欧丹西酮预防曲马多硬膜外术后镇痛期间恶心、呕吐的定量研究

Quantitative study on Ondansetron for prevention of nausea and vomiting during epidural tramadol analgesia after gynecological and obstetric surgery

目的 寻找欧丹西酮 (Ondansetron)预防妇产科手术后曲马多连续硬膜外镇痛期间恶心和呕吐的最佳剂量。方法 ASAⅠ～Ⅱ级妇产科手术病人 12 0例 ,随机分为 4组 (n =30 ) ,于关腹后接镇痛泵前 (配方为曲马多 80 0mg+布比卡因 112 .5mg ,总量 10 0ml,泵速 2ml/h)分别接受欧丹西酮 2mg、4mg、6mg和生理盐水 2ml静注。观察镇痛期不同时点的VAS值和 0～ 2 4h的恶心、呕吐发生率。结果 4组VAS均值无明显差异 (P >0 .0 5 )。在 0～2 4h ,恶心 :2mg组 30 .4 % (7) ,4mg组 3.3% (1) ,6mg组 3.3% (1)和生理盐水组 4 6 .7% (14 ) ;呕吐 :2mg组2 0 .0 % (6 ) ,4mg组 3.3% (1) ,6mg组 3.3% (1)生理盐水组 4 3.3% (13)。在预防恶心和呕吐两个事件方面 ,所有用药组与对照组相比均有显著差异 (P <0 .0 5 ) ;在用药组中 ,2mg组与 4mg和 6mg组间比较P <0 .0 5 ,而后 2个剂量组间无差别。结论 本文 3个剂量组的欧丹西酮均有预防妇产科手术后曲马多连续硬膜外镇痛期间恶心和呕吐的作用 ,其中以 4mg组最优。

Objective In order to determine the optimal Ondansetron dose for prevention of nausea and vomiting during epidural tramadol analgesia after gynecological and obstetric surgery. Methods 120 cases of ASAⅠ-Ⅱ women undergoing gynecological and obstetric surgery under epidural anaesthesia were allocated randomly,in a double-blind study design,to receive Ondansetron 2,4,6 mg,or placebo(normal saline 2 ml) intravenously(n=30)respectively before connecting analgesia pump(prescription : tramadol 800 mg plus bupivacaine 112.5 mg in saline 0.9%,100 ml with infusion velocity 2 ml/h). VAS values,the incidence of nausea and vomiting were observed within 0～24 h. Results There was no significant difference of VAS values among the four groups (P>0.05). During 0～24 h,the incidence of nausea was significantly less in patients receiving Ondansetron2,4 or 6 mg compared with placebo [30(7),30(1),and 30(1) vs 30(14)],respectively,P<0.05 and the incidence of vomiting was also significantly less in 2,4 and 6 mg groups [30(6),30(1),and 30(1) vs 30(13)],respectively,P<0.05. No significant difference was found between 4 mg and 6 mg Ondansetron. Severity of nausea and number of vomiting episodes were also less in 4 mg and 6 mg Ondansetron groups compared with placebo (P<0.05). Conclusion The study suggests that 4 mg and 6 mg Ondansetron can effectively prevent nausea and vomiting during epidural tramadol analgesia after gynecological and obstetric surgery and the optimal dosage is 4 mg.