阿扎司琼不同给药方式预防术后静脉自控镇痛恶心呕吐的临床观察

Clinical Observation on Azasetron in Defferent Infusion Modes in Preventing Postoperative Nausea and Vomiting

目的探讨阿扎司琼不同给药方式对术后静脉自控镇痛恶心呕吐(PONV)的预防效果。方法160例ASA I～II级全麻下行上腹部开腹手术、术后自愿接受静脉自控镇痛的患者,随机分为A、B、C、D 4组,每组40例:A组术毕静脉预注阿扎司琼10mg;B组术毕静脉预注阿扎司琼10mg,镇痛泵内加入阿扎司琼10mg持续给药;C组镇痛泵内阿扎司琼10mg术后静脉持续给药;D组作为对照组,不使用阿扎司琼。4组镇痛泵药物配比均为舒芬太尼2μg／kg加生理盐水至100 ml,背景剂量,单次追加剂量,锁定时间,均一致。分别于术后4、8、12、24、48h观察并记录病人的呼吸频率(RR),心率(HR),平均动脉压(MAP),血氧饱和度(SpO2);PONV发生率;疼痛评分(VAS)的分值。结果4组间比较RR、HR、MAP、SpO2各顶指标的变化差异无统计学意义(P>0．05);PONV发生率,术后各观察时点相比:A、B、C组与D组差异有统计学意义(P<0．01);B、C组与A组在第2个24 h内差异有统计学意义(P<0．05),B组与C组之间差异无统计学意义(P>0．05)。结论阿扎司琼对术后静脉自控镇痛的PONV有明显的预防作用,单纯静脉预注阿扎司琼不能完全预防术后48h内的恶心呕吐,而术后经泵静脉持续给药不管预注与否都能有效的预防术后48 h内的恶心呕吐。

Objective To evaluate the different prophylactic effects of azasetron in defferent infusion modes on postoperative nausea and vomiting（PONV） during patient controlled intravenous analgesia（PCIA）. Methods One hundred and sixty patients, scheduled for selective upper abdominal operations,were randomly divided into four groups ,patients receiving an intravenous bolus of azasetron 10 mg （group A,n= 40）, an intravenous bolus ofazasetron 10 mg and a continued infusion of azasetron 10 mg in pump （group B, n= 40）, 10 mg ofazasetron in pump （group C,n= 40）, no azasetron （group D,n= 40）. Respiration rates（RR）,heart rates（HR）, mean arterial blood pressure （MAP） and SpO2 of patients in different groups were recorded at 4, 8,12,24,48 h postoperatively. The incidences of PONV and the VAS scores in the same time were recorded too. Results RR, HR, MAP, SpO2 had no significant difference in all the groups. The incidence of PONV in groups A, B and C was significantly lower than that in group D（P 〈 0.01）. The incidence of PONV in groups B and C was significantly lower than that in group A in postoperative 24-48 h（P 〈 0.05）. There was no significant difference between groups B and C（P 〉 0.05）,Conclusion Azasetron can be used effectively to prevent PONV during PCIA. An intravenous bolus of azasetron 10 mg can not be used sufficiently to prevent PONV in postoperative 24-48 h,but a continued infusion of azasetron 10 mg in pump with or without an intravenous bolus dose can be used sufficiently to prevent PONV in postoperative 48 h.