昂丹司琼与地塞米松及甲氧氯普胺的不同配伍用于防治口腔颌面外科手术后恶心呕吐的疗效比较

Comparison of different combinations of ondansetron,metoclopramide and dexamethasone in prevention of postoperative nausea and vomiting in patients undergoing oralmaxiilofacial surgery

目的比较昂丹司琼、地塞米松和甲氧氯普胺的3种不同配伍用于防治口腔颌面外科手术后恶心呕吐(PONV)的疗效。方法口腔颌面外科手术患者977例,年龄20～75岁,美国麻醉医师协会分级Ⅰ～Ⅱ级,均采用全身麻醉,术后使用静脉自控镇痛。患者按给予镇吐药的不同配方分为3组,A组(472例)予甲氧氯普胺30 mg,B组(223例)予昂丹司琼4 mg+甲氧氯普胺30 mg,C组(282例)予昂丹司琼4 mg+甲氧氯普胺30 mg+地塞米松5 mg。结果A组的PONV发生率最高,达41.9%,其中重度呕吐占63.6%;B组的PONV发生率达18.8%,重度呕吐占31.0%;C组的PONV发生率最低,仅1.1%,无严重呕吐患者。C组的PONV发生率显著低于A、B组,B组又显著低于A组(P值均<0.05)。结论昂丹司琼联合地塞米松和甲氧氯普胺用于术后PONV的防治具有良好的镇吐疗效。

Objective To compare the efficacies of different combinations of ondansetron, metoclopramide and dexamethasone in prevention of postoperative nausea and vomiting （PONV） in patients undergoing oral and maxillofacial surgery. Methods Nine hundreds and seventy seven Ⅰ- Ⅱ patients （American Society of Anesthesiologists [ASA]） undergoing oral and maxillofacial surgery, aged from 20 to 75 years old, were included in the present study. All patients received general anesthesia and patient-controlled intravenous analgesia （PCIA）. Antiemetic formula were randomly divided into 3 groups. Group A： metoclopramide 30 mg; group B： ondansetron 4 mg＋ metoclopramide 30 mg; group C： ondansetron 4 mg＋ dexamethasone 5 mg＋ metoclopramide 30 mg. Results The incidences of PONV in group C （1. 1%） was significantly lower than those of group A （41. 9%） and B （18. 8%）, and that of group B was significantly lower than that of group A （P〈 0.05）. The rate of severe vomiting was 63.6% in group A, 31. 0% in group B and none in group C. Conclusion Ondansetron combined with dexamethasone or metroiopramide has strong antiemetic effect in treatment of PONV. （Shanghai Med J, 2008, 31： 349-351）