咪达唑仑联合托烷司琼预防剖宫产术后恶心呕吐

Combined use of midazolam and tropisetron in the prevention of postoperative nausea and vomiting in patients undergoing lower segment cesarean section under spinal anesthesia

目的探讨咪达唑仑或托烷司琼单独应用或咪达唑仑联合托烷司琼应用对蛛网膜下腔阻滞麻醉下剖宫产手术患者术后恶心呕吐（posloperative nausea and vomiting，PONV）的疗效。方法择期行剖宫产的健康产妇160例，采用完全随机分组法分成4组（每组40例）：空白对照组（S组）、托烷司琼组（T组）、咪达唑仑组（M组）、咪达唑仑＋托烷司琼组（MT组）。所有患者均采用右侧卧位下L3-L4椎间隙蛛网膜下腔穿刺。麻醉用药为0．75％罗哌卡因2ml＋1ml脑脊液稀释成3ml后蛛网膜下腔注入。胎儿娩出钳夹脐带时S组、T组、M组、MT组分别静脉注射0．9％氯化钠注射液4ml、托烷司琼4mg（4m1）、咪达唑仑40ixg／kg（4m1）、咪达唑仑40μg／kg＋托烷司琼4mg（4m1）。所有患者术后常规给予静脉自控镇痛。PONV的严重程度采用视觉模拟评分法（visual analogue scales，VAS）评估。分别记录手术结束后0-6h、6h-12h、12h-18h、18h-24hPONV发生的严重程度和频次。结果M组（2．5％）和MT组（2．5％）PONV的发生率明显低于S组（37．5％）和T组（20％）（P〈0．05）。M组与MT组药物对PONV的疗效相同，T组与s组药物对PONV的疗效比较，差异无统计学意义（P〉O．05）。S组（20％）和T组（10％）术后0—24h对止吐药的需求量明显高于M组（0）和MT组（0）。结论单独应用咪达唑仑（40μg／kg）或咪达唑仑联合托烷司琼应用均可有效预防蛛网膜下腔阻滞麻醉下剖宫产手术患者PONV，二者疗效相同。

Objective To compare the effect of midazolam or tropisetron or midazolam-tropisetron on postoperative nausea and vomiting （PONV） in patients undergoing lower segment cesarean section under spinal anesthesia. Methods One hundred and sixty healthy full-term parturients scheduled for elective cesarean section were randomly divided into four groups （n=40）： placebo group （group S）, tropisetron group （group T）, midazolam group （group M ） and midazolam-tropisetron group （group MT）. All patients were positioned in the right lateral decubitus and a 22 gauge spinal needle was introduced through mid-line approach at the L3-L4 inter-space. Patients received 2 ml of 0.75% ropivacaine （hypobaric）＋l ml of cerebrospinal fluid subarachnoid injection, group S, which received 4 ml of normal saline, group T,which received 4 ml of tropisetron （4 mg）, group M, which received 4 ml of midazolam （40 μg/kg） and group MT, which received midazolam （40 μg/kg）＋ 4 ml of tropisetron （4 mg） after clamping of the umbilical cord. Postoperative pain management was carried with patient controlled intravenous analgesia. Then the severity of nausea was measured by visual analog scales/score （VAS）. Each patient was observed and asked for at 0-6 h,6 h-12 h, 12 h-18 h, 18 h-24 h after surgery occurrence of nausea and vomiting. Results The incidence of PONV in group M （2.5%） and group MT （2.5%） was significantly lower than that in group S（37.5 %） and group T（20%）. Group M was as equally effective as group MT for PONV. Group T was not significant, compared with group S for PONV. Compared with group M （0） and group MT （0）, the request for a rescue antiemetic of group S （20%） and group T （ 10% ） was significantly higher. Conclusions Midazolam or midazolam-troposetron combination is more effective than tropisetron or placebo group in the prevention of postoperative nausea and vomiting in lower segment cesarean section under spinal anesthesia. Midazolam alone is as equally effective as midazolam-tropisetron combination.