上腹部热敷对全麻妇科腹腔镜手术后患者恶心呕吐发生率的影响(1)
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【摘要】 目的 探讨上腹部热敷对术后恶心呕吐(PONV)发生率的影响。方法 选择100例ASA1~2级、在气管插管全身麻醉下行妇科腹腔镜手术患者，随机分为对照组(C组)与热敷组(H组)，每组50例。H组在术后用热水袋热敷上腹部6~8 h，C组不作任何处理。观察术后24 h恶心、呕吐发生率。结果 C组与H组恶心发生率分别为42.0%、22.0%，H组显著低于C 组(P<0.05)； C组与H组呕吐发生率分别为18.0%、12.0%，两组间比较无显著性差异(P>0.05)。结论 术后早期上腹部热敷可有效降低术后恶心的发生率，作为一个辅助防治措施，有一定的临床应用价值。但它不能完全消除PONV的发生，且不能降低呕吐的发生率。
【关键词】腹部；热敷；术后恶心呕吐
Effect of hot fomentation epigastrium on the incidence of nausea and vomitting after gynaecological laparoscopic operation
LI Yu-mei,DENG Yuan,YANG Zi-jin.Department of Gynecology,Shenzhen Hospital,Peking University,Shenzhen，Guangdong 518035,China
【Abstract】 Objective To investigate effect of hot fomentation epigastrium on the incidence of nausea and vomitting after gynaecological laparoscopic operation with general anaesthesia.Methods The 100 patients(ASA I-II)who underwent gynaecological laparoscopic operation with general anaesthesia were divided into control group(C group,n=50)and hot fomentation group(H group,n=50).The patients of H group underwent hot fomentation epigastrium for 6-8 hours after operation,and the C didn’t.To observe the incidence of nausea and vomitting in postoperative 24 hours.Results The incidence of nausea to the H and C group were 42.0%and 22.0%,and the two groups comparison,the difference was significant(P<0.05).The incidence of vomitting to the H and C group were 18.0%and 12.0%,and the difference was not significant.Conclusion The postoperative early hot fomentation epigastrium can cut down significantly the incidence of nausea in postoperative 24 hours,but can not eliminate fully postoperative nausea and vomitting and not cut down the incidence of vomitting.
【Key words】Epigastrium; Hot fomentation; Postoperative nausea and vomitting
术后恶心呕吐(postoperative nausea and vomitting,PONV)是麻醉手术后常见并发症。文献报道，妇科腹腔镜手术时PONV发生率为36%。PONV不仅给患者带来不适，还可引起切口裂开、吸入性肺炎、颅内压升高、水电解质紊乱等并发症，进而延长治疗时间、增加医疗费用[1]。目前对PONV的防治主要依靠药物治疗，但它们均存在着一定的不良反应，且成本效益比并非最佳。近年来，PONV非药物防治手段(如：针灸、指压、电剌激、穴位刺激等)受到重视[1，2]，Lee和Done的Meta分析显示，成年患者应用这些方法的效果与镇吐药相当[3]。胃肠道是直接参与PONV的主要器官 ......
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