腹腔镜胆囊切除术后恶心呕吐反应相关因素分析及昂丹司琼治疗效果观察

目的探讨腹腔镜胆囊切除术（LC）后恶心呕吐反应的相关因素并对昂丹司琼预防恶心呕吐疗效进行观察。方法将76例行LC治疗的患者随机分为治疗组与对照组，治疗组在LC术后静脉注射4mg昂丹司琼．观察患者术后恶心呕吐（PONV）的发生率、体重指数（BMI）、气腹压力、手术时间、芬太尼用量、麻醉复苏时间、术后VAS评分、肌松剂用量、住院天数以及血清5-羟色胺（5-HT）浓度等，并针对PONV发生率进行Logistic回归分析。结果PONV发生率与BMI、芬太尼用量、麻醉恢复时间以及血清5-HT水平显著相关，差异有统计学意义（P〈0．05）；患者LC术后5-HT水平显著升高（P〈0．05），术后应用昂丹司琼可明显抑制5-HT水平升高与PONV发生率。结论PONV与BMI、芬太尼用量、麻醉恢复时间以及血清5-HT水平相关，昂丹司琼可有效抑制血清5-HT水平升高并降低PONV发生率。

Analysis of related factors on post operative nausea and vomiting of laparoscopic cholecystectomy and treatment effect of Ondansetron

Objective To discuss related factors of nausea and vomiting after laparoscopic cholecystectomy(LC) and to observe effect of Ondansetron on nausea and vomiting.Methods 76 patients received LC were divided into treatment group and control group.Patients in treatment group were treated with 4 mg of Ondansetron(iv) after LC.Logistic analysis was applied to analyze post operative nausea and vomiting(PONV) incidence rate,body mass index(BMI),pneumoperitoneum pressure,operation time,dosage of Fentanyl,anesthesia recovery time,post-operation VAS score,and dosage of muscle relaxant and serum 5-HT concentration.Results Incidence of PONV was found correlated closely with BMI,anesthesia recovery time,dosage of Fentanyl and serum 5-HT concentration;5-HT concentration was found increased significantly in control group after LC(P < 0.05),and at mean time,increase of 5-HT and decreased PONV incidence rate were blocked by application of Ondansetron in treatment group significantly(P < 0.05).Conclusion PONV is highly related with BMI,anesthesia recovery time,dosage of Fentanyl and serum 5-HT concentration;Ondansetron shows effects of decreasing incidence of PONV and inhibiting increasing level of 5-HT.