托烷司琼预防术后恶心和呕吐

Tropisetron in the prevention of postoperative nausea and vomiting.

作者信息

Boogaerts J G, Bardiau F M, Seidel L, Albert A, Ickx B E

机构信息

Department of Anesthesiology, University Hospital Center, Charleroi and Erasme Hospital, Brussels, Belgium.

出版信息

J Clin Anesth. 2000 Aug;12(5):402-8. doi: 10.1016/s0952-8180(00)00182-3.

DOI:10.1016/s0952-8180(00)00182-3

PMID:11025243

Abstract

STUDY OBJECTIVES

To evaluate the efficacy of tropisetron, a selective 5-HT(3) receptor antagonist, in preventing nausea and vomiting in high-risk inpatients undergoing various surgical procedures.

DESIGN

Prospective, open, nonrandomized, observational, interventional study.

SETTING

Postanesthesia care unit, and surgical wards of the University Hospital Center, Charleroi.

PATIENTS

A total of 1,132 elective surgical inpatients (>15 years of age) in two separate surveys. The first prospective survey covered all surgical adult inpatients (n = 671) after various surgical procedures over a 3-month period. A new 3-month survey was performed to assess the effectiveness of the preventive measure and included another 461 patients.

INTERVENTIONS

Risk factors associated with nausea and vomiting were recorded in the first survey and used to establish an antiemetic policy. This consisted in the administration of tropisetron 2 mg intravenously after anesthesia induction, if two patient-related risk factors associated with high-risk surgery and general anesthesia were present.

MEASUREMENTS AND MAIN RESULTS

Nausea frequency and intensity, assessed every 4 hours using a visual analog scale (VAS), frequency and times of vomiting episodes and the need for rescue medication were recorded for 72 hours postoperatively. Nausea was experienced by 18.8% and vomiting by 9.8% of the patients in the first survey (211 high risk-patients of 671). In the second survey, 137 patients of 461, considered at high-risk received prophylactic tropisetron. The proportion of patients having nausea decreased to 11.1% (p,178 0.01) and vomiting episodes to 2.8% (p < 0.001). Twenty-six of the tropisetron-treated patients (19%) suffered subsequent postoperative nausea and vomiting (PONV). Patient satisfaction with tropisetron was high.

CONCLUSION

Prophylactic tropisetron can reduce the incidence of PONV in selected high-risk inpatients undergoing various types of surgical procedures.

摘要

研究目的

评估选择性5-羟色胺（5-HT）3受体拮抗剂托烷司琼预防接受各类外科手术的高危住院患者恶心和呕吐的疗效。

设计

前瞻性、开放性、非随机、观察性、干预性研究。

地点

沙勒罗瓦大学医院中心的麻醉后护理病房和外科病房。

患者

在两项独立调查中，共有1132例择期手术住院患者（年龄>15岁）。第一项前瞻性调查涵盖了3个月内接受各类外科手术后的所有成年住院患者（n = 671）。进行了一项新的为期3个月的调查，以评估预防措施的有效性，纳入了另外461例患者。

干预措施

在第一项调查中记录与恶心和呕吐相关的危险因素，并据此制定一项止吐策略。该策略是，如果存在两个与高危手术和全身麻醉相关的患者相关危险因素，则在麻醉诱导后静脉注射2 mg托烷司琼。

测量指标和主要结果

术后72小时内，每4小时使用视觉模拟量表（VAS）评估恶心频率和强度、呕吐发作频率和次数以及使用急救药物的需求。在第一项调查中，18.8%的患者出现恶心，9.8%的患者出现呕吐（671例患者中有211例高危患者）。在第二项调查中，461例被视为高危的患者中有137例接受了预防性托烷司琼治疗。出现恶心的患者比例降至11.1%（p = 0.01），呕吐发作比例降至2.8%（p < 0.001）。26例接受托烷司琼治疗的患者（19%）随后出现术后恶心和呕吐（PONV）。患者对托烷司琼的满意度较高。