静注异丙嗪可以预防硬膜外吗啡术后镇痛并发的恶心呕吐

PREVENTIVE EFFECTS OF PROMETHAZINE ON POSTOPERATIVE NAUSEA AND VOMITING(PONV) ASSOCIATED WITH MORPHINE EPIDURAL ANALGESIA

吗啡术后镇痛并发恶心呕吐的发生率约为２０％～５０％。为提高镇痛质量，本组将硬膜外注入吗啡镇痛的１３０例患者，采用不同的药物或方法，进行预防恶心呕吐的临床效果观察。所有患者硬膜外麻醉成功后，均辅用盐酸异丙嗪０．５ｍｇ／ｋｇ，甲氧氯普胺１０ｍｇ和地塞米松１０ｍｇ静滴。于术毕前３０ｍｉｎ经硬膜外导管精确注入吗啡２～３ｍｇ。１３０例分三组，Ⅰ组３０例，为对照组，不再用药；Ⅱ组３０例，静滴氟哌啶５ｍｇ；Ⅲ组７０例，静脉追加首剂量异丙嗪。结果表明恶心呕吐的发生率Ⅰ组为３０％，Ⅱ组降至２０％，Ⅲ组仅为４．３％，远低于Ⅰ、Ⅱ组（Ｐ＜０．０１；Ｐ＜０．０５）。作者认为，异丙嗪追加性用药对预防术后恶心呕吐有很好的效果。

It has been reported that the incidence of PONV associated with epidural morphine was 20% to 50%.To improve analgesia quality,the preventive effect of different drugs on PONV associated with morphine epidural analgesia were observed in 130 patients.All of these patients received promethazine 0.5mg/kg,metoclopramide 10mg and dexamethasone 10mg by intravenous drip after epidural anaesthesia.Morphine 2mg or 3mg were injected into epidural space 30 minutes prior to the termination of the operation.They were then divided into three groups: patients in group Ⅰ(n=30) did not receive any drugs after the administration of morphine,5mg of droperidol was used intravenously for patients in group Ⅱ(n=30),and patients in group Ⅲ (n=70) received suplemental intravenous injection of promethazine.The results showed that the incidence of PONV in group Ⅲ(4.3%) was significantly lower than that in group Ⅰ(30%,P<0.01) and group Ⅱ(20%,P<0.05). It is concluded that intravenous supplement of promethazine is an effective method in preventing PONV.