Kasagi Yoshihiro, Hayashida Masakazu, Sugasawa Yusuke, Kikuchi Iwaho, Yamaguchi Keisuke, Okutani Ryu, Takeda Satoru, Inada Eiichi
Department of Anesthesiology and Pain Medicine, Juntendo University Faculty of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan,
J Anesth. 2013 Dec;27(6):879-84. doi: 10.1007/s00540-013-1630-8. Epub 2013 May 11.
We examined the effects of dexamethasone, droperidol, naloxone, and a combination of these three agents on postoperative nausea and vomiting (PONV) in female patients.
In this randomized, controlled study, 120 female patients with ASA PS I or II undergoing laparoscopic gynecological surgery were randomly allocated into four groups. Patients received dexamethasone 8 mg (Dx group) or droperidol 1 mg (Dr group) before induction of general anesthesia. Anesthesia was induced and maintained with propofol and remifentanil. Postoperative analgesia was provided by intravenous patient-controlled analgesia using a disposable infusion pump filled with fentanyl 20 μg/kg alone (Dx group), fentanyl 20 μg/kg with droperidol 2 mg (Dr group), fentanyl 20 μg/kg with naloxone 0.1 mg (Nx group), or fentanyl 20 μg/kg with droperidol 2 mg and naloxone 0.1 mg (Cm group) in a total volume of 80 ml, with a constant infusion rate of 4 ml/h and a bolus dose 2 ml with a 30-min lockout time.
The number of patients who developed PONV and required a rescue antiemetic was significantly less in the Cm group than in the Nx group (p < 0.001 for all). The incidence of PONV was 43, 43, 70, and 17 % in the Dx, Dr, Nx, and Cm groups, respectively.
A combination of naloxone, droperidol, and dexamethasone was effective for preventing PONV in patients receiving fentanyl for postoperative analgesia after laparoscopic gynecological surgery, although further investigations are required to examine the effect of adding naloxone to other antiemetics.
我们研究了地塞米松、氟哌利多、纳洛酮以及这三种药物联合使用对女性患者术后恶心呕吐（PONV）的影响。
在这项随机对照研究中，120例美国麻醉医师协会（ASA）分级为Ⅰ或Ⅱ级、接受腹腔镜妇科手术的女性患者被随机分为四组。患者在全身麻醉诱导前接受8毫克地塞米松（Dx组）或1毫克氟哌利多（Dr组）。麻醉诱导和维持采用丙泊酚和瑞芬太尼。术后镇痛通过静脉自控镇痛提供，使用一次性输液泵，其中单独填充20微克/千克芬太尼（Dx组）、20微克/千克芬太尼加2毫克氟哌利多（Dr组）、20微克/千克芬太尼加0.1毫克纳洛酮（Nx组）或20微克/千克芬太尼加2毫克氟哌利多和0.1毫克纳洛酮（Cm组），总体积80毫升，恒定输注速率4毫升/小时，推注剂量2毫升，锁定时间30分钟。
Cm组发生PONV并需要使用抢救性止吐药的患者数量显著少于Nx组（所有比较p<0.001）。Dx、Dr、Nx和Cm组的PONV发生率分别为43%、43%、70%和17%。
纳洛酮、氟哌利多和地塞米松联合使用对接受芬太尼进行腹腔镜妇科手术后镇痛的患者预防PONV有效，尽管需要进一步研究以检验将纳洛酮添加到其他止吐药中的效果。
