昂丹司琼联合甲氧氯普胺防治术后自控镇痛相关恶心呕吐疗效观察

Observation the curative effect of ondansetron combined with metoclopramide on postoperative nausea and vomiting during patient controlled analgesia

目的观察昂丹司琼联合甲氧氯普胺对手术后患者自控硬膜外镇痛(PCEA)相关恶心呕吐的防治效果。方法随机将180例在腰硬联合麻醉下行子宫全切除术的患者分为三组,每组60例:昂丹司琼(Ⅰ)组;甲氧氯普胺(Ⅱ)组;昂丹司琼、甲氧氯普胺联合(Ⅲ)组。三组患者手术后均行PCEA,并通过PCA泵分别将不同止吐药注入硬膜外腔。观察患者术后24h镇痛效果、镇静程度和恶心呕吐发生情况。结果各组间镇痛效果评分、镇静程度评分和吗啡用药量差异无统计学意义;Ⅲ组患者恶心、呕吐的发生率分别为12%和8%,显著低于Ⅰ组(28%和20%)和Ⅱ组(32%和23%),差异有统计学意义(P<0·05);Ⅰ组与Ⅱ组差异无统计学意义(P>0·05)。结论昂丹司琼和甲氧氯普胺单独应用均能有效防治患者手术后PCEA相关的恶心呕吐,两药联合应用能进一步减少患者手术后PCEA相关恶心呕吐的发生率。

Objective To observe the effect of ondansetron combined with metoclopramide on postoperative nausea and vomiting（PONV） during patient controlled analgesia. Methods 180 patients scheduled for hysterectomy under combined spinal-epidural anesthesia were randomly divided into three groups：group ondansetron（group Ⅰ ）, group metoclopramide（group Ⅱ ）, group ondansetron combined with metoclopramide（group Ⅲ ）. All patients received patient control epidural analgesia after operation and the drugs were infused into epidural space by PCA pump. Analgesia effect,sedation score, nausea and vomiting episodes were recorded for 24h after surgery. Results It had no significant difference among three groups at the VAS scores, sedation score and morphine dose. The incidence of nausea and vomiting in group Ⅲ （12% and 8% ） was less than that in group Ⅰ （28% and 20% ） and group Ⅱ （32% and 23 % ） evidently,and it had significant difference（P 〈 0.05）. It had no significant difference between group Ⅰ and group Ⅱ （ P 〉 0.05 ）. Conclusion Ondansetron or metoelopramide gived alone can decrease the incidence of nausea and vomiting during PCEA. The combination of two antiemeties can reduce the incidence of nausea and vomiting further.