吐发生率。托烷司琼加入PCA泵内持续泵入，48h时的止吐效果要好于术后单纯静脉推注。

Clinical Observation on Antiemetic Effect of Different Dosage Regimen of Tropisetron for Patients Undergoing Liver Surgery at the Stage of Patient Controlled Analgesia with Tramadol

Objective To evaluate the antiemetic effect of different methods of administering troplsetron for patients undergoing liver surgery at the stage of patient controlled analgesia（PCA） with tramadol. Methods Three hundred ASA class I or Ⅱ patients scheduled for liver surgery under general anesthesia were randomly divided into five groups after ethics committee approval. At the end of surgery, all patients received PCA with tramadol. Before commencement of PCA, the patients received no tropisetron （ group I ） ,troplsetron 2.5 mg immediately （ group Ⅱ） , tropisetron 2.5 mg immediately and tropisetron 2.5 mg in PCA pump （group Ⅲ） ,tropisetron 5 mg in PCA pump （group Ⅳ） , and tropisetron 10 mg in PCA pump （group V） respectively. Incidence of nausea and vomiting and side effects were recorded 2, 24, and 48 hs after operation. Results In group Ⅱ Ⅲ, Ⅳ, and group V, the incidences of nausea and vomiting decreased significantly compared with those in group 1 at 2,24 and 48 hs after surgery （P 〈 0.05）. In group Ⅲ, Ⅳ, and group V, the incidences of nausea and vomiting reduced significantly compared with those in group Ⅱ at 48 h after surgery （P〈0.05）. In addition, there are no significant differences of incidences of nausea and vomiting between group Ⅲ, Ⅳ, and V（P〉0.05）. Conclusion Tropisetron can reduce the incidence of nausea and vomiting for undergoing liver surgery at the stage of patient controlled analgesia （PCA） with tramadol by different dosage regimen. Intravenous continuous tropisetron administration in PCA pump is better than that of intravenous tropisetron 5 mg alone in reducing the incidence of PONV associated with the use of PCA tramadol.