预防腹腔镜胆囊切除术后恶心呕吐：一项前瞻性、随机、双盲研究。
Preventing postoperative nausea and vomiting after laparoscopic cholecystectomy: a prospective, randomized, double-blind study.
作者信息
Arslan Mustafa, Ciçek Ramazan, Kalender Hülya Üstün, Yilmaz Hüseyin
机构信息
Department of Oral and Maxillofacial Surgery, Gazi University Faculty of Dentistry, Ankara, Turkey.
Department of Anaesthesiology and Reanimation, Yüksek İhtisas Hospital, Kırıkkale, Turkey.
出版信息
Curr Ther Res Clin Exp. 2011 Feb;72(1):1-12. doi: 10.1016/j.curtheres.2011.02.002.
BACKGROUND
Postoperative nausea and vomiting (PONV) are potential complications in patients after laparoscopic cholecystectomy (LC). Combination antiemetic therapy often is effective for preventing PONV in patients undergoing LC, and combinations of antiemetics targeting different sites of activity may be more effective than monotherapy.
OBJECTIVE
The aim of this study was to compare the administration of a subhypnotic dose of propofol combined with dexamethasone with one of propofol combined with metoclopramide to prevent PONV after LC.
METHODS
Sixty adult patients scheduled for LC were randomly assigned to 1 of 2 treatment groups. The patients in group 1 received 0.5 mg/kg propofol plus 8 mg dexamethasone, and those in group 2 received 0.5 mg/kg propofol plus 0.2 mg/kg metoclopramide. The number of patients experiencing nausea and vomiting at 0 to 4, 4 to 12, and 12 to 24 hours postoperatively and as well as additional use of rescue antiemetics were recorded.
RESULTS
The total PONV rates up to 24 hours postanesthesia were 23.3% and 50% for group 1 and group 2, respectively. Comparisons of the data revealed that at 0 to 4 hours, the number of patients experiencing vomiting was 6 (20%) in group 1 and14 (46.7%) in group 2 (P = 0.028). The frequency of vomiting in group 1 was significantly lower than that for group 2 (P = 0.028), and the rate of rescue antiemetic use in group 2 was higher than that in group 1 (20% vs 46.7%; P = 0.028). In the evaluation of PONV based on the nausea and vomiting scale scores, the mean PONV score was 0.4 (0.2) in group 1 compared with 1.0 (0.2) in group 2 (P = 0.017). There were no significant differences between the values at 4 to 12 hours and at 12 to 24 hours. The frequency of adverse reactions (respiratory depression: 1.3%, 1.3%; laryngospasm: 1.3%, 0%; cough: 1.3%, 0%; hiccup: 1.3%, 0%;) was not significantly different in the 2 groups.
CONCLUSIONS
Administration of a subhypnotic dose of 0.5 mg/kg propofol plus 8 mg dexamethasone at the end of surgery was more effective than administration of 0.5 mg/kg propofol plus metoclopramide in preventing PONV in the early postoperative period in adult patients undergoing LC.
背景
术后恶心呕吐（PONV）是腹腔镜胆囊切除术（LC）患者的潜在并发症。联合使用止吐疗法通常对预防LC患者的PONV有效，针对不同作用部位的止吐药联合使用可能比单一疗法更有效。
目的
本研究旨在比较亚催眠剂量丙泊酚联合地塞米松与丙泊酚联合甲氧氯普胺预防LC术后PONV的效果。
方法
60例计划行LC的成年患者被随机分为2个治疗组之一。第1组患者接受0.5mg/kg丙泊酚加8mg地塞米松，第2组患者接受0.5mg/kg丙泊酚加0.2mg/kg甲氧氯普胺。记录术后0至4小时、4至12小时和12至24小时出现恶心呕吐的患者数量以及急救止吐药的额外使用情况。
结果
麻醉后24小时内，第1组和第2组的总PONV发生率分别为23.3%和50%。数据比较显示，在0至4小时，第1组有6例（20%）患者出现呕吐，第2组有14例（46.7%）患者出现呕吐（P = 0.028）。第1组的呕吐频率显著低于第2组（P = 0.028），第2组急救止吐药的使用比例高于第1组（20%对46.7%；P = 0.028）。根据恶心呕吐量表评分评估PONV时，第1组的平均PONV评分为0.4（0.2），第2组为1.0（0.2）（P = 0.017）。在4至12小时和12至24小时的值之间没有显著差异。两组不良反应的发生率（呼吸抑制：1.3%，1.3%；喉痉挛：1.3%，0%；咳嗽：1.3%，0%；呃逆：1.3%，0%）没有显著差异。
结论
在接受LC的成年患者中，手术结束时给予0.5mg/kg亚催眠剂量的丙泊酚加8mg地塞米松在预防术后早期PONV方面比给予0.5mg/kg丙泊酚加甲氧氯普胺更有效。
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