Departments of Anesthesiology, Duke University Medical Center, Durham, North Carolina; Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada; and Carver College of Medicine, University of Iowa, Iowa City, Iowa.
Obstet Gynecol. 2013 Mar;121(3):615-623. doi: 10.1097/AOG.0b013e3182839fee.
To estimate whether the addition of metoclopramide or its combination with ondansetron to a prophylactic phenylephrine infusion provides improved intraoperative nausea and vomiting prophylaxis compared with phenylephrine infusion alone.
Women scheduled for elective cesarean delivery were randomized to one of three groups: placebo (placebo plus placebo); metoclopramide (metoclopramide 10 mg plus placebo); or combination (metoclopramide 10 mg plus ondansetron 4 mg). The first study drug was administered before spinal placement and the second was administered after cord clamping. Spinal anesthesia was standardized. The primary outcome was intraoperative nausea and vomiting.
Three-hundred patients completed the study in two centers. Intraoperative nausea and vomiting occurred in 49%, 31%, and 23% of patients in the placebo, metoclopramide, and combination groups, respectively (P<.001). There was a significant difference between the two centers in exteriorization of the uterus (93% compared with 39%; P<.001) and intraoperative nausea and vomiting rates (47% compared with 20%; P<.001). In a multivariable model adjusting for center, exteriorization of the uterus, age, and hypotension, intraoperative nausea and vomiting were significantly lower in the metoclopramide and combination groups compared with placebo (odds ratio [OR] 2.34, 95% confidence interval [CI] 1.24--4.42; P=.001 and OR 4.06, 95% CI 2.06--7.97; P<.001, respectively). Postoperative nausea and vomiting were reduced with the combination compared with placebo at 2 hours (39% compared with 20%; P<.017), but not at 2-6 hours or at 6-24 hours.
Metoclopramide with ondansetron reduced intraoperative nausea and vomiting and early postoperative nausea and vomiting compared with placebo. Metoclopramide alone also decreased intraoperative but not postoperative nausea and vomiting. Surgical factors contributed to a significant difference in intraoperative nausea and vomiting between the two centers.
评估甲氧氯普胺或其与昂丹司琼联合应用于预防性苯肾上腺素输注是否比单独使用苯肾上腺素输注更能改善术中恶心和呕吐的预防效果。
择期行剖宫产术的妇女被随机分为三组：安慰剂（安慰剂加安慰剂）；甲氧氯普胺（甲氧氯普胺 10mg 加安慰剂）；或联合用药（甲氧氯普胺 10mg 加昂丹司琼 4mg）。第一次研究药物在脊髓放置前给予，第二次在脐带夹闭后给予。脊髓麻醉标准化。主要结局是术中恶心和呕吐。
在两个中心完成研究的 300 名患者中，安慰剂组、甲氧氯普胺组和联合组患者分别有 49%、31%和 23%发生术中恶心和呕吐（P<.001）。两个中心之间在子宫外展（93%比 39%；P<.001）和术中恶心呕吐发生率（47%比 20%；P<.001）方面存在显著差异。在调整中心、子宫外展、年龄和低血压的多变量模型中，甲氧氯普胺组和联合组的术中恶心和呕吐明显低于安慰剂组（比值比[OR] 2.34，95%置信区间[CI] 1.24-4.42；P=.001 和 OR 4.06，95% CI 2.06-7.97；P<.001）。与安慰剂相比，联合用药组在术后 2 小时（39%比 20%；P<.017）时减少了术后恶心呕吐，但在 2-6 小时或 6-24 小时时没有减少。
与安慰剂相比，甲氧氯普胺联合昂丹司琼可减少术中恶心和呕吐以及术后早期恶心和呕吐。甲氧氯普胺单独使用也可减少术中但不减少术后恶心和呕吐。手术因素导致两个中心之间术中恶心和呕吐发生率存在显著差异。
