托烷司琼预防吗啡硬膜外自控镇痛引起恶心呕吐的效果观察

Effects of tropisetron on preventing nausea and vomiting caused by patient controlled epidural analgesia with morphine

目的观察托烷司琼用于预防术后吗啡硬膜外自控镇痛（PCEA）引起恶心呕吐的效果。方法选择在腰麻与硬膜外联合麻醉下行开腹妇科手术患者120例，随机分成两组，每组60例。A组为托烷司琼4mg，B组为生理盐水4ml，分别加入PCEA药盒注入硬膜外间隙。术毕行吗啡PCEA镇痛，PCEA药液为吗啡8mg、0．75％左旋布卡因25ml。加生理盐水至100ml。观察两组术后48h内的镇痛效果及恶心呕吐的发生率。结果两组患者术后镇痛效果比较差异无统计学意义（P〉0．05）。两组患者术后48h内恶心呕吐发生率A组显著低于B组。恶心：A组7例（11．7％）B组16例（26．7％）；呕吐：A组3例（5．0％）B组19例（31.6％）（P％0．05或P％0．01），差异有统计学意义。结论托烷司琼能够安全有效地减少硬膜外吗啡术后镇痛引起的恶心呕吐。

Objective To observe the effect of tropisetron on preventing postoperative nausea and vomiting during patient controlled epidural analgesia with morphine. Methods One hundred and twenty patients undergoing gynecological operations under combined spinal-epidural anesthesia were randomly assigned into two groups with 60 in each. Tropisetron 4mg in group A and normal saline 4ml in group 13 was directly added into PCEA kits and then was contineously injected into epidural space. After operation, patient controlled epidural analgesia with morphine 8rag and 0.75% levobupivaeaine 25ml was used to relieve pain. which was diluted to 100ml with normal saline. The effects of pain relief and the incidences of vomiting and nausea within 48 hours after operation were observed. Results There was no statistically singnificant difference in the effects of pain relief between the two groups（P〉0.05） and the incidences of nausea and vomiting in group A were singifi- cantly lower than that in group t3 within 48h after operation. Nausea in group A was in 7 cases （11.70//00） and in group B 16 cases （26.7%）,vomiting in group A 3 cases （5.0 %） and in group B 19 caese（31.6%）（P〈0.05 or P〈0.01）. Conclusion Tropisetron can reduce postoperative nausea and vomiting during patient-controlled epidural analgesia with morphine effectively and safely.