地塞米松、甲氧氯普胺联合托烷司琼预防剖宫产术中卡前列素氨丁三醇诱发恶心呕吐的效果

Effect of Dexamethasone, Metoclopramide and Tropisetron on prevention of nausea and vomiting induced by Carboprost Tromethamine during cesarean section

目的探讨地塞米松、甲氧氯普胺联合托烷司琼预防剖宫产术中卡前列素氨丁三醇诱发恶心呕吐的效果。方法选取2015年1月~2018年1月于我院施行腰硬联合麻下剖宫产术中应用卡前列素氨丁三醇的200例产妇作为研究对象,按照随机数字表法将其分为4组,每组各50例。术前给予患者使用不同药物预防术中恶心呕吐,D组:给予地塞米松5 mg;J组:给予地塞米松5 mg+甲氧氯普胺10 mg;T组:给予地塞米松5 mg+甲氧氯普胺10 mg+托烷司琼5 mg;对照组:给予0.9%氯化钠溶液5 ml。观察并比较各组产妇术中应用卡前列素氨丁三醇后5、6~15、16~30、31~50 min恶心呕吐及不良反应(锥体外系反应)的发生率。结果用药后各时间点内,D、J、T组的恶心呕吐发生率均低于对照组(P<0.05);D、J、T组间比较,各个时间段的恶心呕吐发生率存在差异(P<0.05);用药后5 min,J、T组的恶心呕吐发生率低于D组(P<0.05);J、T组间的恶心呕吐发生率比较,差异无统计学意义(P>0.05);用药后6~15、16~30、31-50 min,J、T组的恶心呕吐发生率均低于D组(P<0.05);T组的恶心呕吐发生率低于J组(P<0.05)。其中J组出现1例可疑锥体外系反应,其余各组无任何不良反应。结论地塞米松+甲氧氯普胺+托烷司琼联合使用在预防剖宫产术中恶心呕吐的效果确切,值得临床进一步研究应用。

Objective To investigate the effect of Dexamethasone,Metoclopramide and Tropisetron on preventing nausea and vomiting induced by Carboprost Tromethamine during cesarean section.Methods From January 2015 to January 2018,200 parturients who were applied Carboprost Tromethamine during caesarean section under combined spinal-epidural anesthesia in our hospital were selected as the research objects,and divided into 4 groups according to the random number table method,with 50 cases in each group.Patients were given different drugs before operation to prevent nausea and vomiting during operation.Group D was given Dexamethasone 5 mg;Group J was given Dexamethasone 5 mg+Metoclopramide 10 mg;Group T was given Dexamethasone 5 mg+Metoclopramide 10 mg+Tropisetron 5 mg;Control group was given 5 ml of 0.9%sodium chloride solution.To observe and compare the incidence of nausea and vomiting and adverse reactions(extrapyramidal reactions)after Carboprost Tromethamine was applied to parturients in each group for 5,6-15,16-30,31-50 min.Results The incidence rates of nausea and vomiting in groups D,J and T were lower than that in the control group at all time points after medication(P<0.05).The incidence ratesof nausea and vomiting in different time periods were different between groups D,J and T(P<0.05).The incidence rates of nausea and vomiting in group J and T were lower than that in group D 5 min after medication(P<0.05).There was no significant difference in nausea and vomiting incidence between J and T groups(P>0.05).The incidence rates of nausea and vomiting in group J and group T were lower than that in group D at 6-15,16-30 and 31-50 min after medication(P<0.05).The incidence rates of nausea and vomiting in group T were lower than that in group J(P<0.05).One case of suspected extrapyramidal reaction occurred in group J,and no adverse reactions occurred in other groups.Conclusion Dexamethasone+Metoclopramide+Tropisetron combined use has definite effect in preventing nausea and vomiting during cesarean section,which is worthy of further clinical research and application.