股骨近端防旋髓内钉内固定后静滴盐酸托烷司琼减少恶心呕吐的安全性

Safety of reducing nausea and vomiting by intravenous infusion of tropisetron hydrochloride after internal fixation with proximal femoral nail antirotation

背景:已经有相关文献研究证明,盐酸托烷司琼能有效减少股骨转子间骨折患者股骨近端防旋髓内钉内固定术后恶心呕吐的发生率,且安全有效。目前对于术中托烷司琼的使用方式主要为术后加入自控静脉镇痛泵中及术后静脉滴注,而对于两种使用方式临床疗效的差异目前国内外鲜见报道。目的:探究盐酸托烷司琼不同给药方式对防治股骨近端防旋髓内钉内固定后恶心呕吐的有效性及安全性。方法:在2018年7月至2020年3月于汕头市中医医院行股骨近端防旋髓内钉内固定的股骨转子间骨折患者中,选取90例患者随机分为2组,每组45例。A组(静脉滴注给药组)患者在术后即予静脉滴注盐酸托烷司琼5 mg+生理盐水100 mL同时接自控静脉镇痛泵(泵内不加入盐酸托烷司琼);B组(自控静脉镇痛泵给药组)患者在术后即予静脉滴注生理盐水100 mL同时接自控静脉镇痛泵(泵内加入盐酸托烷司琼5 mg)。统计两组患者术后1,6,12,24,48 h的疼痛、镇静评分、术后恶心呕吐评分及术后恶心呕吐发生率并做出比较。结果与结论:(1)两组患者术后疼痛、镇静评分在各时间点上差异均无显著性意义(P>0.05);(2)术后1,6 h时A组患者术后恶心呕吐评分及发生率均明显少于B组,差异有显著性意义(P<0.05);而在术后12,24,48 h时两组患者术后恶心呕吐评分及发生率相比差异无显著性意义(P>0.05);(3)两组患者不良反应发生率相比差异无显著性意义(P>0.05);(4)提示对比在自控静脉镇痛泵中加入盐酸托烷司琼,术后静脉滴注盐酸托烷司琼能更快速且安全地减少股骨近端防旋髓内钉内固定术后恶心呕吐的发生。

BACKGROUND:Tropisetron hydrochloride has been shown to effectively reduce postoperative nausea and vomiting in patients undergoing proximal femoral nail antirotation fixation,and it is safe and effective.At present,the use of tropisetron in this operation is mainly added to patient controlled intravenous analgesia or intravenous drip after the operation.However,the comparison of two administration methods of tropisetron is rarely reported.OBJECTIVE:To investigate the effectiveness and safety of different administration methods of tropisetron hydrochloride for reduction of postoperative nausea and vomiting in proximal femoral nail antirotation.METHODS:Ninety patients with intertrochanteric fracture of femur who underwent proximal femoral nail antirotation admitted in Shantou Hospital of Traditional Chinese Medicine from July 2018 to March 2020 were randomly divided into two groups(n=45).Patients in the group A(intravenous drip administration group)were given tropisetron hydrochloride 5 mg+normal saline 100 mL by intravenous drip immediately after the operation,and the patient controlled intravenous analgesia pump(tropisetron hydrochloride was not added into the pump)was used.Patients in the group B(patient controlled intravenous analgesia pump group)were given 100 mL normal saline by intravenous drip immediately after the operation,and the patient controlled intravenous analgesia pump(5 mg tropisetron hydrochloride was added into the pump)was used.The pain score,sedative score,postoperative nausea and vomiting score and postoperative nausea and vomiting incidence at 1,6,12,24,and 48 hours after the operation of two groups were counted and compared.RESULTS AND CONCLUSION:(1)The pain score and sedative score of the two groups were not statistically significant(P>0.05)at various time points.(2)The postoperative nausea and vomiting score and postoperative nausea and vomiting incidence of group A were significantly less than those in the group B at 1 and 6 hours after the operation(P<0.05).The differences in postoperative nausea and vomiting score and postoperative nausea and vomiting incidence of the two groups were not statistically significant at 12,24,and 48 hours after the operation(P>0.05).(3)There was no significant difference in incidence of adverse reactions between the two groups(P>0.05).(4)Compared with added tropisetron hydrochloride to patient controlled intravenous analgesia pump,postoperative intravenous drip administration of tropisetron hydrochloride can quickly reduce the occurrence of nausea and vomiting after proximal femoral nail antirotation fixation.