静脉应用东莨菪碱在预防剖宫产术后恶心呕吐中的作用

Efficacy of Intravenous Scopolamine for Preventing Postoperative Nausea and Vomiting after Cesarean Section

目的观察静脉应用东莨菪碱在预防剖宫产术后恶心呕吐中的效果。方法选择260例择期在腰硬联合麻醉下行剖宫产的患者(美国麻醉医师协会病情分级标准Ⅰ～Ⅱ级),随机分为4组,每组65例。分别于手术结束缝皮时静脉注射生理盐水5 ml(对照组)、东莨菪碱0.3 mg/5 ml(东莨菪碱组)、昂丹司琼4 mg/5 ml(昂丹司琼组)、东莨菪碱0.3 mg+昂丹司琼4 mg/5 ml(联合用药组)。观察术后24 h内恶心呕吐情况及药物不良反应发生率,并对上述4组的各项结果进行比较。结果术后24 h内完全无恶心呕吐的百分率在东莨菪碱组、昂丹司琼组及联合用药组分别为87.7%、89.2%和92.3%,高于对照组的73.8%,差异均有统计学意义(P<0.05)。但东莨菪碱组、昂丹司琼组和联合用药组3组之间在疗效方面差异无统计学意义(P>0.05)。4组患者不良反应发生率差异无统计学意义(P>0.05)。结论静脉注射东莨菪碱0.3 mg能有效预防术后24 h内恶心呕吐的发生,其疗效与昂丹司琼4 mg相当。

To observe the efficacy of intravenous scopolamine in the prevention of postoperative nausea and vomiting （PONV） after cesarean section （CS）. Methods A total of 260 pregnant women with American Society of Anesthesiologists （ASA） Physical Status Classification class Ⅰ-Ⅱ 11 who underwent elective CS under combined spinalepidural anesthesia （CSEA） were randomly divided into four groups （n = 65 ） ： at the end of surgery, 0.3 mg/5 ml scopolamine （ scopolamine group） , 4 rag/5 ml ondansetron （ ondansetron group） , 0.3 mg scopolamine plus 4 mg ondansetron per 5 ml （ combination group） , or 0.9% normal saline 5 ml （ control group） were intravenously infused, respectively. The episodes of PONV and adverse effects were observed within 24 hours after operation. Results The incidences of PONV within 24 hours after surgery were 87.7%, 89.2%, and 92.3%, respectively, in scopolamine group, ondansetron group, and combination group, which were all significantly higher than that in control group （73.8%） （all P 〈 0.05 ）. However, the incidences of PONV showed no significant difference among these three groups （ P 〉 0.05 ）. No significant difference in the incidence of adverse effects was observed among the four groups （ P 〉 0.05 ）. ConclusionIntravenous scopolamine （0. 3 mg） , with a comparable efficacy as ondansetron 4 mg, can effectively decrease the incidence of PONV after CS.