昂丹司琼不同给药方式对腹腔镜胆囊切除术后恶心、呕吐的预防

Effects of Different Administrations of Ondansetron on Nausea and Vomiting During Postoperative Laparoscopic Cholaparoscopic

目的研究昂丹司琼不同给药方式对预防腹腔镜胆囊切除手术(LC)后恶心呕吐(PONV)的临床疗效。方法将200例美国麻醉医师协会分级(ASA)Ⅰ～Ⅱ级,择期行LC的患者随机分为4组:Ⅰ组术毕未使用昂丹司琼;Ⅱ组术毕静注昂丹司琼8 mg;Ⅲ组术毕镇痛泵内加昂丹司琼4 mg,静脉推注昂丹司琼4 mg;Ⅳ组术毕镇痛泵内加昂丹司琼8 mg。记录术后2、4、8、20、36和48 h患者的PONV情况。结果与Ⅰ组相比,Ⅱ组在术后2、4和8 h恶心、呕吐发生率显著降低(P<0.05),Ⅲ组在术后2、4、8、20、36和48 h恶心、呕吐发生率明显降低(P<0.05);Ⅰ组和Ⅳ组各时间点呕吐的发生率差异无统计学意义。与Ⅱ组相比,Ⅲ组在术后36、48 h呕吐发生率明显降低(P<0.05);与Ⅳ组相比较,Ⅱ组在术后2、4、8 h恶心、呕吐发生率明显降低(P<0.05),Ⅲ组在术后2、4、8、20、36和48 h呕吐发生率明显降低(P<0.05)。结论术毕单次注射昂丹司琼4mg,并通过术后镇痛泵(PCA)持续输注,可以在术后48 h内有效预防恶心、呕吐的发生。

Objective To evalute the prophylactic efficacy of different modes of and ministration of ondansetron on postoperative nausea and vomiting on the laparoscopie cholecystectomy （ LC ）. Methods The 200 patients of American Society Anesthesiologists （ASA） I - H scheduled for LC were randomly divided into 4 groups with 50 cases each. Before commencement of PAC, the patients received no ondansetron （ group I ）, ondansetron 8 mg immediately （ group Ⅱ ） , ondansetron 4 mg immediately and ondansetron 4 mg in PCA pump （groupIII）, and ondansetron 8 mg in PCA pump （group IV ）. Incidences of nausea and vomiting and side effects were re- corded at 2,4,8,20,36,48 h after operation. Results In group [[ , the incidences of nausea and vomiting were reduced significantly compared with thous in group I at 2,4,8 h （ P 〈 0.05 ）. In group m, the incidence of nausea and vomiting were reduced significantly compared with the group I at 2,4,8,20,36,48 h （P 〈 0.05）. In group Ⅲ, the incidences of PONV were reduced compared with the group II at 36,48 h （P 〈0.05）. In group I1 ,the incidences of PONV were reduced significantly compared with group IV at 2,4,8 h （ P 〈 O. 05 ）. In group Ⅲ,the incidences of PONV were reduced compared with group IV at 2,4,8,16,20,36,48 h（ P 〈 0.05 ）. Con- clusion The strategy of intravenous ondansetron 4 mg after the surgery and 4 mg in PCA pump is better than that of intravenous in re- ducing the incidence of PONV in 48 h.