地塞米松联合昂丹司琼对胸腔镜术后病人静脉自控镇痛PONV的影响

The Effect of Combining Dexamethasone with Ondansetron for Nausea and Vomiting Associated with Sufentanyl-based Intravenous Patient-controlled Analgesia

目的：观察地塞米松联合昂丹司琼对胸腔镜术后病人自控静脉镇痛（PCIA）相关恶心呕吐的防治效果。方法：120例ASAⅠ~Ⅱ接受胸腔镜手术的患者,随机分为两组：地塞米松与昂丹司琼联合组（OD组）和昂丹司琼组（O组）。OD组患者在诱导时给予10 mg地塞米松,O组给予等量生理盐水,在手术结束前10分钟时,患者均给予静脉注射8 mg昂丹司琼,术后均行病人自控静脉镇痛（PCIA：生理盐水将2μg/kg舒芬太尼和8 mg昂丹司琼稀释到100 m L）。观察术后48小时内的恶心呕吐的发生率及严重程度。结果：在术后恶心呕吐整体发生率上OD组（53.3%）与O组（60%）,差异无统计学意义（P〉0.05）,但在重度PONV发生率上OD组（10%）要显著低于O组（26.7%）,差异有统计学意义（P〈0.05）。结论：地塞米松联合昂丹司琼能有效地降低胸腔镜手术后以舒芬太尼为主的病人自控静脉镇痛所致严重恶心呕吐的发生率。

Objective：We investigated whether combined dexamethasone and ondansetron is more effective than ondansetron alone in preventing postoperative nausea vomiting in patients with patient-controlled analgesia.Methods：One hundred and twenty patients ASA Ⅰ to Ⅱ who underwent video-assisted thomcoscopic surgery were assigned to either an ondansetron group （groupO） or a dexamethasoneand ondansetron group （group OD）.In all patients,ondansetron 8mg was administered at the end of surgery and 8 mg was added to the patient-controlled analgesia solution.The dexamehthasone and ondnsetron group received dexamethasone 10 mg at the induction of anaesthesia.Results：The overall incidence of nausea and vomiting during the first 48h postoperatively did not differ between groups （60%） vs （53.3%） in the ondansetron group and dexamethasone and ondansetron goup）.The incidence of severe nausea and vomiting was higher in the ondansetron group than in the dexamethasone and ondansetron group （26.7%） vs （10%）.Conclusion：Combined dexamethasone and ondansetron is more effective in reducing sevsre nausea and vomiting than ondansetron alone in patients receiving sufentanyl-based intravenous paient-controlled analgesia.