盐酸雷莫司琼不同给药方式对剖宫产术后静脉镇痛引起恶心呕吐的防治效果

Effect of different administration routes of ramosetron hydrochloride on postoperative nausea and vomiting induced by intravenous analgesia in cesarean patients

目的探讨盐酸雷莫司琼对剖宫产术后芬太尼静脉镇痛引起的术后恶心呕吐(PONV)的防治效果。方法选取拟在蛛网膜下腔阻滞麻醉下行剖宫产术的单胎足月产妇120例,美国麻醉医师学会(ASA)分级Ⅰ或Ⅱ级,随机均分入静脉组(在胎儿娩出后予产妇缓慢静脉注射盐酸雷莫司琼0.3mg)、镇痛泵组(将盐酸雷莫司琼0.3mg加入镇痛泵持续输注)、联合组(在胎儿娩出后予产妇缓慢静脉注射盐酸雷莫司琼0.3mg,并将盐酸雷莫司琼0.3mg加入镇痛泵持续输注)和对照组(不使用盐酸雷莫司琼),每组30例。术后所有产妇均予芬太尼静脉自控镇痛。应用疼痛视觉模拟评分(VAS评分)评价产妇术后1、6、12、24、48h的疼痛情况,记录术后48h内PONV的发生情况及严重程度。结果组内术后不同时间点间,及4组间任一时间点间疼痛VAS评分的差异均无统计学意义(P值均>0.05)。静脉组、镇痛泵组、联合组和对照组的PONV发生率分别为30.0%(9/30)、36.7%(11/30)、6.7%(2/30)和63.3%(19/30),静脉组、镇痛泵组和联合组的PONV发生率显著低于对照组(P值均<0.05),联合组又显著低于静脉组和镇痛泵组(P值均<0.05)。结论盐酸雷莫司琼能有效预防剖宫产术后芬太尼静脉镇痛引起的PONV,且分别于胎儿娩出后静脉注射、加入镇痛泵持续输注各0.3mg盐酸雷莫司琼是最佳给药方式。

Objective To explore the preventive effect of ramosetron hydrochloride on postoperative nausea and vomiting （PONV） induced by intravenous fentanyl for analgesia in cesarean patients. Methods A total of 120 full-term women with singleton pregnancy （American Society of Anesthesiologists [ASA] grade Ⅰ or Ⅱ ） scheduled for cesarean section under epidural anesthesia were randomly divided into four groups （n = 30）. Ramosetron hydrochloride 0. 3 mg was intravenously injected after delivery in intravenous group; ramosetron hydrochloride 0.3 mg was added into fentanyl patient-controlled intravenous analgesia （PCIA） pump in PCIA group; the combination of intravenous injection and PCIA of 0.3 mg ramosetron hydrochloride in joint group and ramosetron hydrochloride was not used in control group. All patients received postoperative pain management with intravenous fentanyl PCIA. Visual analogue scale （VAS） scores for pain were recorded at 1, 6, 12, 24 and 48 h after surgery and the incidence of PONV within 48 hours were evaluated. Results No significant differences in VAS pain scores were found not only at different time points in the same group but also at each time point among the four groups （all P〈0.05）. The incidence rates of PONV in intravenous group, PCIA group, joint group and control group were 30.0% （9/30）, 36.7% （11/30）, 6.7% （2/30） and 63.3% （19/30）, respectively. The incidence rate of PONV in control group was significantly higher than that in the other three groups （all P〈0.05）. The incidence rate of PONV in joint group was significantly lower than that in intravenous group and PCIA group （both P 〈 0.05）. Conclusion Ramosetron hydrochloride can effectively reduce the incidence rate of PONV induced by intravenous fentanyl for analgesia. The best route of administration may be intravenous injection of 0. 3 mg ramosetron hydrochloride plus 0.3 mg ramosetron hydrochloride added into the fentanyl PCIA pump after delivery.