地塞米松复合阿扎司琼对腹腔镜胆囊切除术后恶心呕吐影响的随机对照研究

Use of dexamethasone in combination with azasetron for postoperative nausea and vomiting after laparoscopic cholecystectomy-A randomized controlled trial

目的观察地塞米松复合阿扎司琼对腹腔镜胆囊切除术后的镇吐效果.方法随机将ASAⅠ～Ⅱ150例择期行腹腔镜胆囊切除术的患者分为3组(各50例):地塞米松复合阿扎司琼组(D+A组)于术毕时静脉注射地塞米松5 mg和阿扎司琼10 mg;阿扎司琼组(A组)于术毕时静脉注射阿扎司琼10 mg;对照组(C组)则于术毕时静脉注射生理盐水2 ml.观察术后24 h内患者的恶心、呕吐的发生情况.结果 D+A组恶心发生率为4%(2/50),明显低于A组(16%,8/50)和C组(34%,17/50)(χ2＝4.00,14.62;P=0.046,0.000).D+A组呕吐发生率为2%(1/50),明显低于A组(14%,7/50)和C组(32%,16/50)(χ2＝4.89,15.95;P=0.027,0.000).A组恶心、呕吐发生率亦明显低于C组(χ2＝4.32,4.57;P=0.038,0.033).结论地塞米松复合阿扎司琼控制腹腔镜胆囊切除术后的恶心、呕吐发生率效果优于单纯使用阿扎司琼.

Objective To observe the effectiveness of dexamethasone combined with azasetron for the prevention of postoperative nausea and vomiting （PONV） in patients after laparoscopic cholecystectomy （LC）. Methods A total of 150 ASA Ⅰ-Ⅱ patients undergoing an elective LC were randomly divided into three groups with 50 patients in each group： Group D ＋ A was given intravenous dexamethasone 5mg and azasetron 10mg （2ml） at the end of surgery, Group A received intravenous azasetron 10mg （2ml） at the end of surgery, and Group C received normal saline （NS） 2 ml as the control, Episodes of nausea and vomiting were recorded for 24 h following the surgery. Results The incidence of nausea was 4% in the Group D ＋ A （2/50）, which was significantly lower than in the Group A （16%, 8/50） and the Group C （34%, 17/50） （χ^2 =4.00 and 14.62; P =0.046 and 0. 000）. The incidence of vomiting was 2% in the Group D ＋ A （1/50） , which was significantly lower than in the Group A （14% , 7/50） and the Group C （32% , 16/50） （χ^2 =4.89 and 15.95 ;P =0. 027 and 0. 000）. The incidences of nausea and vomiting were significantly lower in the Group A than in the Group C （χ^2 = 4.32 and 4.57 ; P = 0. 038 and 0. 033 ）. Conclusions Use of a low dose of dexamethasone in combination with azasetron is more effective than azasetron prophylaxis alone for a successful control of PONV after LC.