不同剂量地塞米松联合托烷司琼预防腹腔镜辅助阴式子宫切除术后恶心呕吐的比较

Comparison between different doses of dexamethasone combined with tropisetron in the prevention of postoperative nausea and vomiting for laparoscopic assisted vaginal hysterectomy

目的比较静脉注射不同剂量地塞米松联合托烷司琼对腹腔镜辅助阴式子宫切除术(LAVH)患者术后恶心呕吐(PONV)的影响。方法择期LAVH女性患者120例,随机分为三组,每组40例:D1组手术结束时静注地塞米松5mg和托烷司琼8mg,D2组静注地塞米松10mg和托烷司琼8mg,对照组(C组)静注托烷司琼8mg。记录三组患者的手术时间、麻醉时间和芬太尼用量。观察并记录三组患者术后24h内恶心、呕吐的发生例数及比例。结果三组患者手术时间、麻醉时间、芬太尼用量比较差异无统计学意义(P>0.05)。术后24hD1组和D2组患者恶心、呕吐的发生率及总发生例数低于C组,差异有统计学意义(P<0.05)。D1组和D2组恶心、呕吐的发生率及总发生例数差异无统计学意义(P>005)。结论地塞米松联合托烷司琼用于预防LAVH术后恶心、呕吐的效果显著优于单独使用托烷司琼,但随着地塞米松剂量的加大,并未相应降低术后恶心、呕吐发生率。

Objective To compare the clinical effect of different doses ofdexamethasone combined with tro- pisetron in the prevention of postoperative nausea and vomiting （PONV） for laparoscopic assisted vaginal hysterectomy （LAVH）. Methods One hundred and twenty patients ofASA I - Ⅱ undergoing laparoscopic hysterectomy operation were randomly divided into three groups, with 40 cases in each group. At the end of the operation, patients in group D1 were given dexamethasone 5 mg and tropisetron 8 rag, patients in group D2 were given dexamethasone 10 mg and tro- pisetron 8 mg, while those in control group （C） were given tropisetron 8 mg only. The operation time, anesthesia time, amount of fentanyl were recorded. The cases and incidence of PONV were observed and recorded in the three groups within 24 hours after the operation. Results There were no statistically significant difference in the operation time, anesthesia time and fentanyl consumption between the three groups （/9〉0.05）. The eases and incidence of PONV in group D~ and group D2 was significantly lower than those in group C （P〈0.05）. The incidence and the total number of cases of PONV showed no statistically significant differences between group D1 and group D2 （P〉0.05）. Conclusion Dexamethasone combined with tropisetron shows significantly better effects than tropisetron alone for the prevention of PONV after LAVH. The incidence of PONV does not reduces as the doses of dexarnethasone increases.