托烷司琼对口腔颌面外科术后带管患者恶心、呕吐的预防作用

The effect of tropisetron in the prevention of postoperative nausea and vomiting in patients with tracheal catheter after oral and maxillofacial surgery

目的:探讨盐酸托烷司琼用于预防口腔颌面外科手术后带气管导管(以下简称为带管)患者恶心、呕吐的效果。方法:120例全麻下择期行口腔颌面外科手术患者,ASA评分I或Ⅱ级,术前无恶心、呕吐,无胃肠疾病,术前24h未用任何抗呕吐药物,术毕苏醒后均带管入SICU。所有患者均无手术及麻醉史。对药物过敏,有精神性恶心、呕吐者除外。以随机双盲法将患者分为A、B、C、D、E、F6组,每组20例。A为对照组,不使用盐酸托烷司琼;B组在手术结束即刻静脉推注盐酸托烷司琼2.5mg;C组在手术结束即刻静脉推注盐酸托烷司琼5mg;D组只在自控静脉镇痛泵(PCIA)中加盐酸托烷司琼2.5mg;E组只在PCIA泵中加盐酸托烷司琼5mg;F组在手术结束即刻静脉推注盐酸托烷司琼2.5mg,同时在PCIA泵中加盐酸托烷司琼2.5mg。采用视觉模拟评分法(VAS),对术后12、24、48h镇痛评分;采用4级评分法对恶心、呕吐评分。采用SPSS11.0软件包对数据进行统计学分析。结果:各组均有恶心、呕吐患者,但其发生率及程度不同,A组恶心、呕吐发生例数显著高于其余5组(P<0.05)。F组恶心、呕吐发生率以及程度显著低于A、B、C、D组(P<0.05)。各组患者术后镇痛评分(VAS)无显著性差异(P>0.05)。结论:静脉注射盐酸托烷司琼能有效降低口腔颌面外科手术后带管患者恶心、呕吐的发生率,而且持续泵入给药较单次静脉给药效果更确切。

PURPOSE： To evaluate the curative effect of tropisetron hydrochloride in the prevention of postoperative nausea and vomiting in patients with tracheal catheter after oral and maxillofacial surgery. METHODS： 120 cases with tracheal catheter after oral and maxillofaeial surgery, ASA I or II, were randomly divided into six groups with 20 cases in each group. At the end of the surgery group A did not use tropisetron; Group B,C,D,E,F used tropisetron（2.5 mg and 5mg through single intravenous injection at group B and C,2.5 mg and 5mg through continuous intravenous infusion by PCIA pump at group D and E, 2.5 mg single intravenous injection and 2.5mg through continuous intravenous infusion by PCIA pump at group F after operation）. The VAS 12, 24, 48 hours after operation and the incidences of nausea and vomiting in the 6 groups were recorded.The data was analyzed using SPSS11.0 software package. RESULTS： PONV was in all 6 groups but the incidence and degree were different.The incidence of nausea and vomiting in Group A was significantly higher than that in other groups（P〈0.05）. The incidence and degree of nausea and vomiting in Group F were significantly lower than that in group A, B, C, D （P〈0.05）.There was no significant difference in VAS among all 6 groups（P〉0.05）. CONCLUSION： Intravenous infusion of tropisetron can decrease PONV in patients with tracheal catheter after oral and maxillofacial surgery and continuous intravenous infusion is more effective than single intravenous infusion.