恩—氟混合液内关穴注射超前镇吐预防腹腔镜手术后恶心呕吐的疗效观察

The clinical study on preemptive anti vomit by Neiguan point injection of ondansetron and droperidol mixed liquor in laparoscopic surgery

目的观察内关穴注射小剂量恩丹西酮、氟哌利多混合液超前镇吐用于腹腔镜手术的临床效果。方法选择ASAⅠ～Ⅱ级拟行腹腔镜手术患者180例,按手术顺序将患者随机分为3组,每组60例。Ⅰ组患者于术前20min行恩—氟混合液(恩丹西酮4 mg,氟哌利多2.5 mg,共3 ml)行双侧内关穴注射;Ⅱ组患者于术前20 min静脉注射恩—氟混合液3 ml;Ⅲ组患者术前20 min静脉注射0.9%氯化钠液3 ml。观察各组患者术后24 h恶心呕吐的发生次数与程度,并按评定标准予以评分。结果Ⅰ组恶心、呕吐发生率分别为20.0%、21.7%,低于Ⅱ组46.7%、45.0%,亦低于ⅢⅡ组68.3%、63.3%,差异均有统计学意义(P<0.01);3组患者均未发现明显嗜睡、焦虑及锥体外系反应等并发症。结论针药结合超前镇吐用于腹腔镜手术,能阻断引起术后恶心呕吐的多个因素,临床效果确切,可减少或避免大剂量单一用药所导致的诸多并发症。

Objective To investigate the clinical effects of Neiguan point injection with small dose of ondansetron and droperidol mixed liquor for preemptive anti vomit in laparoscopic surgery.Methods 180 ASAⅠ～Ⅱpatients who were took laparoscopic surgery were randomly divided into 3 groups（60 cases in each group）.Patients in groupⅠwere given an injection of ondansetron and droperidol mixed liquor（ondansetron 4 mg and droperidol 2.5 mg,total of 3 ml） on bilateral Neiguan point 20 minutes before operation;Patients in groupⅡwere given a vein shot of 3 ml ondansetron and droperidol mixed liquor while in groupⅢinjected with 3 ml of 0.9%sodium chloride solution 20 minutes before operation.The frequency and degree of nausea and vomiting 24 hours after operation in each group were observed and scored according to evaluation standard.Results The incidence rate of nausea and vomiting was 20.0%and 21.7%in groupⅠwhich has statistical different（P0.01） compared with 46.7%and 45.0%in groupⅡand 68.3%and 63.3%in groupⅢ.No complication such as obvious drowsiness,anxiety and extra-corticospinal tract reaction was found among the three groups.Conclusion Neiguan point injection with small dose of ondansetron and droperidol mixed liquor for preemptive anti vomit in laparoscopic surgery can block many factors causing PONV,which can reduce or avoid many complications caused by large dose of single medication.