【作者】 王爽；

【导师】 刘钢；

【作者基本信息】 中国医科大学 ， 麻醉学（专业学位）， 2018， 硕士

【摘要】 目的:妇科腹腔镜手术术后恶心呕吐发生率高,本文旨在比较托烷司琼5mg和甲泼尼龙40mg+托烷司琼5mg对术后0-6h内PONV和术后6-72h内PONV的预防作用。方法:本双盲前瞻性研究共收集病例数294例,两组最终纳入研究的患者分别为托烷司琼组(T组)130人,托烷司琼+甲泼尼龙组(T+M组)127人。托烷司琼组术毕前静注托烷司琼5mg,托烷司琼+甲泼尼龙组术毕前静注甲泼尼龙40mg+托烷司琼5mg。记录两组患者术后0-6h、术后6-72h恶心和呕吐的发生情况以及Apfel评分为2分、3分、4分患者术后0-6h、术后6-72h恶心和呕吐的发生情况。记录患者术后疼痛情况和镇静情况。结果:妇科腹腔镜手术术后联合应用托烷司琼+甲泼尼龙可显著降低术后0-6h恶心和呕吐发生率(p<0.05),还可显著降低术后6-72h呕吐发生率(p<0.01),但对于6-72h恶心发生率无明显影响。术后0-6h内发生恶心主要为Apfel评分3分患者,联合应用托烷司琼+甲泼尼龙可显著降低其术后0-6h内恶心发生率(p<0.01),但对6-72h内恶心发生率影响不显著。联合应用托烷司琼+甲泼尼龙还可显著降低不同高危因素患者术后0-6h内呕吐发生率(p<0.05)。术后6-72h内发生呕吐主要为Apfel评分3分患者,联合应用托烷司琼+甲泼尼龙可显著降低其术后6-72h内呕吐发生率(p<0.05)。结论:甲泼尼龙联合托烷司琼对术后0-6h内的恶心及呕吐的预防效果较好,对术后6-72h内的呕吐有一定预防效果,但对6-72h内的恶心预防效果不佳。更多还原

【Abstract】 Objective: gynecological laparoscopy has a high risk of postoperative nausea and vomiting(PONV).Our aim is evaluate the effects of tropisetron and tropisetron combined methylprednisolone in prevention of postoperative nausea and vomiting in0-6h and 6-72 h after surgery.Methods: 294 patients were scheduled in this double blind,prospective study.Patients were divided into two groups,receiving 5mg tropisetron(group T,n=130);5mg tropisetron and 40 mg methylprednisolone(group T+M,n=127)according to exclusion criteria.PONV were assessment by direct questioning or spontaneous complaints by patients in 0-6h and 6-72 h after surgery.Furthermore,we evaluate the incidence of PONV in 0-6h and 6-72 h after surgery according to Apfel risk score of patients.Visual Analog Scale(VAS)and Ramsay score were recorded as postoperative pain and sedation evaluation.Results: The incidence of acute PONV was significantly lower in group T+M,compared with group T(p<0.05).The incidence of postoperative vomiting(POV)was significantly lower in group T+M in comparison with group T(p<0.01).The incidence of acute postoperative nausea(PON)was significantly lower in group T+M patients with Apfel score III,compared with those in group T(p<0.01).The incidence of acute POV was lower in group T+M in comparison with group T(p<0.05).The incidence of delayed POV is lower in group T+M in comparison with group T.Conclusion: Tropisetron combined with methylprednisolone showed a greater efficacy in the prevention of PONV in 0-6h after surgery and POV in 6-72 h after surgery compared to tropisetron in patients after gynecological laparoscopy.更多还原