昂丹司琼联合地塞米松在预防腹腔镜胆囊切除术后恶心呕吐的临床观察(1)
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[摘要] 目的 探讨昂丹司琼联合地塞米松预防腹腔镜胆囊切除术后恶心呕吐(PONV)的临床效果。方法 将我院收治的120例择期行腹腔镜胆囊切除术的患者随机分为对照组、单用昂丹司琼组和昂丹司琼联合地塞米松组各40例。观察PONV发生情况及不良反应情况。结果 昂丹司琼联合地塞米松组的术后PONV发生率明显低于对照组和单用昂丹司琼组，昂丹司琼联合地塞米松组与单用昂丹司琼组不良反应发生率差异无统计学意义。结论 昂丹司琼联合地塞米松预防腹腔镜胆囊切除PONV优于单用昂丹司琼。
[关键词]昂丹司琼；地塞米松；腹腔镜胆囊切除术；术后恶心呕吐
[中图分类号] R657.4 [文献标识码] B [文章编号] 1673-9701(2011)33-157-02
Ondansetron Combined with Dexamethasone in the Prevention of Nausea and Vomiting after Llaparoscopic Cholecystectomy A：Clinical Observation
ZHANG Fan ZHANG Hang LI Feng
Department of Anesthesiology, Wushan District, Hangzhou First People's Hospital in Zhejiang Province, Hangzhou 310002, China
[Abstract] Objective To investigate the effect of ondansetron combined with dexamethasone in controlling PONV after laparoscopic cholecystectomy. Methods All of 120 patients treated with elective laparoscopic cholecystectomy by our hospital, were randomly divided into control group, ondansetron group and the ondansetron with dexamethasone group, 40 patients in every group . the occurrence of PONV and adverse reactions was observed. Results The occurrence of PONV in the ondansetron with dexamethasone group was lower than the control group and the ondansetron group ,but there were no statistical difference in the occurrence of adverse reactions among Ondansetron with dexamethasone and the ondansetron groups.Conclusion Ondansetron with dexamethasone have better effect in controlling PONV after laparoscopic cholecystectomy than ondansetron alone.
[Key words] Ondansetron; Dexamethasone；Laparoscopic cholecystectomy；Postoperative nausea and vomiting
腹腔镜胆囊切除术已经成为临床胆囊切除的主要手术方式，但由于术中麻醉药物残留及气腹CO2气体的刺激和残留等因素，腹腔镜胆囊切除术后恶心呕吐(PONV)的发生率较常规腹部手术明显增高。通过分析我院腹腔镜胆囊切除术患者行昂丹司琼联合地塞米松预防术后恶心呕吐的病例，探讨其联合应用在PONV中的临床效果，现报道如下。
1 资料与方法
1.1 临床资料
选取我院2009年7月~2010年12月择期行腹腔镜胆囊切除术的患者120例，ASAⅠ~Ⅱ级，男43例，女77例。年龄25~67岁，体重49~73kg。相关原发疾病包括：胆囊炎症及息肉68例，胆囊结石52例。术前各项临床及辅助检查无明显麻醉禁忌，无心肺功能异常及电解质紊乱病史。排除既往眩晕、术前恶心呕吐史的病人及手术时间超过1h的病例。随机分为三组：对照组(A组)40例，单纯昂丹司琼组40例(B组)和昂丹司琼联合地塞米松组40例(C组)。三组病例在年龄、性别、体重等方面无明显统计学差异(P>0.05)。
1.2 方法
所有患者术前诊断明确，完善相关检查，无明显麻醉禁忌。术前常规禁食、水，麻醉前在无禁忌下常规肌注苯巴比妥钠100 mg和阿托品0.5 mg。各组麻醉方式相同，均采用全凭静脉全身麻醉，麻醉诱导采用芬太尼(3~4)μg/kg、异丙酚2mg/kg、维库溴铵0.15mg/kg，待快速诱导完全后行气管插管。术中维持采用持续泵入异丙酚及间断静推芬太尼和维库溴铵。手术结束后根据肌松恢复情况给予新斯的明+阿托品对抗。A组手术结束时不给予任何预防PONV药物；B组手术拔管前给予昂丹司琼(宁波市天衡制药有限公司，国药准字H20057259)8 mg；C组在麻醉诱导的同时静推地塞米松10mg,手术结束前再静脉给予昂丹司琼8mg。术后随访患者48h，分别记录术后4h、1d、2d的相关PONV的发生情况及相关不良反应 ......
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