Kontrimaviciute E, Baublys A, Ivaskevicius J
Vilnius University, Anesthesiology and Intensive Care Clinic, Vilnius University Hospital, Santariskiu Klinikos, Vilnius, Lithuania.
Eur J Anaesthesiol. 2005 Jul;22(7):504-9. doi: 10.1017/s0265021505000864.
Patients undergoing total abdominal hysterectomy under general anaesthesia have a high risk of developing postoperative nausea and vomiting (PONV). The aim of this study was to evaluate the incidence of PONV in patients undergoing total abdominal hysterectomy under spinal anaesthesia with intravenous patient-controlled analgesia (PCA) using morphine and to compare its incidence with and without antiemetic prophylaxis.
Thirty-four patients undergoing total abdominal hysterectomy under spinal anaesthesia with i.v. PCA morphine postoperatively were divided into two groups. The first (n = 17) received ondansetron prophylaxis near the end of surgery while the second (n = 17) received no prophylaxis. Morphine consumption, emetic episodes (on a 3-point scale), patient satisfaction (visual analogue score), sedation and pruritus were evaluated 2, 4, 6, 9, 12, 18 and 24h postoperatively.
Patient characteristics, postoperative morphine consumption (43.3 +/- 7.6 vs. 40.3 +/- 12.3 mg) and peristaltic recovery time (16.9 +/- 5 vs. 18.4 +/- 5.2 h) were similar in both groups. Overall nausea and vomiting were significantly lower in the ondansetron prophylaxis group than in the group without prophylaxis (52.9% vs. 88.2%, P < 0.05). Though nausea alone was higher in the prophylaxis group (41.2% vs. 29.4%), nausea with vomiting was significantly lower in the prophylaxis group (11.8% vs. 58.8%, P < 0.01). Patients' satisfaction scores were higher in the ondansetron group at all times and the difference was significant (P < 0.05) 4 h postoperatively.
The incidence of PONV in patients undergoing total abdominal hysterectomy under spinal anaesthesia with i.v. PCA morphine is very high (88.2%). Antiemetic prophylaxis with ondansetron is highly recommended in this patients group resulting in a lower incidence of nausea and vomiting, and significantly improves patient' satisfaction and life quality in the early postoperative period.
全身麻醉下接受全腹子宫切除术的患者发生术后恶心呕吐（PONV）的风险较高。本研究的目的是评估在脊髓麻醉下使用吗啡静脉自控镇痛（PCA）的全腹子宫切除术患者中PONV的发生率，并比较有无预防性使用止吐药时的发生率。
34例在脊髓麻醉下接受全腹子宫切除术且术后使用静脉PCA吗啡的患者被分为两组。第一组（n = 17）在手术接近结束时接受昂丹司琼预防性用药，第二组（n = 17）不接受预防性用药。在术后2、4、6、9、12、18和24小时评估吗啡用量、呕吐发作情况（采用3分制）、患者满意度（视觉模拟评分）、镇静和瘙痒情况。
两组患者的特征、术后吗啡用量（43.3±7.6 vs. 40.3±12.3 mg）和肠蠕动恢复时间（16.9±5 vs. 18.4±5.2小时）相似。昂丹司琼预防性用药组的总体恶心呕吐发生率显著低于未预防性用药组（52.9% vs. 88.2%，P < 0.05）。虽然单独恶心在预防性用药组中较高（41.2% vs. 29.4%），但伴有呕吐的恶心在预防性用药组中显著较低（11.8% vs. 58.8%，P < 0.01）。昂丹司琼组患者在所有时间的满意度评分均较高，且术后4小时差异有统计学意义（P < 0.05）。
在脊髓麻醉下使用静脉PCA吗啡的全腹子宫切除术患者中，PONV的发生率非常高（88.2%）。强烈建议在该患者群体中使用昂丹司琼进行预防性止吐治疗，这可降低恶心呕吐的发生率，并在术后早期显著提高患者满意度和生活质量。
