不同剂量5-HT_3受体拮抗剂格拉司琼防治围术期恶心呕吐的临床研究

Effects of granisetron on postoperative nausea and vomiting(PONY) after upper abdominal surgery

目的观察不同剂量的5-HT3受体拮抗剂格拉司琼(ranisetron)对围术期恶心呕吐(PONY)的作用时效,以寻求合适的剂量预防和减少PONY的发生。方法择期上腹部吸入全麻手术患者120例,随机双盲分成生理盐水对照组(A组)、昂丹司琼8mg组(B组)、格拉司琼3mg(C组)及6mg(D组),每组各30例。术毕观察给止吐药至第1次出现恶心呕吐的时间、各组发生恶心呕吐的患者数、接受补救药物的患者数、恶心的严重程度、患者对止吐药物的满意度、头晕头痛、椎体外系症状等不良反应等。结果各组患者性别、体重、年龄、麻醉持续时间、术中生命体征等各组间比较差异无统计学意义(P>0.05)。各组发生恶心、呕吐和接受补救药物患者数,初次出现恶心的时间,恶心严重程度评级的比较中,格拉司琼均优于昂丹司琼,差异有统计学意义(P<0.05);格拉司琼3mg及6mg头晕头痛的发生率相近,均低于昂丹司琼,差异有统计学意义(P<0.05)。结论(1)格拉司琼的镇吐效果优于昂丹司琼;(2)格拉司琼3mg不仅可以减少药物用量、增强抗吐时效,而且能减少不良反应的发生,是一种安全有效的止吐方法。

Objective To study the effects of granisetron on postoperative nausea and vomiting（PONV） after upper abdominal surgery. Methods One hundred and twenty patients,ASA score Ⅰ-Ⅱ,scheduled for elective upper abdominal surgery, were randomly allocated into four groups：normal saline control group （group A）, ondanstron group （group B）, 3mg granisetron group （group C）, 6mg granisetrongroup（group D）. The time course between drug administration and the first time of PONV,the numbers of patients with PONV, the scores of PONV and side effets were observed respectively. Results The time course between drug administration and the first time of PONV, the numbers of patients with PONV,the scores of PONV and side effets in group Cand goup D were respectively lower than those in group B（P〈0.05）. Group C had the same rate of side effects as group D,but it was less than that in group B. Conclusion Compared with ondanstron,granisetron is a better anti-PONV agent. Granisetron 3mg has the better efficacy and less side effects on preventing PONV of upper abdominal surgery.