小儿斜视矫正术后恶心呕吐的联合治疗观察

Combination therapy for preventing postoperative nausea and vomiting in pediatric strabismus surgery

目的 观察联合治疗用于小儿斜视手术后恶心呕吐（PONV）的情况。方法 选择160例（年龄2～12岁）ASAI级择期斜视手术儿童，随机分成4组，每组40例：Ⅰ组预防性给予生理盐水2mL（C组）；Ⅱ组预防性给予地塞米松150μg／kg，最大剂量8mg（D组）；Ⅲ组预防性给予恩丹西琼100μg／kg，最大剂量4mg（O组）；Ⅳ组预防性给予地塞米松50μg/kg（最大剂量8mg）＋恩丹西琼5μg／kg（最大剂量4mg）（DO组）。术中监测心率、血氧饱和度，术后24h出院。术后0～2h，2～6h，6～24h评估恶心呕吐。结果 同其他3组比较，Ⅰ组呕吐发生情况明显多于其他3组。地塞米松组、恩丹西琼组和联合治疗组发生严重呕吐的数量为11、10、3，0～2h联合治疗组与其他两治疗组比较差异无统计学意义（P〈0．05），其余两时段差异无统计学意义。结论预防性给予地塞米松50μg/kg（最大剂量8mg）＋恩丹西琼5μg/kg（最大剂量4mg）对于早期防治PONV比单一药物更有效。

Objective To study postoperctive nausea and vomiting （PONV） of the combination therapy in squint surgery. Methods In this double-blind, randomized, placebo-controlled study, there were 160 children （aged 2～12 years,ASA Ⅰ rank） for strabismus surgery. Patients were divided into 4 groups and received i. v. saline 2 mL, dexamethasone 150 μg/kg, Ondansetron 1 00μg/kg, and dexamethasone 50 μg/kg plus ondansetron 50 μg/kg, respectively, immediately before induction of general anesthesia. Patients were discharged at h 24 after surgery. Nausea and vomiting were assessed in 0～2,2～6 and 6～24 after surgery. Resets More patients in group C had vomiting in （h） 0～2,2～6 and 6～24. Fewer patients in the dexamethasone group,ondansetron group and dexamethasone plus ondansetron group （ n = 11,10 and 3 respectively） had severe PONV compared with saline group （ P 〈 0.05）. Conclusion The results suggest that combination therapy is clear improved over monotherapy for preventing PONV after pediatric strabismus surgery.