CAJ | 학술논문

目的观察比较单一和多模式联合方法对甲状腺切除术后恶心呕吐(PONV)高危人群恶心呕吐发生率的控制作用.方法将200例行甲状腺切除术的PONV高危人群(女性,有晕动症史或PONV史,非吸烟者,应用阿片类药)按随机数字表法分为5组,每组40例.单用药物组:手术结束前10 min分别给予恩丹西酮8 mg和胃复安10 mg(各稀释于10 mL生理盐水中静脉注射);脐贴药物组:除围手术期给予恩丹西酮和胃复安两种药物外,入手术室即给予止吐脐贴;耳穴药物组:除围手术期给予恩丹西酮和胃复安两种药物外,入手术室即采用耳穴贴压;多模式组除围术期给予恩丹西酮和胃复安两种药物外,联合给予止吐脐贴和耳穴贴压;对照组:以等量生理盐水替代.观察5组患者术后24 h的痛觉模拟评分和发生恶心呕吐情况.结果对照组(77.5%)、单用药物组(47.5%)、脐贴药物组(32.5%)、耳穴药物组(30.0%)、多模式组(7.5%)PONV的发生率5组间比较差异有统计学意义(P<0.05),对照组明显高于其他4组(P<0.05或P<0.01),多模式组明显低于其他4组(P<0.05或P<0.01);而脐贴药物组与耳穴药物组相近,均低于单用药物组,但差异均无统计学意义(均P>0.05).结论对于行甲状腺切除术的PONV高危人群,多模式止吐方法联合使用优于双模式,双模式优于单一药物模式.
목적 관찰비교단일화다모식연합방법대갑상선절제술후악심구토(PONV)고위인군악심구토발생솔적공제작용.방법 장200례행갑상선절제술적PONV고위인군(녀성,유훈동증사혹PONV사,비흡연자,응용아편류약)안수궤수자표법분위5조,매조40례.단용약물조:수술결속전10 min분별급여은단서동8 mg화위복안10 mg(각희석우10 mL생리염수중정맥주사);제첩약물조:제위수술기급여은단서동화위복안량충약물외,입수술실즉급여지토제첩;이혈약물조:제위수술기급여은단서동화위복안량충약물외,입수술실즉채용이혈첩압;다모식조제위술기급여은단서동화위복안량충약물외,연합급여지토제첩화이혈첩압;대조조:이등량생리염수체대.관찰5조환자술후24 h적통각모의평분화발생악심구토정황.결과 대조조(77.5%)、단용약물조(47.5%)、제첩약물조(32.5%)、이혈약물조(30.0%)、다모식조(7.5%)PONV적발생솔5조간비교차이유통계학의의(P<0.05),대조조명현고우기타4조(P<0.05혹P<0.01),다모식조명현저우기타4조(P<0.05혹P<0.01);이제첩약물조여이혈약물조상근,균저우단용약물조,단차이균무통계학의의(균P>0.05).결론 대우행갑상선절제술적PONV고위인군,다모식지토방법연합사용우우쌍모식,쌍모식우우단일약물모식.
Objective To observe the comparisons among different antiemetic methods, using single or multiple methods in combination, to control the incidence of nausea and vomiting in people with high-risk of such occurrence after thyroidectomy.Methods 200 people with high-risk to develop post-operative nausea and vomiting (PONV) such as female, having the medical history of motion sickness or PONV, non-smoker, person with administration of opioids underwent thyroidectomy, and they were randomly divided into five groups by using a random number table, 40 cases in each group. Medicine group: the patients in this group received 8 mg ondansetron and 10 mg metoclopramide (each diluted in 10 mL of normal saline for intravenous injection) 10 minutes before the completion of surgery. Navel stick and medicine group: besides the two drugs in medicine group given in peri-operative period, the patients in this group received anti-nausea navel stick immediately after entering the operating room. Ear acupoint and medicine group: besides the above mentioned two drugs used in peri-operative period, the patients in this group were treated with ear acupoint stick and press therapy immediately after entering the surgical room. Combined-mode group: besides the above mentioned two drugs used in peri-operative period, the patients in this group were treated with the combination of anti-nausea navel stick and ear acupoint therapies. Control group: the patients in this group received equal amount of normal saline. After operation, the situations of pain sensation imitative score and the occurrence of nausea and vomiting of each case were observed for 24 hours in the five groups.Results The incidences of PONV were of statistically significant differences among control group (77.5%), medicine group (47.5%), navel stick medicine group (32.5%), ear acupoint medicine group (30.0%) and combined-mode group (7.5%,P < 0.05 orP < 0.01). The incidence of PONV in control group was significantly higher than the incidences in other four groups (P < 0.05 orP < 0.01). The incidence of PONV in combined-mode group was obviously lower than the incidences of other four groups (P < 0.05 orP < 0.01). The incidence of PONV in navel stick medicine group was similar to that in ear acupoint medicine group, and the incidences of PONV in the above two groups were both lower than the incidence in the medicine group, but the difference had no statistical significance (allP > 0.05).Conclusion In the high-risk people with PONV after thyroidectomy, the therapeutic effect of combined use of multiple antiemetic methods is better than that of the double mode which is more effective than the single mode medicine method.