盐酸帕洛诺司琼预防上腹部手术后硬膜外吗啡镇痛所致的恶心呕吐

Palonosetron prevent postoperative nausea and vomiting related to epidural morphine analgesia following upper abdominal surgery

目的观察和评价帕洛诺司琼对上腹部手术后硬膜外吗啡镇痛引起的恶心呕吐的预防效果和安全性。方法择期行上腹部手术并术后接受硬膜外吗啡镇痛患者60例,随机分为帕洛诺司琼组(P组)和托烷司琼组(T组)。手术结束前30min,P组患者缓慢静注帕洛诺司琼0.25mg,T组患者缓慢静注托烷司琼6mg。观察记录两组患者术后24h、48hVAS及Ramsay评分、恶心呕吐的程度,计算恶心呕吐有效控制率。同时记录患者腹胀、头痛、椎体外系症状等不良反应。结果两组患者术后24h及48h的VAS及Ramsay评分差异无统计学意义。P组患者术后24h的恶心及呕吐有效控制率分别为80.0%和73.3%,T组分别为63.3%和60.0%;P组患者术后48h的恶心及呕吐有效控制率分别为90.0%和93.3%,T组分别为66.6%和63.3%。两组患者术后24h恶心、呕吐有效控制率差异无统计学意义。P组患者术后48h恶心、呕吐有效控制率明显优于T组患者(P<0.05)。帕洛诺司琼的不良反应主要为头痛。结论腹部手术后24h内,帕洛诺司琼预防吗啡硬膜外镇痛所致的恶心呕吐的效果与托烷司琼相当,但术后48h预防恶心呕吐的效果优于托烷司琼,且不良反应发生率低,程度较轻,安全性好。

Objective To observe the effect of Palonosetron preventing postoperative nausea and vomiting related to epidural morphine analgesia following upper abdominal surgery. Methods Sixty patients undergoing combined epidural morphine analgesia after elective upper abdominal surgery were randomly divided into Group P and Group T. At the end of operation, Group P intravenously received Palonosetron 0.25 mg, and Group T received Tropisetron 5 rag. The severity of nausea and vomiting, pain rating and side effects were recorded at 24 h and 48 h after surgery. Results 24 h and 48 h after upper abdominal surgery, the VAS and Ramsay scores have no significant difference between two groups （all P 〈 0.05 ）. 24 h after the surgery, the effective control rate of nausea and vomiting in Group P was 80.0% and 73.3%, respectively, while 90.0% and 93.3% at 48 h after surgery. In Group T, the effective control rate of nausea and vomiting was 63.3% and 60.0% at 24 h postoperatively, while 66.6% and 63.3% at 48 h postoperatively. The effective control rate of nausea and vomiting in Group P was significantly higher than in Group T at 48 h after surgery （P 〈 0.05）. Conclusion Palonosetron is an ideal long-acting antiemetic drug which can effectively prevent postoperative nausea and vomiting related to epidural morphine analgesia following upper abdominal surgery.