盐酸戊乙奎醚复合托烷司琼对防治中耳手术后恶心呕吐的应用观察

目的评价盐酸戊乙奎醚复合托烷司琼对中耳手术后恶心呕吐（PONV）的防治效果及其安全性。方法选择ASAⅠ～Ⅱ级择期行中耳手术患者80例，均采用静吸复合麻醉。患者随机分为4组，诱导前10min分别静注生理盐水10mL（Ⅰ组）、托烷司琼2mg（Ⅱ组）、盐酸戊乙奎醚1mg（Ⅲ组）、托烷司琼2mg加盐酸戊乙奎醚1mg（Ⅳ组）。记录术前、诱导后、术毕心率、血压的变化；术毕口干程度；术后24h PONV发生情况、严重程度及补救措施。结果各组诱导后MAP均明显降低（P〈0．05），Ⅰ组、Ⅱ组和Ⅲ组术毕MAP均明显增高（P〈0．05）。Ⅰ组和Ⅱ组诱导后和术毕HR明显增加（P〈0．05），Ⅲ组和Ⅳ组HR变化不明显（P〉0．05）。Ⅲ组和Ⅳ组明显口干，气道分泌物明显少于Ⅰ组和Ⅱ组（P〈0．05）。Ⅳ组术后PONV的发生率明显低于Ⅰ组、Ⅱ组和Ⅲ组（P〈0．05）。结论术前应用盐酸戊乙奎醚复合托烷司琼可以稳定术中血液动力学，减少气道分泌物，明显降低中耳术后恶心呕吐的发生率。

Clinical Observation of the Combination of Penehyclidine Hydrochloride and Tropisetron on Nausea and Vomiting after Middle Ear Surgery

Objective To evaluate the antiemetic effect and safety of penehyclidine hydrochloride and tropisetron in adults undergoing middle ear surgery. Methods Eighty ASA Ⅰ - Ⅱ patients scheduled for middle ear surgery under general anesthesia were randomly divideded into four groups with 20 cases each. Group Ⅰ received physiologic saline 10ml,Group Ⅱ tropisetron 2mg,Group Ⅲ penehyclidine hydrochloride ling,Group Ⅳ tropisetron 2mg plus penehyclidine hydrochloride ling. MAP and HR were measured before operation,after induction and operation end. Thirst scores were observed and the incidence of postoperative nausea and vomiting（PONV）, the requirement for rescue antiemetics were recorded by a blinded observer. Results MAP decreased significantly after induction in every group and increased significantly at operation end in group Ⅰ , Ⅱ and Ⅲ （P〈 0.05）. HR increased significantly in group Ⅰ and Ⅱ at operation end and after induction than before operation（P 〈 0.05 ）. Group m and IV had no significant change（P 〉 0.05 ）. Thirst scores were lower in group Ⅰ and Ⅱ （P 〈 0.05）. Airway secretion was less in group Ⅲ and Ⅳ （P 〈 0.05）. The incidence of PONV was significantly lower in the combination group than other groups. No clinically adverse events were observed in any groups. Conclusion The prophylactic use of combination of penehyclidine hydrochloride and tropisetron can maintain stable hemodynamics and reduce the incidence of PONV,is an effective and safe choice to prevent PONV for 24h after middle ear surgery.