甲氧氯普胺、氟哌利多、枢复宁对术后自控镇痛患者恶心呕吐预防作用的比较

目的 :通过患者自控镇痛 (PCA)泵 ,硬膜外腔注射甲氧氯普胺、氟哌利多、枢复宁三种镇吐药 ,观察对术后PCA患者恶心呕吐的预防作用。方法 :将 10 0例妇科及腹部手术的病人 ,随机分成 4组 ,即甲氧氯普胺组、氟哌利多组、枢复宁组、枢复宁 +氟哌利多组 ,通过PCA泵分别将镇吐药注入硬膜外腔 ,观察术后 72h内恶心呕吐情况。结果 :枢复宁组和联合用药组预防恶心呕吐的效果明显高于甲氧氯普胺组和氟哌利多组 ,术后恶心呕吐 (PONV)发生率分别为 2 6 .8% ,16 % ,6 0 %和 73.7% (P <0 .0 1) ,单用甲氧氯普胺和氟哌利多预防术后PONV的效果不理想 ,联合用药组PONV发生率最低 ,但与枢复宁组之间无显著性差异 (P >0 .0 5 )。结论 :枢复宁单用及与氟哌利多联合用药都能很好地预防术后恶心呕吐的发生。

Prophylactic Antiemetic Therapy with Patient-controlled Analgesin:Comparison of Metoclopramide, Droperidol, Ondansetron and a Combination of Ondansetron and Droperidol

Objective: To study the effect of antiemetic therapy delivered by patient-controlled analgesia(PCA) device to prevent postoperative nausea and vomiting. Methods: One hundred patients were randomly allocated to four treatment groups according to the antiemtics as: metoclopramide alone (10 mg bolus and 10 mg in PCA setting, Group M ), droperidol alone (2.5 mg bolus and 5 mg in PCA setting, Group D),ondansetron alone (4 mg bolus and 4 mg in PCA setting, Group O) and both droperidol and ondansetron in combination(Group U).Results: Patients had a 73.7% incident of postoperative nausea or vomiting(PONV) in Group M, 60% in Group D, 26.8% in Group O, 16% in Group U. Patients receiving ondansetron or combination therapy experienced significantly less nausea than those receiving metoclopramide or droperidol antiemetric therapy(P<0.01). But there were no difference between ondansetron alone and combination.Conclusion: Ondansetron, ondansetron and droperidol added in a PCA system reduces postoperative nausea and vomiting to a greater extent than treatment with either drug alone.