恩丹西酮复合用药对芬太尼术后镇痛并发恶心呕吐的预防和治疗

The effect of ondansetron’s compound medication for treatment and prevention of postoperative nausea and vomiting caused by using the pain-killer fentanyl

目的观察恩丹西酮、地塞米松、氟哌利多联合用药对芬太尼术后镇痛并发恶心呕吐（PONV）的影响。方法将180例ASAⅠ或Ⅱ级的手术患者随机分为6组，每组30例。镇痛药基础配方均采用芬太尼0．7～1．0mg＋生理盐水稀释至100ml，输注速度为2ml／h。A组静脉注射地塞米松10mg；B组地塞米松10mg＋镇痛泵中加氟哌利多5mg；C组地塞米松10mg＋镇痛泵中加氟哌利多2．5mg；D组地塞米松10mg＋恩丹西酮8mg；E组地塞米松10mg＋恩丹西酮8mg＋镇痛泵中加氟哌利多2．5mg；F组（对照组）静脉注射生理盐水5ml。观察并记录患者术后24小时内的PONV情况。结果E组术后恶心呕吐的发生率最低，明显优于A组（P〈0．05）和B组、C组、D组、F组（P〈0．01）。结论恩丹西酮、地塞米松、氟哌利多联合用药能明显减轻芬太尼术后镇痛所致的恶心、呕吐，且安全有效，值得在临床上推广。

Objective To observe the effect of ondansetran, dexamethasone and droperidol for prevention of postoperative nausea and vomiting（PONV）caused by using the pain-killer fentanyl. Methods One hundred and eighty patients considered to have Ⅰ or Ⅱ level of surgery were enrolled and divided into six groups randomly, each group 30 patients. The fundamental prescription for pain-killer was to use fentanyl 0.7-1.0rag plus physiological saline to dilute to 100 ml. The infusion speed was 2ml/h. The A group were injected dexamethasone 10mg through veins. The B group： dexamethasone 10mg plus droperidol 5mg contained in analgesia pumps. The C group： dexamethasone 10mg plus droperidol 2.5mg contained in analgesia pumps. The D group： dexamethasone 10 mg plus ondansetran 8mg. The E group： dexamethasone 10rag plus ondansetran 8rag plus droperidol 2.5mg contained in analgesia pumps. The F group （the comparative group） were injected physiological saline 5ml through veins. The PONV situations of patients for the postoperative 24 hours were observed and recorded. Resuits The formation rate of postoperative nausea and vomiting in group E was the lowest , surpassing A group significantly （ P 〈0.05） and B ,C ,D ,F groups （ P 〈0.01） and achieved the anticipated treatment goal. Conclusion The compound medication of ondansetran, dexamethasone and droperidol can significantly reduce postoperative nausea and vomiting（ PONV） caused by using the pain-killer fentanyl. Meanwhile it＇s safe and effective and is worth applying to clinical application.