不同剂量托烷司琼预防妇科腹腔镜术后PCA中恶心、呕吐的效果
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摘要
目的观察不同剂量托烷司琼预防妇科腹腔镜术后自控镇痛(PCA)中恶心、呕吐的效果。方法选择接受全身麻醉妇科腹腔镜手术且接受静脉PCA的ASA为Ⅰ～Ⅱ级的150例患者为研究对象,将其随机分为A、B、C三组,每组50例。A组在镇痛泵中加入15 mg托烷司琼,B组在镇痛泵中加入20 mg托烷司琼,C组在镇痛泵中未加入止吐类药物,观察三组患者术后48 h内恶心、呕吐发生情况。结果 A、B两组患者术后恶心、呕吐发生率比较,差异无统计学意义(P>0.05),但均明显优于C组,差异具有统计学意义(P<0.05);C组呕吐人数与平均呕吐次数均显著多于A、B两组,B组平均呕吐次数显著少于A组(P<0.05)。所有患者均未观察到药物相关不良反应。结论不同剂量的的托烷司琼均可有效的减少妇科腹腔镜术后镇痛恶心、呕吐发生率,增加托烷司琼剂量可减少部分患者术后呕吐的发生次数。
Objective To evaluate the effect of different doses of tropisetron in the prevention of nausea and vomiting in postoperative patient-controlled analgesia(PCA) in gynecologic laparoscopic. Methods A total of 150 patients with ASA of grade Ⅰ to Ⅱ who underwent gynecological laparoscopic surgery under general anesthesia and received intravenous PCA were selected as the study objects; they were randomly divided into three groups: A, B and C, with 50 cases in each group. In the group A, 15 mg tropisetron was added to the analgesic pump, in the group B, 20 mg tropisetron was added to the analgesic pump, and in the group C, no antiemetic drug was added to the analgesic pump. The incidences of nausea and vomiting of the three groups within 48 hours after operation were observed. Results There were no significant differences in the incidences of nausea and vomiting between the group A and B(P>0.05), but those in the group C were significantly worse than the group A and B(P<0.05). The numbers of vomiting and average vomiting times in the group C were significantly more than those in the group A and B, and the average vomiting times in the group B was significantly less than that in the group A(P<0.05). No adverse drug reactions were observed in all patients. Conclusion Different doses of tropisetron can effectively reduce the incidences of nausea and vomiting in postoperative PCA in gynecological laparoscopic, and increasing the dosage of tropisetron can reduce the incidence of vomiting in some patients.
Objective To evaluate the effect of different doses of tropisetron in the prevention of nausea and vomiting in postoperative patient-controlled analgesia(PCA) in gynecologic laparoscopic. Methods A total of 150 patients with ASA of grade Ⅰ to Ⅱ who underwent gynecological laparoscopic surgery under general anesthesia and received intravenous PCA were selected as the study objects; they were randomly divided into three groups: A, B and C, with 50 cases in each group. In the group A, 15 mg tropisetron was added to the analgesic pump, in the group B, 20 mg tropisetron was added to the analgesic pump, and in the group C, no antiemetic drug was added to the analgesic pump. The incidences of nausea and vomiting of the three groups within 48 hours after operation were observed. Results There were no significant differences in the incidences of nausea and vomiting between the group A and B(P>0.05), but those in the group C were significantly worse than the group A and B(P<0.05). The numbers of vomiting and average vomiting times in the group C were significantly more than those in the group A and B, and the average vomiting times in the group B was significantly less than that in the group A(P<0.05). No adverse drug reactions were observed in all patients. Conclusion Different doses of tropisetron can effectively reduce the incidences of nausea and vomiting in postoperative PCA in gynecological laparoscopic, and increasing the dosage of tropisetron can reduce the incidence of vomiting in some patients.
引文
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[12]MEI W,LI M,YU Y,et al.Tropisetron alleviate early post-operative pain after gynecological laparoscopy in sevoflurane based general anaesthesia:a randomized,parallel-group,factorial study[J].Eur JPain,2014,18(2):238-248.
[13]魏欣,姚尚龙,张小洺.托烷司琼不同给药方式对术后镇痛恶心、呕吐的预防作用[J].临床麻醉学杂志,2007,23(6):454-456.
[14]CHEN FC,ZHU J,LI B,et al.Stability of tramadol with three 5-HT3receptor antagonists in polyolefin bags for patient-controlled delivery systems[J].Drug Des Devel Ther,2016,10:1869-1875.
[15]CHEN FC,SHI XY,LI P,et al.Stability of butorphanol-tropisetron mixtures in 0.9%sodium chloride injection for patient-controlled analgesia use[J].Medicine(Baltimore),2015,94(6):e432.
[2]MOMENI M,CRUCITTI M,DE KOCK M.Patient-controlled analgesia in the management of postoperative pain[J].Drugs,2006,66(18):2321-2337.
[3]FLETCHER D,MARTINEZ V.Opioid-induced hyperalgesia in patients after surgery:a systematic review and a meta-analysis[J].Br J Anaesth,2014,112(6):991-1004.
[4]ALON E,KOCIAN R,NETT PC,et al.Tropisetron for the prevention of postoperative nausea and vomiting in women undergoing gynecologic surgery[J].Anesth Analg,1996,82(2):338-341.
[5]ZOMERS PJ,LANGENBERG CJ,DE BRUIJN KM.Tropisetron for postoperative nausea and vomiting in patients after gynaecological surgery[J].Br J Anaesth,1993,71(5):677-680.
[6]顾连兵,孙来荣,黄凤伦.不同剂量托烷司琼预防术后病人自控镇痛恶心呕吐的临床观察[J].临床麻醉学杂志,2004,20(5):299-300.
[7]杨水根,蔡兴建,黄宜发,等.托烷司琼不同给药方式对老年患者硬膜外自控镇痛后恶心、呕吐的防治[J].中国当代医药,2013,20(34):115-116.
[8]LEE B,KIM K,SUH DH,et al.Efficacy of single-dose and 2-dose intravenous administration of ramosetron in preventing postoperative nausea and vomiting after laparoscopic gynecologic operation:a randomized,double-blind,placebo-controlled,phase 2 trial[J].Surg Laparosc Endosc Percutan Tech,2017,27(3):183-188.
[9]WANG X,LIU W,XU Z,et al.Effect of dexmedetomidine alone for intravenous patient-controlled analgesia after gynecological laparoscopic surgery:a consort-prospective,randomized,controlled trial[J].Medicine(Baltimore),2016,95(19):e3639.
[10]SHAIKH SI,NAGAREKHA D,HEGADE G,et al.Postoperative nausea and vomiting:a simple yet complex problem[J].Anesth Essays Res,2016,10(3):388-396.
[11]SWEIS I,YEGIYANTS SS,COHEN MN.The management of postoperative nausea and vomiting:current thoughts and protocols[J].Aesthetic Plast Surg,2013,37(3):625-633.
[12]MEI W,LI M,YU Y,et al.Tropisetron alleviate early post-operative pain after gynecological laparoscopy in sevoflurane based general anaesthesia:a randomized,parallel-group,factorial study[J].Eur JPain,2014,18(2):238-248.
[13]魏欣,姚尚龙,张小洺.托烷司琼不同给药方式对术后镇痛恶心、呕吐的预防作用[J].临床麻醉学杂志,2007,23(6):454-456.
[14]CHEN FC,ZHU J,LI B,et al.Stability of tramadol with three 5-HT3receptor antagonists in polyolefin bags for patient-controlled delivery systems[J].Drug Des Devel Ther,2016,10:1869-1875.
[15]CHEN FC,SHI XY,LI P,et al.Stability of butorphanol-tropisetron mixtures in 0.9%sodium chloride injection for patient-controlled analgesia use[J].Medicine(Baltimore),2015,94(6):e432.