枢丹不同给药时间对全子宫切除术后不良反应的观察(1)
【摘要】目的：本文旨在探讨枢丹不同给药时间对妇科腹腔镜全子宫切除术后预防PONV效应的观察。方法：80例ASAI～2级妇科腹腔镜全子宫手术病人随机分成四组，每组20例，第Ⅰ组(对照组)术前、术后给予生理盐水5毫升。第Ⅱ组(术前枢丹组)于麻醉诱导前予枢丹4毫克(用生理盐水稀释至5毫升)。第Ⅲ组(手术结束即刻组)于手术结束即刻静脉予枢丹4毫克(用生理盐水稀释至5毫升)。第Ⅳ组(全麻抜管后30分钟组)全麻抜管30分钟后静脉予枢丹4毫克(用生理盐水稀释至5毫升)。观察患者术后24小时内恶心呕吐的发作情况。结果：如若手术时间过短(<2h)或过长(>4h)或改进腹，此病例被剔除，再行选择。确保每组20例病例。第二组与对照组恶心、呕吐发生率相比均降低，但无明显差异(P>0.05)。第Ⅲ、Ⅳ组与对照组恶心、呕吐发生率相比均明显降低，有明显差异(P<0.05)。第Ⅳ组与第Ⅲ组恶心、呕吐发生率相比均降低，但无明显差异(P>0.05)。结论：枢丹的给药时机应选择在手术结束后。
关键词：枢丹；妇科腹腔镜手术
, http://www.100md.com
中图分类号：R722.12 文献标识码：B 文献编号：1671-4954(2010)10-742-03
Doi：10.3969/j.issn.1671-4954.2010.10.022
AbstractObject：To compare the effects of injecting ondansertron at different time on preventing postoperative nausea and vomiting(PONV)for patients undergone gynaecological laparoscopic totalhysterectomy.Methods：randomly divide 80 patients who have undergone gynaecological laparoscopic totalhysterectomyinto 4 groups，20 patients each.Patients in groupⅠ.(control group)were injected 5ml physiological saline solution each before induction and after operation.Patients in groupⅡ(preoperative ondansertron group)were injected 4mg ondansertron before induction.patients in groupⅢ(postoperative ondansertron group)were injected 4mg ondansertron after operation.Patients in groupⅣ(30minutes after extubation ondansertron group)were injected 4mg ondansertron 30minutes after extubation(The ondansertron was diluted with physiological saline solution to 5mg).Record the postoperative nausea and vomiting 24 hours after operation.Results：If the operation period was too short(<2h)or too long(>4h)or the operation was turned to be laparotomy，it was not be included in the study.The postoperative nausea and vomiting rates in groupⅡ were lower than group I，with no obvious difference though(P>0.05).The postoperative nausea and vomiting rates in groupⅢ and in guoupⅣ were significantly lower than groupⅠ(P<0.05).The postoperative nausea and vomiting rates in groupⅣ were lower than groupⅢ with no significant difference(P>0.05).Conclutions The injection of ondansertron to prevent nausea and vomting should be conducted at the end of operation.
, 百拇医药
Key words： Ondansertron Postoperative nausea and vomiting；Gynaecological laparoscopic totalhysterectomy.
腹腔镜手术由于切口创伤小、术后恢复快，普遍受到医生和患者的欢迎。近年来妇科手术中腹腔镜手术的比例也越来越高，但术后恶心呕吐是这类手术的常见并发症。枢丹是5-HT3受体拮抗剂，已被广泛应用于术后恶心、呕吐的预防和治疗。本研究采用随机对照双盲法比较了枢丹不同时间应用对防治妇科腹腔镜术后恶心呕吐(PONV)的效应，以期达到合理用药的目的。
1 资料
1.1一般资料
选择ASAI～2级的80例妇科腹腔镜全子宫手术病人，年龄在35～58岁。术前无恶心呕吐史，无明显胃肠疾病史或化疗史。术前24 h内未用过任何抗呕吐药。且过度肥胖者排除在外。随机分为4组，每组20例。如若手术时间过短(<2h)或过长(>4h)或改进腹，此病例被剔除，再行选择。确保每组20例病例。
, 百拇医药
1.2 麻醉方法
所有病例均免术前用药，仅在麻醉诱导前1 min缓慢静注阿托品0.25 mg。麻醉诱导以高流量的纯氧吸入，静脉注射咪唑安定5 mg、芬太尼2ug/kg、丙泊酚2～2.5mg/kg、维库溴铵0.6～1mg/kg诱导插管，后行机械通气。切皮前再予芬太尼0.1 mg静注。麻醉维持以推注泵持续输注丙泊酚4mg/kg·h，同时复合低流量异氟醚吸入，新鲜氧流量为1 l/min，间断给予芬太尼、维库溴铵维持镇痛肌松。术中维持生命体征稳定。手术临结束前腹腔冲洗时停止吸入异氟醚，以氧流量3～4 L/min洗出，手术结束缝皮时停止丙泊酚泵注，结束后清除呼吸道分泌物，待病人自主呼吸恢复并稳定后拔除气管导管，入PACU鼻导管吸氧监测，直至完全清醒。拔管前尽量不用新斯的明拮抗肌松，如用过拮抗剂则该病例剔除本研究。
1.3 研究方法
全部病例随机分为4组，每组20例 第Ⅰ组(对照组)术前、术后给予生理盐水5毫升。第Ⅱ组(术前枢丹组)于麻醉诱导前予枢丹4毫克(用生理盐水稀释至5毫升)。第Ⅲ组(手术结束即刻组)于手术结束即刻静脉予枢丹4毫克(用生理盐水稀释至5毫升)。第Ⅳ组(全麻抜管后30分钟组)全麻抜管30分钟后静脉予枢丹4毫克(用生理盐水稀释至5毫升)。观察患者术后24小时内恶心呕吐的发作情况。, http://www.100md.com
关键词：枢丹；妇科腹腔镜手术
, http://www.100md.com
中图分类号：R722.12 文献标识码：B 文献编号：1671-4954(2010)10-742-03
Doi：10.3969/j.issn.1671-4954.2010.10.022
AbstractObject：To compare the effects of injecting ondansertron at different time on preventing postoperative nausea and vomiting(PONV)for patients undergone gynaecological laparoscopic totalhysterectomy.Methods：randomly divide 80 patients who have undergone gynaecological laparoscopic totalhysterectomyinto 4 groups，20 patients each.Patients in groupⅠ.(control group)were injected 5ml physiological saline solution each before induction and after operation.Patients in groupⅡ(preoperative ondansertron group)were injected 4mg ondansertron before induction.patients in groupⅢ(postoperative ondansertron group)were injected 4mg ondansertron after operation.Patients in groupⅣ(30minutes after extubation ondansertron group)were injected 4mg ondansertron 30minutes after extubation(The ondansertron was diluted with physiological saline solution to 5mg).Record the postoperative nausea and vomiting 24 hours after operation.Results：If the operation period was too short(<2h)or too long(>4h)or the operation was turned to be laparotomy，it was not be included in the study.The postoperative nausea and vomiting rates in groupⅡ were lower than group I，with no obvious difference though(P>0.05).The postoperative nausea and vomiting rates in groupⅢ and in guoupⅣ were significantly lower than groupⅠ(P<0.05).The postoperative nausea and vomiting rates in groupⅣ were lower than groupⅢ with no significant difference(P>0.05).Conclutions The injection of ondansertron to prevent nausea and vomting should be conducted at the end of operation.
, 百拇医药
Key words： Ondansertron Postoperative nausea and vomiting；Gynaecological laparoscopic totalhysterectomy.
腹腔镜手术由于切口创伤小、术后恢复快，普遍受到医生和患者的欢迎。近年来妇科手术中腹腔镜手术的比例也越来越高，但术后恶心呕吐是这类手术的常见并发症。枢丹是5-HT3受体拮抗剂，已被广泛应用于术后恶心、呕吐的预防和治疗。本研究采用随机对照双盲法比较了枢丹不同时间应用对防治妇科腹腔镜术后恶心呕吐(PONV)的效应，以期达到合理用药的目的。
1 资料
1.1一般资料
选择ASAI～2级的80例妇科腹腔镜全子宫手术病人，年龄在35～58岁。术前无恶心呕吐史，无明显胃肠疾病史或化疗史。术前24 h内未用过任何抗呕吐药。且过度肥胖者排除在外。随机分为4组，每组20例。如若手术时间过短(<2h)或过长(>4h)或改进腹，此病例被剔除，再行选择。确保每组20例病例。
, 百拇医药
1.2 麻醉方法
所有病例均免术前用药，仅在麻醉诱导前1 min缓慢静注阿托品0.25 mg。麻醉诱导以高流量的纯氧吸入，静脉注射咪唑安定5 mg、芬太尼2ug/kg、丙泊酚2～2.5mg/kg、维库溴铵0.6～1mg/kg诱导插管，后行机械通气。切皮前再予芬太尼0.1 mg静注。麻醉维持以推注泵持续输注丙泊酚4mg/kg·h，同时复合低流量异氟醚吸入，新鲜氧流量为1 l/min，间断给予芬太尼、维库溴铵维持镇痛肌松。术中维持生命体征稳定。手术临结束前腹腔冲洗时停止吸入异氟醚，以氧流量3～4 L/min洗出，手术结束缝皮时停止丙泊酚泵注，结束后清除呼吸道分泌物，待病人自主呼吸恢复并稳定后拔除气管导管，入PACU鼻导管吸氧监测，直至完全清醒。拔管前尽量不用新斯的明拮抗肌松，如用过拮抗剂则该病例剔除本研究。
1.3 研究方法
全部病例随机分为4组，每组20例 第Ⅰ组(对照组)术前、术后给予生理盐水5毫升。第Ⅱ组(术前枢丹组)于麻醉诱导前予枢丹4毫克(用生理盐水稀释至5毫升)。第Ⅲ组(手术结束即刻组)于手术结束即刻静脉予枢丹4毫克(用生理盐水稀释至5毫升)。第Ⅳ组(全麻抜管后30分钟组)全麻抜管30分钟后静脉予枢丹4毫克(用生理盐水稀释至5毫升)。观察患者术后24小时内恶心呕吐的发作情况。, http://www.100md.com