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。

The Effects of Ondansetron and Metoclopramide on Postoperative Nausea and Vomiting in Patients with Sufentanyl after Microvascular Decompression

Objective To investigate the clinical efficacy of ondansetron and metoclopramide for the prevention of postoperative nausea and vomiting （ PONV） in adult patients with patients-control intravenous analgesia （ PCIA） of sufentanyl after microvascular decom-pression.Methods One hundred and fifty adult patients with ASA ⅠorⅡ,35 to 65 years old,who underwent microvascular decompression were randomly classified into three groups .Group A received ondansetron 16mg,group B received metoclopramide 60mg,and group C received ondansetron 16mg and metoclopramide 30mg.All the patients received PCIA with sufentanyl 100μg after operation.Episodes of PONV,pain scores as well as side effects were assessed during the first 6h,12h,24h,and 48h postoperatively.Results Postoperative analgesia was satis-factory in three groups.From 6 to 48 hours after operation the VAS of three groups had no significant difference （P〉0.05）.Within 24h after the operation,the incidence and severity of nausea were significantly lower in both group A and C than in group B （P〈0.01）,however there was no statistical difference in group A and C .The incidence of vomiting in 12hs and the severity in 6hs after operation were lower in group C than in group A and B（P〈0.01）,and there was no statistical difference in group A and B .Also,the incidence and severity of vomiting at 24h after operation were significantly lower in group C than in group B （P〈0.01）.There were no statistical differences in three groups on the incidence and severity of PONV at 48hs after operation .Conclusion Ondansetron is effective in preventing PONV of adult patients with PCIA of sufentanyl ,and the combination of ondansetron with metoclopramide might be better for vomiting .