昂丹司琼用于预防妇科腹腔镜术后恶心、呕吐的临床观察

Clinical Observation of Ondansetron Using for the Prophylaxis of Postoperative Nausea and Vomiting After Gynaecological Surgery Under Laparoscopy

目的探讨不同剂量昂丹司琼（ondansetron）用于预防妇科腹腔镜术后恶心、呕吐（postoperative nausea and vomiting,PONV）的临床效果。方法选取2009年10月至2010年3月,在同济大学附属上海市第一妇婴保健院行择期妇科腹腔镜手术的120例患者为研究对象。将其随机分为4组,A组（n=30）,静脉注射昂丹司琼8mg;B组（n=30）,静脉注射昂丹司琼4mg＋地塞米松5mg;C组（n=30）,静脉注射昂丹司琼4mg;对照组（n=30）,静脉注射生理盐水5mL。纳入标准：根据美国麻醉师协会（American society of Aanesthesiologists,ASA）分级标准分为Ⅰ~Ⅱ级,患者年龄为20~57岁,术前无恶心、呕吐病史,未接受抗恶心、呕吐治疗患者（本研究遵循的程序符合同济大学附属上海市第一妇婴保健院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象的知情同意,并与之签署临床研究知情同意书）。麻醉诱导前1min,对4组患者分别静脉注射相应药物。4组患者年龄、体重、ASA分级、术前病史,术中麻醉时间、气腹压及气腹时间等比较,差异无显著意义（P〉0.05）。观察4组患者术后24h内恶心、呕吐发生情况。结果 A组患者术后24h内恶心、呕吐发生率明显低于对照组,两组比较,差异有显著意义（P〈0.01）;B组和C组术后24h内恶心、呕吐发生率比较,差异无显著意义（P〉0.01）;B,C组术后24h内恶心、呕吐发生率明显低于对照组,两组比较,差异有显著意义（P〈0.05）。结论静脉注射昂丹司琼8mg预防妇科腹腔镜术后恶心、呕吐失败率最低。静脉注射昂丹司琼4mg＋地塞米松5mg并不比单用昂丹司琼4mg预防妇科腹腔镜术后恶心、呕吐更有效。

Objective To investigate clinical effects of different doses of ondansetron on postoperative nausea vomiting（PONV）after gynaecological surgery under laparoscopy.Methods From October 2009 to March 2010,120 patients ASA 1～2 who underwent gynaecological surgery under laparoscopy in Shanghai First Maternity and Infant Hospital,Tongji University School of Medicine were divided into 4 groups：Group A（n=30）,ondansetron 8 mg;group B（n=30）,ondansetron 4 mg;group C（n=30）,ondansetron 4 mg＋dexamethasone 5 mg;control group（n=30）,saline 5 mL.Those drugs were given intravenously according to the different groups.The postoperative nausea and vomiting of all patients during 24 hours were investigated.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Shanghai First Maternity and Infant Hospital,Tongji University School of Medicine.Informed consent was obtained from all participants.Results The incidence of postoperative nausea and vomiting in group A was significantly lower than that in control group（P0.05）.The incidence of postoperative nausea and vomiting in group B had no difference compared with group C（P0.05）.But the incidence in group B and C were significantly lower than that of control group（P0.05）.Conclusion Intravenous administration of ondansetron 8 mg had the best effect on the prophylaxis of postoperative nausea and vomiting.Intravenous administration of ondansetron 4 mg combined with dexamethasone 5 mg had no better effect compared with ondansetron 4 mg only.