Department of Anesthesiology, The First People's Hospital of Chenzhou, Institute of Translation Medicine, Chenzhou, 423000, Hunan, People's Republic of China.
J Anesth. 2012 Dec;26(6):864-9. doi: 10.1007/s00540-012-1443-1. Epub 2012 Aug 10.
Postoperative nausea and vomiting (PONV) are common complications after gynecological laparoscopic surgery. Because monotherapy with antiemetics is insufficient, combinations of various antiemetics are often recommended by experts. In this study, our purpose was to find out whether penehyclidine could enhance the efficacy of tropisetron in preventing PONV.
With hospital ethics committee approval, we investigated 120 women undergoing gynecological laparoscopic surgery receiving prophylactic tropisetron (0.1 mg/kg; maximal dose, 5 mg) (group T) or tropisetron (0.1 mg/kg; maximal dose, 5 mg) plus penehyclidine (0.01 mg/kg; maximal dose, 1 mg) (group TP), or penehyclidine (0.01 mg/kg; maximal dose, 1 mg) (group P). The incidence of vomiting, the intensity of nausea (assessed by a visual analogue scale [VAS]), antiemetic rescues, and adverse effects were recorded at 2, 6, 12, and 24 h after surgery in the gynecological ward by a visiting nurse anesthetist who was unaware of the treatments. Collected data were analyzed using analysis of variance (ANOVA) and the χ(2) test. Continuous variables were expressed as means ± SD, and non-continuous variables were expressed as n (%).
The overall incidence of vomiting was 28.3 % (34/120) in our study. The incidence of vomiting was significantly lower in group TP (4 cases, 10 %) than that in group T (12 cases, 30 %) and group P (18 cases, 45 %). The incidence of vomiting in group TP was also significantly lower than that in group T at 0-2 h and 2-6 h postoperatively and it was also significantly lower than that in group P at 0-2 h, 2-6 h, 6-12 h, and 12-24 h postoperatively. The incidence of vomiting was significantly lower in group T than that in group P at 12-24 h postoperatively. The VAS of nausea was significantly lower in group TP than that in group T and group P at 2 and 6 h after surgery. It also showed a significant higher score in group P than that at group T and group TP at 12 and 24 h. Within group P, the VAS of nausea was significantly lower at 2 h postoperatively than that at 24 h.
Penehyclidine showed less efficacy in preventing PONV than tropisetron; however, compared with tropisetron or penehyclidine monotherapy, prophylactic medication with tropisetron plus penehyclidine significantly reduced the incidence of vomiting and decreased the intensity of nausea in women undergoing gynecological laparoscopic surgery.
术后恶心呕吐（PONV）是妇科腹腔镜手术后常见的并发症。由于单独使用止吐药效果不佳，专家通常建议联合使用各种止吐药。本研究旨在探讨盐酸戊乙奎醚是否能增强托烷司琼预防 PONV 的效果。
本研究经医院伦理委员会批准，调查了 120 例行妇科腹腔镜手术的女性，她们分别接受托烷司琼（0.1mg/kg；最大剂量 5mg）（T 组）、托烷司琼（0.1mg/kg；最大剂量 5mg）加盐酸戊乙奎醚（0.01mg/kg；最大剂量 1mg）（TP 组）或盐酸戊乙奎醚（0.01mg/kg；最大剂量 1mg）（P 组）预防治疗。术后在妇科病房由一名不知道治疗方案的巡回护士麻醉师在 2、6、12 和 24 小时记录呕吐的发生情况、恶心的强度（用视觉模拟评分量表[VAS]评估）、止吐药的解救情况和不良反应。收集的数据采用方差分析（ANOVA）和 χ(2)检验进行分析。连续变量表示为均数±标准差，非连续变量表示为 n（%）。
本研究中，呕吐的总发生率为 28.3%（34/120）。TP 组（4 例，10%）的呕吐发生率明显低于 T 组（12 例，30%）和 P 组（18 例，45%）。TP 组的呕吐发生率在术后 0-2 小时和 2-6 小时也明显低于 T 组，在术后 0-2 小时、2-6 小时、6-12 小时和 12-24 小时也明显低于 P 组。T 组的呕吐发生率在术后 12-24 小时也明显低于 P 组。与 T 组和 P 组相比，TP 组术后 2 小时和 6 小时的恶心 VAS 评分明显较低。与 T 组和 TP 组相比，P 组在术后 12 小时和 24 小时的评分也明显较高。在 P 组中，术后 2 小时的恶心 VAS 评分明显低于术后 24 小时。
与托烷司琼相比，盐酸戊乙奎醚预防 PONV 的效果较差；然而，与托烷司琼或盐酸戊乙奎醚单药治疗相比，预防性使用托烷司琼加盐酸戊乙奎醚可显著降低妇科腹腔镜手术女性的呕吐发生率，减轻恶心程度。
