甲强龙联合托烷司琼对妇科日间手术全身麻醉患者术后恶心呕吐的预防作用

Prophylactic effect of methylprednisolone combined with tropisetron on nausea and vomiting after general anesthesia for gynecological day surgery

目的探究甲强龙联合托烷司琼对妇科日间手术全身麻醉患者术后恶心呕吐(PONV)的预防作用。方法选取我院2017年6月至2018年6月择期行妇科日间手术全身麻醉患者300例,按照随机数表法分为2组:托烷司琼组(T组;手术结束前15 min静脉注射托烷司琼5 mg)和托烷司琼+甲强龙组(T+M组;手术结束前15 min静脉注射托烷司琼5 mg,甲强龙40 mg)。所有患者均知情同意并签署知情同意书。根据纳入与排除标准最终纳入289例,其中T组143例,T+M组146例。记录2组术后0~6 h、6~24 h恶心和呕吐发生情况,术后24 h VAS评分、Ramsay评分和内脏牵拉评分。结果与T组比较,T+M组术后急性恶心、呕吐及延迟性呕吐发生率明显降低(P<0.05)。对于PONV高危(APFEL评分2~4分)患者,与T组比较,T+M组术后呕吐的发生率明显降低(P<0.05)。对于PONV高危(APFEL评分3分)患者,与T组比较,T+M组术后恶心发生率明显降低(P<0.05)。2组术后VAS评分、Ramsay镇静评分、内脏牵拉评分无统计学差异(均P>0.05)。结论甲强龙联合托烷司琼可明显降低妇科日间手术全身麻醉患者PONV的发生率,尤其对于急性恶心、呕吐以及延迟性呕吐有明显的预防作用。对于PONV高危患者甲强龙和托烷司琼联合应用预防效果更佳。

Objective To study the effects of methylprednisolone combined with tropisetron on postoperative nausea and vomiting(PONV)after gynecologic day surgery.Methods We selected 289 patients who received general anesthesia for gynecological day surgery.The patients were divided into group T(n=143)and group T+M(n=146)according to the random number table.All patients provided written informed consent.PONV within 6 h and within 6-24 h was recorded,and visual analogue scale(VAS)scores,Ramsay scores,and visceral traction scores were evaluated within 24 h.Results The incidence of urgent and delayed vomiting,and urgent nausea in group T+M after surgery was significantly lower than that in group T(P<0.05).Patients with APFEL scores of 2-4 showed benefit from taking methylprednisolone and tropisetron in terms of postoperative vomiting(P<0.05).The incidence of postoperative nausea in group T+M(patients with APFEL scores of 3)was significantly lower than that in group T(P<0.05).There were no significant differences in VAS scores,Ramsay scores,and visceral traction scores between the two groups(all P>0.05).Conclusion Methylprednisolone combined with tropisetron significantly reduced the incidence of PONV after gynecologic day surgery,especially in urgent PONV and delayed postoperative nausea,compared to tropisetron alone.Patients with higher APFEL scores benefit more from combined methylprednisolone and tropisetron.