评价盐酸戊乙奎醚用于预防全凭静脉麻醉下丙泊酚-瑞芬太尼用于甲状腺切除术患者术后恶心呕吐。
Evaluation of penehyclidine for prevention of post operative nausea and vomitting in patients undergoing total thyroidectomy under total intravenous anaesthesia with propofol-remifentanil.
机构信息
Department of Anesthesiology and Perioperative Medicine, First Affiliated Hospital with Nanjing Medical University, Nanjing, 210029, Jiangsu, China.
出版信息
BMC Anesthesiol. 2022 Oct 14;22(1):317. doi: 10.1186/s12871-022-01857-5.
BACKGROUD
Postoperative nausea and vomiting (PONV) is one of the most common complications after total thyroidectomy under general anesthesia. Total intravenous anesthesia (TIVA) has been documented to prevent PONV in patients undergoing total thyroidectomy. Penehyclidine, an anticholinergic agent with an elimination half-life of over 10 h, is widely used as premedication to reduce glandular secretion. This study aimed to explore the preventative effects of penehyclidine with propofol-remifentanil-TIVA to single-TIVA on PONV in patients undergoing total thyroidectomy.
METHODS
A total of 100 patients scheduled for total thyroidectomy were randomly assigned to either the penehyclidine group (n = 50) or TIVA group (n = 50). Propofol and remifentanil were was used for TIVA in all patients. No patients who received premedication. Patients were administrated with either 5 ml of normal saline or 0.5 mg of penehyclidine soon after anesthesia induction. The incidence of nausea and vomiting, the severity of nausea, the requirement of rescue antiemetics, and adverse effects were investigated during the first 24 h in two time periods (0-2 h and 2-24 h).
RESULTS
The overall PONV incidence during the 24 h after surgery was significantly lower in the penehyclidine group compared with the TIVA group (12% vs 36%, P < 0.005). Besides, the incidence of nausea and the incidence of vomiting were significantly lower in the penehyclidine group compared with the TIVA group at 2-24 h after surgery. However, there was no significant difference between the two groups at 0-2 h after surgery.
CONCLUSIONS
Administration of penehyclidine under TIVA with propofol-remifentanil is more effective for prevention of PONV than TIVA alone, especially 2-24 h after total thyroidectomy.
TRIAL REGISTRATION
https://www.chictr.org.cn/edit.aspx?pid=132463&htm=4 (Ref: ChiCTR2100050278, the full date of first registration: 25/08/2021).
背景
全麻下甲状腺全切除术后恶心呕吐（PONV）是最常见的并发症之一。全凭静脉麻醉（TIVA）已被证明可预防甲状腺全切除术患者发生 PONV。盐酸戊乙奎醚作为一种半衰期超过 10 小时的抗胆碱能药物，被广泛用作预防腺体分泌的术前用药。本研究旨在探讨盐酸戊乙奎醚复合丙泊酚-瑞芬太尼 TIVA 对甲状腺全切除术后患者PONV 的预防作用。
方法
选择拟行甲状腺全切除术的 100 例患者，随机分为盐酸戊乙奎醚组（n=50）和 TIVA 组（n=50）。所有患者均采用丙泊酚和瑞芬太尼进行 TIVA。两组患者均未接受术前用药。麻醉诱导后，患者分别给予生理盐水 5ml 或盐酸戊乙奎醚 0.5mg。观察两组患者在 0-2h 和 2-24h 两个时间段内（术后 0-2h 和术后 2-24h）恶心呕吐的发生率、恶心程度、需要使用解救性止吐药的情况以及不良反应。
结果
术后 24h 内，盐酸戊乙奎醚组恶心呕吐的总发生率明显低于 TIVA 组（12%比 36%，P<0.005）。此外，与 TIVA 组相比，盐酸戊乙奎醚组术后 2-24h 的恶心发生率和呕吐发生率明显降低。然而，两组在术后 0-2h 时无显著差异。
结论
与单独使用 TIVA 相比，在丙泊酚-瑞芬太尼 TIVA 中使用盐酸戊乙奎醚预防 PONV 更为有效，特别是在甲状腺全切除术后 2-24h。
试验注册
https://www.chictr.org.cn/edit.aspx?pid=132463&htm=4（参考：ChiCTR2100050278，首次注册完整日期：2021 年 8 月 25 日）。
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