三种药物对全身麻醉外科手术后恶心呕吐的预防作用

Protective effects of the 3 drugs on postsurgical nausea and vomiting under general anesthesia

目的评估和比较昂丹司琼、格拉司琼和雷莫司琼对全身麻醉下进行的外科手术后的恶心呕吐(postoperative nausea and vomiting,PONV)的预防作用。方法 90例被确诊为美国麻醉师协会(ASA)分级为I和II级患者,年龄20~65岁,预定在全身麻醉下进行外科手术。经患者知情同意,并签署知情同意书后,将全部患者分成3组,每组30例。昂丹司琼组:昂丹司琼0.1 mg/kg,格拉司琼组:格拉司琼40μg/kg,雷莫司琼组:雷莫司琼0.3 mg,用5 ml生理盐水稀释药物后在麻醉前5 min通过静脉给药。在术后的第1个24 h,记录所发生的恶心、呕吐和干呕等症状情况。如没有发生恶心、呕吐、干呕和使用紧急止吐药则为完全发挥药效,以此评估药物的作用。用单因素方差分析和卡方检验对获得的数据进行观察。结果术后0~3 h期间,所有实验组之间没有明显区别(P>0.05);在术后3~24 h期间,雷莫司琼和昂丹司琼有明显的区别,昂丹司琼组70%的患者无恶心、呕吐和干呕,雷莫司琼组93%的患者无恶心、呕吐和干呕,2组比较差异有统计学意义(P<0.05)。然而,在同样的时期格拉司琼和雷莫司琼之间没有区别(P>0.05)。结论术后0~3 h内,所有的研究药物对预防恶心、呕吐和干呕的作用没有明显的区别。在术后3~24 h阶段,格拉司琼和雷莫司琼与昂丹司琼相比能更好的预防PONV。

Objective To evaluate and compare the preventive effects of ondansetron, granisetron and ramosetron on postsur-gical nausea and vomiting under general anesthesia. Methods Ninety patients of ASA grade I and II with an age range of 20 - 65 years were scheduled for surgery under general anesthesia. With the knowledge and consent of the patients and following the signing of the let-ter of agreement, the patients were divided into 3 groups, each consisting of 30. The patients received the following drugs intravenously. The ondansetron group received 0. 1 mg/kg ondansetron, the granisetron group was given granisetron at a dose of 40μg/kg, and the ramosetron group had 0. 3 mg ramosetron, which was diluted with 5 ml physiological saline and transfused intravenously 5 minute before surgery. Episodes of nausea, vomiting and retching were recorded in the first 24 hours after surgery. If there were no nausea, retching or vomiting or if acute antiemetic drug was used, it showed that the drugs had produced certain effect upon which the drugs were evalua-ted. Observation results were assessed and analyzed by using analysis of variance （ANOVA） and chi-square test. Results Within 0 - 3 hours after surgery, no statistical significance could be noted in all the study groups （P 〉0.05）. Within the period of 3 -24 hours, significant differences could be shown, when comparisons were made between the ramosetron group and the ondansetron group. Seventy per cent of the patients in the ondansetron group had no nausea and vomiting or retching, while 93% of the patients in the ramosetron group had no nausea and vomiting or retching. Statistical significance could be noted, when comparisons were made between them （P 〈 0. 05）. However, during the period, no significant statistical differences could be seen between the granisetron and the ramosetron groups （ P 〉 0.05 ）. Conclusion Within 0- 3 hours after surgery, all the study drugs were not significantly different in the prevention of nausea, retching and vomiting. However, both ramosetron and granisatron were superior to ondansetron in the prevention of PONV with-in the period of 3 - 24 hours after surgery.