不同剂量帕洛诺司琼预防妇科手术术后恶心呕吐的临床观察

OBSERVATION OF DIFFERENT DOSES OF PALONOSETRON ON THE PREVENTION OF POSTOPERATIVE NAUSEA AND VOMITING(PONV) FOR GYNECOLOGICAL SURGERY

目的观察不同剂量帕洛诺司琼预防妇科手术术后恶心呕吐的有效性及安全性。方法选择在气管内全麻的妇科患者60例,ASAⅠ～Ⅱ级,均采用静脉镇痛,随机分为三组:帕洛诺司琼0.075 mg组(A组,n=20),帕洛诺司琼0.15 mg组(B组,n=20),帕洛诺司琼0.25 mg组(C组,n=20)。开始麻醉诱导前予以帕洛诺司琼,观察术后0～24 h、24～72 h、0～6 h、6～72 h及0～72 h的完全缓解率(CR)、恶心程度及治疗失败时间(TTF)。结果①术后0～24 h(p=0.194)、0～6 h(p=0.912)和0～72 h(p=0.252),三组的完全缓解率无显著性差异;而在24～72 h(p=0.025)、6～72 h(p=0.016),B、C组的完全缓解率明显高于A组。②与A组相比,B、C组恶心程度评分在术后24～72 h(p=0.025)、6～72 h(p=0.018)明显下降。③B组和C组0～24 h的治疗失败率为15%,明显减少(p=0.043)。④B、C组在所有观察时段内,完全缓解率、恶心程度及治疗失败率相似。结论妇科手术前静脉注射单剂量的帕洛诺司琼0.15 mg能增加24～72 h的恶心呕吐的完全缓解率并减少恶心程度,同时也减少了0～24 h的治疗失败率,增加帕洛诺司琼剂量至0.25 mg并未增加其效应。

Objective To observe the efficacy and safety of three different doses of palonosetron on the incidence and severity of postoperative nausea and vomiting（PONV） for gynecological surgery. Methods sixty patients（ASAⅠ-Ⅱ）undergoing gynecological surgery with general anesthesia,scheduled for intravenous analgesia were divided into three groups randomly： Group A（palonosetron 0.075 mg,n=20）,Group B（palonosetron 0.15 mg,n=20） and Group C（palonosetron 0.25 mg,n=20）.A single IV dose of palonosetron（0.075 mg,0.15 mg,or 0.25 mg）was administered immediately before induction of anesthesia.Complete response（CR： no emetic episodes and no rescue medication）,nausea severity and TTF（time to treatment failure） were observed during the 0 to 24 h,24 to 72 h,0 to 6 h,6 to 72 h and 0 to 72 h postoperative time intervals. Results ①CR rates were similar for the 0 to24 h（p=0.194）,0 to 6h（p=0.912）,0 to 72h（p=0.252） postoperative interval for three groups.Compared with Group A,CR rates for Group B and Group C were significantly increased for the 24 to 72 h（p=0.025）,6 to 72 h interval（p=0.016）.②Compared with Group A,Group B and Group C associated with a significant downward shift toward less intense nausea for the 24 to 72 h（p=0.025）,6 to 72 h interval（p=0.018）.③The proportion of treatment failure for Group B（15%）and Group C（15%） is significantly decreased for the 0 to 24 h interval（p=0.043）④CR rates,nausea seversity and proportion of treatment failure were similar in both of Group B and Group C for every interval. Conclusion A single IV dose of palonosetron 0.15mg before gynecological surgery significantly increased the CR rate（no emetic episodes and no rescue medication） and decreased nausea severity from 24 to 72 h.It also decreased the proportion of treatment failure for 0~24 h.Efficacy of palonosetron was not significantly increased with increasing doses to 0.25 mg.