联合用药对全麻术后自控镇痛患者恶心呕吐的随机对照研究

目的探讨联合用药对术后自控镇痛患者恶心呕吐的疗效。方法 176例手术后应用患者自控镇痛(patient controlled analgesia,PCA)随机分为4组:A组,分别在术中、PCA泵中给予昂丹司琼8mg;B组,在PCA泵中给予地塞米松5mg、氟哌利多2.5mg;C组,在术中给予昂丹司琼8mg、PCA泵中给予地塞米松5mg、氟哌利多2.5mg及昂丹司琼8mg;D组,分别在术中给予昂丹司琼8mg、在PCA泵中给予地塞米松5mg及氟哌利多2.5mg。术后48h回访患者术后恶心呕吐(postoperative nausea and vomiting,PONV)的发生情况。结果 4组PONV发生率分别为A组29.5%(13/44)、B组34.1%(15/44)、C组7.0%(3/43),D组11.4%(5/44),联合用药组即C组和D组PONV发生率明显低于单一用药组A组和B组(P0.05);A、B2组PONV发生率差异无显著性(χ2=0.210,P=0.647),C组PONV发生率与D组间差异无显著性(χ2=0.114,P=0.736)。结论联合应用昂丹司琼、地塞米松及氟哌利多3种止吐药可以显著减少术后自控镇痛患者的恶心呕吐的发生率。

Effects of Different Combinations of Antiemetics on Nausea and Vomiting during Postoperative Patient Controlled Analgesia: Randomized Controlled Study

Objective To evaluate the efficacy of different combinations of antiemetics on nausea and vomiting in postoperative patient controlled analgesia （PCA）. Methods Totally 176 patients,who was receiving PCA,were divided randomly into 4 groups：in group A,8 mg ondansetron was used intraoperatively and postoperatively; in group B,5 mg dexamethasone and 2.5 mg droperidol were employed; in group C,intraoperative ondansetron （8 mg） and postoperative dexamethasone （5 mg）,droperidol （2.5 mg） and ondansetron （8 mg） were given; and in group D,intraoperative ondansetron （8 mg） and postoperative dexamethasone （5 mg） and droperidol （2.5 mg） were administered. In all the groups,the antiemetics were given by using PCA pump. In 48 hours after the operation,the rate of postoperative nausea and vomiting （PONV） was recorded. Results The incidence rate of PONV was 29.5% （13/44）,34.1% （15/44）,7.0% （3/43）,and 11.4% （5/44）,respectively in groups A,B,C,and D. The rates in groups C and D were significantly lower than that in groups A and B （P0.05）. No significant difference in the rate of PONV between groups A and B （χ2=0.210,P=0.647）,or between groups C and D （χ2=0.114,P=0.736）. Conclusions Combination of ondansetron,dexamethasone,and droperidol in PCA pump can significantly reduce both the incidence rate and severity of postoperative PONV.