甲泼尼龙琥珀酸钠联合托烷司琼在预防面肌痉挛微血管减压术后恶心呕吐中的应用

Application of Methylprednisolone Sodium Succinate Combined with Tropisetron in Prevention of Nausea and Vomiting under Microvascular Decompression of Hemifacial Spasm

目的评价术中联合应用甲泼尼龙琥珀酸钠和托烷司琼对面肌痉挛微血管减压术后恶心呕吐(PONV)的疗效。方法以2019年1月至6月在北京大学人民医院神经外科行面肌痉挛微血管减压手术的485例患者为研究对象,采用随机数字表法随机分为以下2组:(1)A组(n=242):诱导前静脉滴注2 ml生理盐水,手术结束时静脉滴注托烷司琼5 mg;(2)B组(n=243):诱导前静脉滴注甲泼尼龙琥珀酸钠40 mg,手术结束时静脉滴注托烷司琼5 mg。记录并比较2组患者麻醉时间、手术时间以及术后0~24 h和24~48 h PONV发生率,同时比较两组患者恶心呕吐的补救治疗率。结果两组患者在年龄、性别、吸烟史、体质量指数、美国麻醉医师协会评分、病史、手术侧别、PONV史、手术时间及麻醉时间方面差异均无统计学意义(P均>0.05)。A组患者在0~24 h和24~48 h的PONV发生率分别为35.5%和18.2%,均明显高于B组患者的18.5%(χ2=7.331,P=0.007)和8.2%(χ2=4.364,P=0.037)。A组患者0~24 h和24~48 h加强止吐药物的比例分别为15.2%和8.7%,均明显高于B组患者的5.3%(χ2=5.327,P=0.021)和2.0%(χ2=4.432,P=0.035)。结论术中联合应用甲泼尼龙琥珀酸钠和托烷司琼可以有效预防面肌痉挛微血管减压术后PONV的发生,其效果优于单药治疗。

Objective To evaluate the effect of methylprednisolone sodium succinate combined with tropisetron on postoperative nausea and vomiting(PONV)under microvascular decompression of hemifacial spasm.Methods From January to June 2019,485 patients undergoing microvascular decompression for facial spasm at Department of Neurosurgery,Peking University People’s Hospital were randomly assigned into two groups with random number table method.For group A(n=242),2 ml saline was administrated by intravenous drip before induction and 5 mg tropisetron after operation.For group B(n=243),40 mg methylprednisolone sodium succinate was administrated by intravenous drip before induction and 5 mg tropisetron after operation.The anesthesia time,operation time,and incidence of PONV in 0-24 h and 24-48 h were recorded for the comparison of the remedial treatment rate of nausea and vomiting between the two groups.Results There was no significant difference in age,gender,smoking history,body mass index value,American Society of Anesthesiologists score,medical history,surgical side,PONV history,operation time or anesthesia time between the two groups(all P>0.05).The incidence of PONV in group A was 35.5%and 18.2%during 0-24 h and 24-48 h,respectively,which was significantly higher than that(18.5%,χ2=7.331,P=0.007;8.2%,χ2=4.364,P=0.037)in group B.The application rate of antiemetic drugs in group A was 15.2%and 8.7%during 0-24 h and 24-48 h,respectively,which was significantly higher than that(5.3%,χ2=5.327,P=0.021;2.0%,χ2=4.432,P=0.035)in group B.Conclusion The combination of methylprednisolone sodium succinate and tropisetron can effectively prevent PONV under microvascular decompression of hemifacial spasm,with the performance superior to single drug treatment.