托烷司琼联合地塞米松对腹腔镜食管裂孔疝修补术患者术后恶心呕吐的影响
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摘要
目的探讨托烷司琼联合地塞米松对腹腔镜食管裂孔疝修补术患者术后恶心呕吐(PONV)的影响。方法选择2016年6月至2018年1月在新疆维吾尔自治区人民医院行择期腹腔镜食管裂孔疝修补术的女性患者150例,完全随机分为地塞米松组、托烷司琼组和联合治疗组,各50例。患者均行全身麻醉,气管插管后5 min,地塞米松组静脉给予地塞米松5 mg;托烷司琼组静脉给予托烷司琼注射液5 mg;联合治疗组静脉给予托烷司琼5 mg和地塞米松5 mg。手术结束后24 h比较各组PONV发生情况和PONV视觉模拟评分。结果地塞米松组和托烷司琼组PONV发生率和PONV视觉模拟评分均明显高于联合治疗组[20. 0%(10/50)、12. 0%(6/50)比4. 0%(2/50),(3. 8±1. 1)、(3. 9±1. 1)分比(2. 4±0. 6)分],差异均有统计学意义(均P <0. 05),而地塞米松组与托烷司琼组比较差异均无统计学意义(均P> 0. 05)。结论托烷司琼联合地塞米松能有效降低腹腔镜食管裂孔疝修补术患者PONV发生率,是围术期减少PONV并发症较为理想的联合用药选择,效果优于单一用药。
Objective To investigate the effect of tropisetron combined with dexamethasone on postoperative nausea and vomiting( PONV) in patients undergoing laparoscopic esophageal hiatal hernia repair. Methods A total of 150 female patients undergoing laparoscopic esophageal hiatal hernia repair in People's Hospital of Xinjiang Uygur Autonomous Region from June 2016 to January 2018 were randomly divided into dexamethasone group,tropisetron group and combined treatment group,with 50 cases in each group. All patients had general anesthesia; 5 minutes after tracheal intubation,the dexamethasone group was intravenously given 5 mg dexamethasone; the tropisetron group was intravenously given 5 mg tropisetron injection; the combined treatment group was intravenously given 5 mg tropisetron and 5 mg dexamethasone. Incidence of PONV and score of PONV Visual Analogue Scale were analyzed 24 h after operation. Results Incidence of PONV and score of PONV Visual Analogue Scale in the dexamethasone group and tropisetron group were significantly higher than those in the combined treatment group[20. 0%( 10/50),12. 0%( 6/50) vs 4. 0%( 2/50);( 3. 8 ± 1. 1),( 3. 9 ± 1. 1) vs( 2. 4 ± 0. 6) ]( P < 0. 05);there was no significant difference between the dexamethasone group and tropisetron group( P > 0. 05).Conclusion Tropisetron combined with dexamethasone can effectively reduce the incidence of PONV after laparoscopic esophageal hiatal hernia repair.
Objective To investigate the effect of tropisetron combined with dexamethasone on postoperative nausea and vomiting( PONV) in patients undergoing laparoscopic esophageal hiatal hernia repair. Methods A total of 150 female patients undergoing laparoscopic esophageal hiatal hernia repair in People's Hospital of Xinjiang Uygur Autonomous Region from June 2016 to January 2018 were randomly divided into dexamethasone group,tropisetron group and combined treatment group,with 50 cases in each group. All patients had general anesthesia; 5 minutes after tracheal intubation,the dexamethasone group was intravenously given 5 mg dexamethasone; the tropisetron group was intravenously given 5 mg tropisetron injection; the combined treatment group was intravenously given 5 mg tropisetron and 5 mg dexamethasone. Incidence of PONV and score of PONV Visual Analogue Scale were analyzed 24 h after operation. Results Incidence of PONV and score of PONV Visual Analogue Scale in the dexamethasone group and tropisetron group were significantly higher than those in the combined treatment group[20. 0%( 10/50),12. 0%( 6/50) vs 4. 0%( 2/50);( 3. 8 ± 1. 1),( 3. 9 ± 1. 1) vs( 2. 4 ± 0. 6) ]( P < 0. 05);there was no significant difference between the dexamethasone group and tropisetron group( P > 0. 05).Conclusion Tropisetron combined with dexamethasone can effectively reduce the incidence of PONV after laparoscopic esophageal hiatal hernia repair.
引文
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[9]彭章龙,赵欣,金珏,等.托烷司琼预防腹腔镜胆囊切除术后病人恶心呕吐的效应[J].中华麻醉学杂志,2006,26(7):609-611.DOI:10.3760/j.issn:0254-1416.2006.07.012.Peng ZL,Zhao X,Jin J,et al.Prophylaxis of nausea and vomiting after laparoscopic cholecystectomy with tropisetron[J].Chinese Journal of Anesthesiology,2006,26(7):609-611.DOI:10.3760/j.issn:0254-1416.2006.07.012.
[10]Murphy GS,Szokol JW,Greenberg SB,et al.Preoperative dexamethasone enhances quality of recovery after laparoscopic cholecystectomy:effect on in-hospital and postdischarge recovery outcomes[J].Anesthesiology,2011,114(4):882-890.DOI:10.1097/ALN.0b013e3181ec642e.
[11]Wang JJ,Ho ST,Liu HS,et al.Prophylactic antiemetic effect of dexamethasone in women undergoing ambulatory laparoscopic surgery[J].Br J Anaesth,2000,84(4):459-462.
[2]邰沁文,程飞,马尔旦·马合木提,等.胃食管反流病的腹腔镜手术治疗[J].中华胃食管反流病电子杂志,2015,2(1):21-24.DOI:10.3877/cma.j.issn.1674-6899.2015.01.007.Tai QW,Cheng F,Maerdan MHMT,et al.Laparoscopic treatment for gastroesophageal reflux disease[J].Chinese Journal of Gastroesphageal Reflux Disease(Electronic Edition),2015,2(1):21-24.DOI:10.3877/cma.j.issn.1674-6899.2015.01.007.
[3]邓小明,姚尚龙,于布为,等.现代麻醉学[M].4版.北京:人民卫生出版社,2014:1464-1465.Deng XM,Yao SL,Yu BW,et al.Modern anesthesiology[M].4th ed.Beijing:People's Medical Publishing House,2014:1464-1465.
[4]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.DOI:10.4103/0259-1162.179310.
[5]Kovac AL.Update on the management of postoperative nausea and vomiting[J].Drugs,2013,73(14):1525-1547.DOI:10.1007/s40265-013-0110-7.
[6]Van den Bosch JE,Moons KG,Bonsel GJ,et al.Does measurement of preoperative anxiety have added value for predicting postoperative nausea and vomiting?[J].Anesth Analg,2005,100(5):1525-1532.DOI:10.1213/01.ANE.0000149325.20542.D4.
[7]宋阳,李洋,郑文慧,等.术后恶心呕吐防治措施的研究进展[J].实用药物与临床,2017,20(6):720-724.DOI:10.14053/j.cnki.ppcr.201706029.Song Y,Li Y,Zheng WH,et al.Research progress on prevention and treatment of postoperative nausea and vomiting[J].Practical Pharmacy and Clinical Remedies,2017,20(6):720-724.DOI:10.14053/j.cnki.ppcr.201706029.
[8]Ekinci O,Malat I,I??tmangil G,et al.A randomized comparison of droperidol,metoclopramide,tropisetron,and ondansetron for the prevention of postoperative nausea and vomiting[J].Gynecol Obstet Invest,2011,71(1):59-65.DOI:10.1159/000320747.
[9]彭章龙,赵欣,金珏,等.托烷司琼预防腹腔镜胆囊切除术后病人恶心呕吐的效应[J].中华麻醉学杂志,2006,26(7):609-611.DOI:10.3760/j.issn:0254-1416.2006.07.012.Peng ZL,Zhao X,Jin J,et al.Prophylaxis of nausea and vomiting after laparoscopic cholecystectomy with tropisetron[J].Chinese Journal of Anesthesiology,2006,26(7):609-611.DOI:10.3760/j.issn:0254-1416.2006.07.012.
[10]Murphy GS,Szokol JW,Greenberg SB,et al.Preoperative dexamethasone enhances quality of recovery after laparoscopic cholecystectomy:effect on in-hospital and postdischarge recovery outcomes[J].Anesthesiology,2011,114(4):882-890.DOI:10.1097/ALN.0b013e3181ec642e.
[11]Wang JJ,Ho ST,Liu HS,et al.Prophylactic antiemetic effect of dexamethasone in women undergoing ambulatory laparoscopic surgery[J].Br J Anaesth,2000,84(4):459-462.