多模式镇吐措施对剖宫产术产妇围生期恶心、呕吐的防治作用

Effect of Multimodal-antiemetic Therapy on Perinatal Nausea and Vomiting in Puerperas Undergoing Caesarean Section with Spinal Anesthesia

目的探讨多模式镇吐措施对蛛网膜下腔阻滞麻醉下剖宫产术产妇围生期恶心、呕吐的影响。方法选择从2014年8月～2015年8月于笔者医院进行剖宫产手术的150例产妇，产妇年龄25．6±4．8岁，体重65．5±9．5kg，美国麻醉医师协会（ASA）分级Ⅰ-Ⅱ级。按照随机数字表法将所有产妇分为两组：多模式镇吐组（M组）和对照组（c组），每组75例。两组产妇均静脉注射利多卡因0．1mg／kg以预防注射痛。M组产妇于蛛网膜下腔阻滞麻醉前5min静脉注射地塞米松10mg和托烷司琼2rag，于结扎脐带后静脉注射丙泊酚0．5～1．0mg／kg，术毕给予托烷司琼2mg及帕瑞昔布钠40rag。C组产妇于蛛网膜下腔阻滞麻醉前5rain及结扎脐带后均给予等剂量生理盐水，术毕给予昂丹司琼4mg及等剂量生理盐水。记录两组产妇术中恶心、呕吐（IONV）和术后24h内恶心、呕吐（PONV）的发生率，并观察药物相关的不良反应发生情况。比较两组产妇术后24h内视觉疼痛模拟评分（VAS）及患者自控静脉镇痛（PCIA）泵按压次数。结果与C组比较，M组产妇未发生IONV或PONV例数升高（P〈0．05），而恶心、呕吐及使用镇吐药例数均降低（P〈0．05）。M组产妇恶心、呕吐程度低于C组（P〈0．05）。M组产妇术后24h内的VAS及PCIA泵按压次数均低于C组（P〈0．05）。两组产妇均未发生药物相关的不良反应。结论多模式镇吐措施可明显降低蛛网膜下腔阻滞麻醉下剖宫产术产妇围生期恶心、呕吐的发生率，且安全性较高。

Objective To explore the effect of muhimodal - antiemetic therapy on perinatal nausea and vomiting in puerperas under- going caesarean section with spinal anesthesia. Methods 150 puerperas from August 2014 to August 2015 in our hospital, aged 25.6 ~ 4.8, weighed 65.5 ＋9.5kg, American Society of Anesthesiologists （ASA） class arranged from I to I] and scheduled for caesarean sec- tion with spinal anesthesia, were chosen and randomly allocated to a muhimodal - antiemetic therapy group （ group M, n = 75 ） or a control group （group C, n = 75 ）. Puerperas of the two groups were all injected intravenously with lidocaine at a dose of 0.1 mg/kg to avoid injec- tion pain. In group M, puerperas received prophylactic dexamethasone （10rag, iv） and tropisetron （2mg, iv） at 5 min before spinal an- esthesia, were given with propofol at a dose of 0.5 - 1.0mg/kg after umbilical cord ligation, and received tropisetron （2mg, iv） and pare- coxib sodium （40mg, iv） at the end of surgery. In group C, puerperas received same quantity of normal saline at 5min before spinal anes- thesia and after umbilical cord ligation, and received ondansetron （4mg, iv） and same quantity of normal saline at the end of surgery. The incidence of intraoperative and postoperative nausea and vomiting （ IONV and PONV） were recorded, and drug - related adverse effect was observed. Visual analogue scale （VAS） and pressing numbers of patient controlled intravenous analgesia （PCIA） were analyzed dur- ing 24 h after surgery. Results Compared to group C, the incidence of IONV and PONV was lower （P 〈 0.05） in group M. The degree of nausea and vomiting of group M was lower （P 〈 0.05） than that of group C. VAS and pressing numbers of PCIA of group M were both lower （P 〈 0.05） than those of group C during 24h after surgery. There was no drug - related adverse effect in the two groups. Conclusion Multimodal - antiemetic therapy could significantly reduce the incidence of perinatal nausea and vomiting after caesarean section with spinal anesthesia, with higher safety in clinical practice.