昂丹司琼、地塞米松预防腹腔镜胆囊切除术术后恶心呕吐和病人自控镇痛治疗的临床观察

Effects of ondansetron and dexamethasone on nausea and vomiting induced by patient-controlled analgesia after laparoscopic cholecystectomy

目的:比较昂丹司琼和地塞米松预防全麻下腹腔镜胆囊切除术和术后曲马朵病人自控镇痛(PCA)引起的的恶心、呕吐的临床效果。方法:选择147例ASAⅠ～Ⅲ级行腹腔镜胆囊切除术女患者,随机分成5组:麻醉诱导前10min静注等渗盐水(P组,n=30例),昂丹司琼组(O组,n=29例),昂丹司琼+地塞米松(OD组,n=29例),昂丹司琼+地塞米松+PCA全量(OD+PCA全量组,n=29例),昂丹司琼+地塞米松+PCA半量(OD+PCA半量组,n=30例)。记录各组恶心、呕吐发生次数和疼痛评分。结果:O组和OD组的恶心呕吐发生率均明显低于P组(P<0.05);OD组的恶心呕吐发生率也低于O组,但两者无统计学差异;PCA组的疼痛评分明显低于O组与OD组(P<0.05),而恶心呕吐的发生率与O组、OD组间无明显差异;PCA半量组的恶心呕吐发生率低于PCA全量组,但两者无统计学差异。结论:昂丹司琼和地塞米松两者合用预防全麻下腹腔镜胆囊切除术引起恶心、呕吐效果佳;术后曲马朵PCA不会增加腹腔镜胆囊切除术患者恶心呕吐的发生率;半量曲马朵PCA腹腔镜胆囊切除术患者恶心呕吐的发生率低于全量PCA。

Objective：To evalate the prophylactive effect of ondansetron and dexamethasone on nausea and vomiting induced by patient-controlled analgesia （PCA） after laparoscopic cholecystectomy. Methods： One hundred and forty-seven women patients, ASA Ⅰ -Ⅲ, scheduled for selective cholecystectomy under laparoscope, were randomly allocated to 5 groups and respectively treated with saline （P group, n = 30） , ondansetron （ O group, n = 29） , ondansetron ＋ dexamethasone （ OD group, n = 29） , ondansetron ＋ dexamethasone ＋ PCA （ OD ＋ PCA group, n = 29 ） and ondansetron ＋ dexamethasone ＋ PCA1/2 （ OD ＋ PCA1/2 group, n = 30）. The scores on nausea, vomiting and pain were recorded respectively. Results：The incidences of nausea and vomiting in the O and OD groups were significantly lower than in the P group （P 〈 0.05）, and so were the VAS scores in the PCA groups than in the O and OD groups （ P 〈 0.05 ）. The incidences of nausea and vomiting were not different between the O and OD groups. Conclusion： Ondansetron and dexamethasone are effective in preventing postoperative nausea and vomiting, and PCA does not increase their incidences after laparoscopic cholecystectomy.