帕洛诺司琼预防妇科手术术后恶心呕吐的临床效果

Randomized controlled trial of palonosetron in preventing postoperative nausea and vomiting in gynecological surgeries

目的比较术前单次注射帕洛诺司琼或托烷司琼对预防妇科手术术后恶心呕吐（PONV）的效果。方法选择Apfel评分≥3分,择期全麻下行妇科大手术的患者60例,随机分为帕洛诺司琼组（P组）和托烷司琼组（T组）,每组30例。麻醉采用气管插管全麻,术前分别单次静脉注射帕洛诺司琼0.25 mg或托烷司琼5 mg,术后使用氢吗啡酮自控镇痛,随访72 h。记录患者术后恶心呕吐程度,并计算完全有效率（CR）和完全控制率（CC）。结果 P组患者术后0~24 h及24~48 h恶心呕吐程度均明显低于T组（P〈0.05）,48~72 h恶心呕吐程度两组差异无统计学意义。P组共5例（17%）发生呕吐,治疗失效时间为（19.6±9.4）h,无一例补救治疗;T组共19例（63%）发生呕吐,治疗失效时间（20.6±4.5）h,补救治疗3例次。术后0~24 h、24~48 h和0~72 h P组CR和CC明显高于T组（P〈0.05）,而术后48~72 h两组CR和CC差异无统计学意义。结论术前单次静脉注射帕洛诺司琼0.25 mg预防妇科手术PONV的疗效在术后48 h内明显优于单次注射托烷司琼5 mg。

Objective To compare the effects of a single injection of palonosetron and tropisetron to prevent postoperative nausea and vomiting（ PONV） in gynecological surgeries. Methods Sixty patients undergoing elective major gynecological surgeries with general anesthesia（ Apfel score ≥3） were included and randomized to group P（ palonosetron） and group T（ tropisetron）,30 patients in each group. All patients received general anesthesia with tracheal intubation,and palonosetron 0. 25 mg or tropisetron 5 mg were injected before anesthesia respectively in two groups. Intravenous hydromorphine was delivered for postoperative analgesia in all patients. PONV were evaluated and followed up for 72 hours. The degree of PONV was recorded and the complete response rate（ CR） and complete control rate（ CC） were calculated.Results The degree of PONV in 0-24 h and 24-48 h was milder in group P than in group T（ P〈0. 05）,while in 48-72 h the degree of PONV was similar between the two groups. In group P,5 patients had vomiting postoperatively with the failure period of treatment of（ 19. 6 ± 9. 4） h,and no patients needed rescue treatments. While in group T,19 patients suffered from vomiting with the failure period of treatment of（ 20. 6 ± 4. 5） h,and rescue treatments were delivered 3 times in total. The CR and CC of preventing PONV in 0-24 h,24-48 h and 0-72 h were significantly higher in group P than in group T（ P〈0. 05）. The CR and CC of the two groups were comparable in 48-72 h postoperatively. Conclusion A preoperative single dose of palonosetron 0. 25 mg is better than tropisetron 5 mg in preventing PONV within 48 hours after gynecological surgery.