瑞芬太尼与沙菲在腹腔镜胆囊切除术患者呕吐防治中的作用

Effect of remifentanil and shafei on preventing and curing vomiting in patients with laparoscopic cholecystectomy

目的:探讨瑞芬太尼术中、沙菲术后镇痛在腹腔镜胆囊切除术(LC)患者,用氟哌利多、地塞米松预防术后恶心呕吐(PONV)中的作用。方法:收集非吸烟、中青年女性LC患者,即PONV的高危人群。全组氟哌利多、地塞米松预防性给药。Ⅰ组术中瑞芬太尼镇痛,术后沙菲镇痛;Ⅱ组术中、术后都用芬太尼镇痛。结果:两组异氟醚吸入,24h PONV的VAS评分(3.6±1.0)分与(6.4±1.2)分;麻醉满意度评分(8.8±1.1)分与(6.8±1.3)分。差异均有显著性(P<0.01)。结论:在LC恶心呕吐的高危人群,采用氟哌利多、地塞米松预防PONV时,瑞芬太尼、沙菲术中、术后镇痛较芬太尼术中术后镇痛,在预防PONV中更具有优势。

Objective：To study the effect of remifentanil and shafei on preventing and curing vomiting in patients with lapamscopic cholecystectomy.Methods：The non-smoking, middle-aged female patients undergoing laparoscopic cholecystectomy （LC） with high risk of postoperative nausea and vomiting （PONV） were collected. All the patients were preventively given droperidol and dexamethasone.Group Ⅰ received remifentanil for operative analgesia and shafei for postoperative analgesia. Group Ⅱ received remifentanil for operative and postoperative analgesia. Results：The VAS score for PONV after 24h of isoflurane inhalation was 3.6±1.0 and 6.4±1.2 in the two groups respectively,the score of anesthesia satisfaction was 8.8±1.1 and 6.8±1.3 respectively in the two groups.Both differences had statistical significance （P〈0.01）. Conclusion：In the LC patients with high risk of PONV and preventing PONV by droperidal and dexamethasone, remifentanil and shafei for operative and postoperative analgesia are superior to fentanyl for preventing PONV.