托烷司琼在高血压患者术后PCIA中的应用研究

Application of tropisetron in treating patient controlled intravenous analgesia of patients with hypertension.

目的观察不同剂量托烷司琼和复合抗精神病药时用于高血压患者术后静脉镇痛对血流动力学影响和对恶心、呕吐的抑制作用及不良反应,寻求一种比较理想的用于高血压患者的术后静脉镇痛配方。方法400例择期行上腹部全麻手术的高血压患者,随机双盲分为5组,每组各80例。全麻苏醒后行PCIA,镇痛药均为芬太尼0.8mg,镇吐药A组托烷司琼2mg、B组托烷司琼4mg、D组托烷司琼2mg+氟哌利多1.25mg,E组托烷司琼4mg+氟哌利多2.5mg,C组为对照组,用生理盐水稀释成200ml。观察各组的血流动力学变化、镇痛效果、发生恶心、呕吐的患者数及严重程度、头晕、头痛、椎体外系症状、嗜睡、瘙痒等不良反应。结果各组患者性别、年龄、体重、麻醉持续时间、术中生命体征及术后镇痛效果比较差异无统计学意义(P>0.05);患者自主按压次数实验组明显低于对照组(P<0.01);A、B组术后MAP升高(P<0.05),D、E组MAP变化不明显(P>0.05);发生恶心、呕吐患者数及严重程度评分的比较中,实验组均优于对照组(P<0.05);其它不良反应的发生率实验组均低于对照组(P<0.05),但以D组发生率最低。结论托烷司琼用于高血压患者术后PCIA有明显的镇吐效果,但随剂量增加对高血压患者的血压有一定的升高作用,合用氟哌利多不但加强了托烷司琼的镇吐作用,同时能维持高血压患者术后的血流动力学稳定和减少不良反应的发生,就高血压患者而言,D组是一种安全、有效的、值得推广的术后PCIA配方。

Objective To observe effect of using different dosages of tropisetron combined with antipsyehotic drug for postoperative intravenous analgesia on hemodynamics, their inhibitory action on nausea and vomiting as well as their side effects, so as to explore an ideal magistral formula for postoperative intravenous analgesia of patients with hypertension. Methods A total of 400 patients with hypertens/on treated with operation under anesthesia of epigast were randomly and double-blindly divided into five groups （80 patients in each group） ,ie,Group A（2 mg tropisetron） ,Group B（4 mg） ,Group D（2 mg tropisetron plus 1.25 mg Droperidol） ,Group E（4 mg tropisetron plus 2.5 mg Droperidol） and Group C（control group）. Posterior to analepsia after anesthesia, patient controlled intravenous analgesia （PCIA） was conducted, with fentanyl at 0.8 mg as pain-killer. An observation was done on hemodynamic changes, analgesia effect, number and severity of patients with vomiting and nausea, and side effects including dizziness and headache, extravertebral symptoms, drowsiness and itching. Results There was no statistical difference upon gender, age, body weight, continuity of anesthesia, intraoperative vital signs and postoperative analgesia results （ P 〉 0.05 ）. The frequency of patients＇ independent pressing in experimental groups was significantly lower than that in control group （ P 〈 0.01） . Mean arterial pressure （ MAP ） was increased in Groups A and B （ P 〈 0.05 ）, while showed no obvious change in Groups D and E （ P 〉 0.05）. As for number and severity of patients with vomiting and nausea, experimental groups were better than cohtrol group （ P 〈 0.05 ）. The other side effects of experimental groups were lower than those in control group （ P 〈 0.05）, with the lowest one in Group D. Conclusion Tropisetron can exert effective action on anti-vomiting for PCIA in patients with hypertension. However, Tropisetron may raise blood pressure with increase of dosage. The combined use of Tropisetron and Droperdol can not only reinforce the anti-vomiting effect of Tropisetron, but also can maintain stability of hemodynamics and diminish side effects in patients with hypertension, which is a safe and effective magistral formula for postoperative PCIA worth further application.