Abou Zeid H, Al-Gahamdi A, Abdul-Hadi M
Department of Anesthesiology, King Faisal University, King Fahd Hospital, Al-Khobar, Saudi Arabia.
Breast J. 2002 Jul-Aug;8(4):216-21. doi: 10.1046/j.1524-4741.2002.08405.x.
In a randomized, placebo-controlled, double-blind trial, we compared the efficacy of dolasetron, dexamethasone, and metoclopramide in a preventing postoperative nausea and vomiting in women undergoing breast surgery. Patients were allocated randomly to one of four groups (20 patients each): group A received 12.5 mg dolasetron, group B received 8 mg dexamethasone, group C received 20 mg metoclopramide, and group D received placebo intravenously. If patients complained of retching or vomiting or if patients demanded an antiemetic, 1.25 mg droperidol was administered intravenously. To quantify postoperative nausea and vomiting, the following score was used: 0 = no nausea, 1 = nausea, 2 = retching, 3 = single vomiting, 4 = multiple vomiting. Dolasetron and dexamethasone reduced the postoperative nausea and vomiting score significantly (p < 0.02 versus metoclopramide; p < 0.0001 versus placebo). Metoclopramide also reduced the postoperative nausea and vomiting score (p < 0.02 versus placebo). Fisher's exact test showed a significant reduction of vomiting in the dolasetron and dexamethasone groups compared with metoclopramide-treated patients (p < 0.007) and placebo-treated patients (p < 0.000006) and a significantly lower rate of nausea in comparison to the placebo group (p < 0.009). There were no significant differences between the metoclopramide and the placebo groups (using Fisher's exact test). The use of postoperative droperidol was significantly lower in both the dolasetron group (p < 0.04 versus metoclopramide; p < 0.0001 versus placebo) and dexamethasone group (p < 0.04 versus metoclopramide; p < 0.0001 versus placebo), as well as in the metoclopramide group (p < 0.02 versus placebo). Intravenous dolasetron and dexamethasone were equally effective and both are more effective than metoclopramide for preventing vomiting after breast surgery. Also both were significantly superior to either metoclopramide or placebo for postoperative nausea and vomiting and the need for droperidol rescue.
在一项随机、安慰剂对照、双盲试验中，我们比较了多拉司琼、地塞米松和甲氧氯普胺预防接受乳房手术女性术后恶心和呕吐的疗效。患者被随机分配到四组之一（每组20例）：A组静脉注射12.5毫克多拉司琼，B组静脉注射8毫克地塞米松，C组静脉注射20毫克甲氧氯普胺，D组静脉注射安慰剂。如果患者主诉干呕或呕吐，或者患者要求使用止吐药，则静脉注射1.25毫克氟哌利多。为了量化术后恶心和呕吐情况，采用以下评分：0 = 无恶心，1 = 恶心，2 = 干呕，3 = 单次呕吐，4 = 多次呕吐。多拉司琼和地塞米松显著降低了术后恶心和呕吐评分（与甲氧氯普胺相比，p < 0.02；与安慰剂相比，p < 0.0001）。甲氧氯普胺也降低了术后恶心和呕吐评分（与安慰剂相比，p < 0.02）。费舍尔精确检验显示，与甲氧氯普胺治疗的患者相比（p < 0.007）以及与安慰剂治疗的患者相比（p < 0.000006），多拉司琼和地塞米松组的呕吐显著减少，与安慰剂组相比恶心发生率显著降低（p < 0.009）。甲氧氯普胺组与安慰剂组之间无显著差异（采用费舍尔精确检验）。多拉司琼组（与甲氧氯普胺相比，p < 0.04；与安慰剂相比，p < 0.0001）、地塞米松组（与甲氧氯普胺相比，p < 0.04；与安慰剂相比，p < 0.0001）以及甲氧氯普胺组（与安慰剂相比，p < 0.02）术后氟哌利多的使用显著减少。静脉注射多拉司琼和地塞米松同样有效，且二者在预防乳房手术后呕吐方面均比甲氧氯普胺更有效。此外，二者在术后恶心和呕吐以及氟哌利多抢救需求方面均显著优于甲氧氯普胺或安慰剂。
