三联疗法预防剖宫产产妇围术期恶心呕吐的临床观察

Effect of triple therapy on perioperative nausea and vomiting in patients undergoing cesarean section

目的为剖宫产产妇围术期恶心呕吐选择合适的止呕方案提供参考。方法选择腰硬联合麻醉下行择期剖宫产产妇84名,随机分为托烷司琼组(T组:托烷司琼4. 48 mg)、托烷司琼+地塞米松组(TD组:托烷司琼4. 48 mg+地塞米松5 mg)、托烷司琼+地塞米松+氟哌利多组(TDD组:托烷司琼4. 48 mg+地塞米松5 mg+氟哌利多1 mg)?胎儿娩出后,每组给予对应止呕药物。记录术中恶心呕吐(Intraoperative nausea and vomiting IONV)和术后恶心呕吐(Postoperative nausea and vomiting,PONV)的发生率、追加使用止呕药的情况及止呕药相关的副作用发生率。结果三组患者IONV、术后24 h内恶心的发生率及术中术后采取补救措施的次数总体来说差异均有统计学意义,(P <0. 05),但术后24 h内呕吐的发生率差异无统计学意义(P> 0. 05);T组与TD组比较结果显示,IONV、术后24 h内PONV发生率及采取补救措施的次数差异均无统计学意义,P> 0. 05;T组与TDD组比较结果显示,IONV、术后24 h内PONV发生率及采取补救措施的次数差异均有统计学意义(P <0. 05);TD组与TDD组比较结果显示,术中恶心及采取补救措施发生率差异有统计学意义(P <0. 05),术中呕吐及术后24 h内PONV发生率差异无统计学意义(P> 0. 05)。三组患者术中及术后24 h内止呕药相关的副作用发生率差异均无统计学意义(P> 0. 05)。结论托烷司琼、地塞米松及氟哌利多联合应用可降低剖宫产产妇围术期恶心呕吐的发生率。

Objective To propose an appropriate antiemetic scheme for preventing nausea and vomiting in patients undergoing cesarean section. Methods Eighty-four patients undergoing cesarean section under combined spinal and epidural analgesia,were randomized into three groups: toranisetron group( Group T: toranisetron 4. 48 mg),toranisetron compound dexamethasone group( Group TD: toranisetron 4. 48 mg + dexamethasone 5 mg),toranisetron compound dexamethasone and droperidol group( Group TDD: toranisetron 4. 48 mg + dexamethasone 5 mg + droperidol 1 mg). The antiemetic drugs were given to each group intravenously after the umbilical cord was clamped. The incidence of intraoperative and postoperative nausea and vomiting and the use of additional antiemetics were recorded. The side effects of antiemetics were also recorded. Results There was a statistically significant difference between three groups in view of the incidence of intraoperative nausea and vomiting( IONV) and postoperative nausea within 24 hours and the frequency of using rescue antiemetics( P < 0. 05).but there was not in terms of the incidence of postoperative vomiting( P > 0. 05). The difference between group T and group TD was not statistically significant in the incidence of intraoperative nausea and vomiting( IONV),postoperative nausea and vomiting( PONV) within 24 hours and the frequency of using rescue antiemetics( P > 0. 05),but the difference was significant between Group T and Group TD. The difference in the incidence of intraoperative nausea and the frequency of using rescue antiemetics between the Group TD and Group TDD were significant( P > 0. 05). However,the difference in the incidence of intraoperative vomiting and postoperative nausea and vomiting,( PONV) within 24 h between them were not significant. The side effects of intraoperative and postoperative within 24 h antiemetics did not show significant differences among the three groups( P > 0. 05). Conclusion The combination of tropisetron and dexamethasone plus droperidol can effectively reduce the incidence of perioperative nausea and vomitingin patients undergoing cesarean section.