中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2013年
1期
41-43
,共3页
术后恶心呕吐%腹腔镜%手术%妇科%多模式镇吐
術後噁心嘔吐%腹腔鏡%手術%婦科%多模式鎮吐
술후악심구토%복강경%수술%부과%다모식진토
Postoperative nausea and vomiting%Laparoscopic%Surgery%Gynecologic%Multimodal-antiemetic
目的 观察多模式镇吐措施预防妇科腹腔镜手术患者术后恶心呕吐(PONV)的效果.方法 经医院伦理委员会审核批准,2011年8月至10月北京大学第一医院择期行妇科腹腔镜患者129例按照随机数字表随机分为两组:多模式镇吐组(M组)与对照组(C组).M组患者术中以丙泊酚、瑞芬太尼靶控输注维持麻醉,并在诱导后静脉给予地塞米松10 mg、手术结束前30 min给予托烷司琼4 mg及帕瑞昔布钠40 mg.C组患者术中以持续吸入50％ N2O和七氟烷维持麻醉,手术结束前30 min给予昂丹司琼4 mg.记录术后24 h内两组病人的PONV发生率.结果 M组术后24 h的PONV发生率29％显著低于C组70％ (P ＜0.05),M组术后0～2、2～6、6～24 h内的PONV发生率分别是8％、6％和25％均低于C组33％、30％和66％(P＜0.05).结论 丙泊酚静脉全麻、术前给予地塞米松10 mg、术毕给予长效止吐剂托烷司琼4 mg及复合COX-2抑制剂进行多模式镇痛可显著降低妇科腹腔镜患者术后24 h恶心呕吐的发生率.
目的 觀察多模式鎮吐措施預防婦科腹腔鏡手術患者術後噁心嘔吐(PONV)的效果.方法 經醫院倫理委員會審覈批準,2011年8月至10月北京大學第一醫院擇期行婦科腹腔鏡患者129例按照隨機數字錶隨機分為兩組:多模式鎮吐組(M組)與對照組(C組).M組患者術中以丙泊酚、瑞芬太尼靶控輸註維持痳醉,併在誘導後靜脈給予地塞米鬆10 mg、手術結束前30 min給予託烷司瓊4 mg及帕瑞昔佈鈉40 mg.C組患者術中以持續吸入50％ N2O和七氟烷維持痳醉,手術結束前30 min給予昂丹司瓊4 mg.記錄術後24 h內兩組病人的PONV髮生率.結果 M組術後24 h的PONV髮生率29％顯著低于C組70％ (P ＜0.05),M組術後0～2、2～6、6～24 h內的PONV髮生率分彆是8％、6％和25％均低于C組33％、30％和66％(P＜0.05).結論 丙泊酚靜脈全痳、術前給予地塞米鬆10 mg、術畢給予長效止吐劑託烷司瓊4 mg及複閤COX-2抑製劑進行多模式鎮痛可顯著降低婦科腹腔鏡患者術後24 h噁心嘔吐的髮生率.
목적 관찰다모식진토조시예방부과복강경수술환자술후악심구토(PONV)적효과.방법 경의원윤리위원회심핵비준,2011년8월지10월북경대학제일의원택기행부과복강경환자129례안조수궤수자표수궤분위량조:다모식진토조(M조)여대조조(C조).M조환자술중이병박분、서분태니파공수주유지마취,병재유도후정맥급여지새미송10 mg、수술결속전30 min급여탁완사경4 mg급파서석포납40 mg.C조환자술중이지속흡입50％ N2O화칠불완유지마취,수술결속전30 min급여앙단사경4 mg.기록술후24 h내량조병인적PONV발생솔.결과 M조술후24 h적PONV발생솔29％현저저우C조70％ (P ＜0.05),M조술후0～2、2～6、6～24 h내적PONV발생솔분별시8％、6％화25％균저우C조33％、30％화66％(P＜0.05).결론 병박분정맥전마、술전급여지새미송10 mg、술필급여장효지토제탁완사경4 mg급복합COX-2억제제진행다모식진통가현저강저부과복강경환자술후24 h악심구토적발생솔.
Objective To evaluate the efficacy of multimodal-antiemetic therapy on postoperative nausea and vomiting (PONV) in patients undergoing gynecological laparoscopy.Methods 129 patients scheduled for gynecological laparoscopy were randomly allocated to a multimodal-antiemetic group (group M,with 65 cases) or an ondansetron control group (group C,with 64 cases).In group M patients received a target-controlled infusion of propofol and remifentanil,prophylactic dexamethasone 10 mg and tropisetron 4 mg were given and parecoxib sodium 40 mg was used 30 minutes before the end of surgery.In group C patients received sevoflurane and 50％ nitrous oxide.Prophylactic ondansetron 4 mg was given to patients 30 min before the end of surgery.The incidence of nausea and vomiting,use of rescue antiemetic drugs were recorded for 24 h.Results 24 h after surgery,the incidence of patients who suffered PONV was significantly lower in Group M compared with Group C (29％ vs 70％,P ＜ 0.05).At 0-2 h,2-6 h,6-24 h after surgery,the incidences of PONV were 8％,6％ and 25％ for group M respectively,significantly lower than those for group C,which were 33％,30％ and 66％ respectively (P ＜ 0.05).Conclusions Multimodal-antiemetic therapy; a regimen including total intravenous anaesthesia with propofol and remifentanil,prophylactic antimetics (dexamethasone at induction and tropisetron at end of surgery),and multimodal analgesia with parecoxib sodium could significantly reduce the incidence of PONV after gynecological laparoscopy.
