地塞米松及欧贝防治术后镇痛不良反应的效果比较

Comparison of the effect of dexamithasone with ondansetron in control the side effects arised postoperational analgesia

目的评价预防术后镇痛所致恶心呕吐二种用药方案的临床疗效。方法选择妇科手术患者100例,随机分为地塞米松组(D组,50例)、欧贝组(O组,50例)。所有病例采用腰麻-硬膜外联合麻醉,手术麻醉过程顺利,术毕关腹腔时经硬膜外导管一次注入:D组0·25%布比卡因加地塞米松5mg的复合液5ml,O组0·25%布比卡因5ml同时静脉注射欧贝4mg。然后连接一次性微量止痛泵行硬膜外腔自控镇痛(PCEA),止痛泵复合液配方:布比卡因187·5mg加氟哌利多5mg加曲马多400mg加生理盐水至100ml。D组加地塞米松10mg,O组加欧贝8mg。术后4h、24h、48h随访并记录术后镇痛效果和恶心呕吐发生率。结果所有患者术后镇痛效果都较满意,两组相比(P>0·05),无统计学意义。恶心呕吐发生率两组相比(P>0·05),无统计学意义。结论地塞米松、欧贝都可以有效减轻曲马多复合液术后行PCEA时所致恶心呕吐的发生率,不影响镇痛效果,不增加副作用。

Objective To evaluate two methods for prevention of postoperative nausea and vomiting. Methods 100 gynecological operative patients were selected to receive randomly dexamethasone (group D,n=50) or ondansetron (group O,n=50). Combined spinal-epidural anesthesia were used, all patients had satisfactory anesthesia. At the end of operation, group D patients had 5 ml of 0.25% bupivacaine and dexamethasone 5 mg administered epidurally, group O patients had 5 ml of 0.25% bupivacaine administered epidurally and ondansetron 4 mg injected intravenously. All patients had patient controlled epidural analgesia (PCFA) postoperatively. PCEA have bupivacaine 187.5 mg + droperidal 5 mg + tramadol 400 mg with 0.9% saline diluted to volume 100 ml at basal infusion of 2 ml/h plus bolus 0.5ml with a lockout time 15 min. In additional Group D and O patients have dexamethasone 5 mg and ondansetron 8 mg to the PCEA respectively. Analgesic effects and nausea and vomiting were recorded at 4, 24 and 48 hours postoperatively. Results Both groups had satisfactory postoperative pain control, there were no significant difference between group D and O (P>0.05). Nausea and vomiting were occurred in 2 (4%) and 1 (2%) patients in group D, and 3 (6%) and 1 (2%) patients in group O respectively. there were no significant difference between group D and O (P>0.05). Conclusion Dexamethasone and ondansetron have same effects to prevent postoperative analgesia induced nausea and vomiting without increase side effects.