Chaudhary Sujata, Sethi A K, Motiani Poonam, Adatia Chirag
Department of Anaesthesiology & Critical Care, University College of Medical Sciences & Guru Teg Bahadur Hospital, Delhi, India.
Indian J Med Res. 2008 Jun;127(6):577-81.
BACKGROUND & OBJECTIVE: Post-operative nausea and vomiting (PONV) is a frequent complication and may be a reason for increased morbidity and cost of treatment. Following elective surgery, it is believed to result from gut ischaemia consequent to hypovolemia from overnight fasting. This study was carried out to study the effects of pre-operative intravenous fluid supplementation, either crystalloids or colloids, on PONV.
In this prospective randomized clinical trial, 60 female patients undergoing elective open cholecystectomy were randomly allocated to three equal groups A, B and C. All patients received preoperative fluid supplementation. Group A patients received 2 ml/kg Ringer lactate iv (intravenously) and served as control, Group B patients received 12 ml/kg Ringer lactate iv whereas Group C patients received 12 ml/kg of 4.5 per cent hydroxyethylstarch (Hetastarch) iv. All patients underwent cholecystectomy under standard anaesthesia technique with intraoperative fluid replacement by Ringer's lactate (6 ml/kg/h). An independent blinded observer assessed PONV during first 24 h following surgery using visual analogue scale (VAS) score (0 = no nausea, 10 = worst imaginable nausea or vomiting). Rescue antiemetic was given whenever VAS was > 5.
The three groups were comparable in terms of age, body weight and duration of surgery. VAS scores in Groups B and C patients were less than that of Group A patients at all time intervals post-operatively and became significantly different at 4 h post-operatively. The VAS scores of Groups B and C patients were comparable throughout. A significantly large number (90%) of Group A patients required rescue antiemetic as compared to 50 and 55 per cent patients in Group B and Group C, respectively.
INTERPRETATION & CONCLUSION: Pre-operative intravenous fluid supplementation using crystalloids and colloids results in significantly decreased incidence of PONV. Both, crystalloids as well as colloids were found to be equally effective in preventing PONV.
术后恶心呕吐（PONV）是一种常见并发症，可能是导致发病率增加和治疗费用上升的原因。择期手术后，人们认为这是由于夜间禁食导致血容量不足进而引起肠道缺血所致。本研究旨在探讨术前静脉补充晶体液或胶体液对PONV的影响。
在这项前瞻性随机临床试验中，60例择期行开腹胆囊切除术的女性患者被随机分为A、B、C三组，每组人数相等。所有患者均接受术前补液。A组患者静脉输注2 ml/kg乳酸林格液作为对照组，B组患者静脉输注12 ml/kg乳酸林格液，C组患者静脉输注12 ml/kg的4.5%羟乙基淀粉（贺斯）。所有患者均在标准麻醉技术下接受胆囊切除术，术中用乳酸林格液（6 ml/kg/h）补充液体。一名独立的盲法观察者使用视觉模拟评分法（VAS）（0 = 无恶心，10 = 难以想象的严重恶心或呕吐）在术后24小时内评估PONV情况。当VAS评分>5时给予补救性止吐药。
三组患者在年龄、体重和手术时间方面具有可比性。术后各时间点B组和C组患者的VAS评分均低于A组患者，且在术后4小时差异有统计学意义。B组和C组患者的VAS评分在整个过程中相当。与B组和C组分别有50%和55%的患者相比，A组中需要补救性止吐药的患者比例显著更高（90%）。
术前静脉补充晶体液和胶体液可显著降低PONV的发生率。晶体液和胶体液在预防PONV方面同样有效。
