昂丹司琼联合地塞米松在预防腹腔镜胆囊切除术后恶心呕吐的临床观察

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1、昂丹司琼联合地塞米松在预防腹腔镜胆囊切除术后恶心呕吐的临床观察［摘要］目的探讨昂丹司琼联合地塞米松预防腹腔镜胆囊切除术后恶心呕吐(PONV)的临床效果。方法将我院收治的120例择期行腹腔镜胆囊切除术的患者随机分为对照组、单用昂丹司琼组和昂丹司琼联合地塞米松组各40例。观察PONV发生情况及不良反应情况。结果昂丹司琼联合地塞米松组的术后PONV发生率明显低于对照组和单用昂丹司琼组，昂丹司琼联合地塞米松组与单用昂丹司琼组不良反应发生率差异无统计学意义。结论昂丹司琼联合地塞米松预防腹腔镜胆囊切除PONV优于单

2、用昂丹司琼。［关键词］昂丹司琼；地塞米松；腹腔镜胆囊切除术；术后恶心呕吐［中图分类号］R657.4［文献标识码］B［文章编号］1673-9701(2011)33-157-02OndansetronCombinedwithDexamethasoneinthePreventionofNauseaandVomitingafterLlaparoscopicCholecystectomyA：ClinicalObservationZHANGFanZHANGHangLIFengDepartmentofAnesthes

3、iology,WushanDistrict,HangzhouFirstPeople'sHospitalinZhejiangProvinee,Hangzhou310002,China[Abstract]ObjectiveToinvestigatetheeffectofondansetroncombinedwithdexamethasoneincontrollingPONVafterlaparoscopiccholecystectomy.MethodsAllof120patientstreatedwithe

4、lectivelaparoscopiccholecystectomybyourhospital,wererandomlydividedintocontrolgroup,ondansetrongroupandtheondansetronwithdexamethasonegroup,40patientsineverygroup・theoccurreneeofPONVandadversereactionswasobserved・ResultsTheoccurrenceofPONVintheondansetro

5、nwithdexamethasonegroupwaslowerthanthecontrolgroupandtheondansetrongroup,buttherewerenostatisticaldiffereneeintheoccurreneeofadversereactionsamongOndansetronwithdexamethasoneandtheondansetrongroups.ConclusionOndansetronwithdexamethasonehavebettereffectin

6、controllingPONVafterlaparoscopiccholecystectomythanondansetronalone.[Keywords]Ondansetron;Dexamethasone；Laparoscopiccholecystectomy；Postoperativenauseaandvomiting腹腔镜胆囊切除术已经成为临床胆囊切除的主要手术方式，但由于术中麻醉药物残留及气腹C02气体的刺激和残留等因素，腹腔镜胆囊切除术后恶心呕吐（PONV）的发生率较常规腹部手术明显增高。通过

7、分析我院腹腔镜胆囊切除术患者行昂丹司琼联合地塞米松预防术后恶心呕吐的病例，探讨其联合应用在PONV中的临床效果，现报道如下。1资料与方法1.1临床资料选取我院2009年7月-2010年22月择期行腹腔镜胆囊切除术的患者220例，ASAITI级,男43例,女77例。年龄25~67岁，体重49~73kg。相关原发疾病包括：胆囊炎症及息肉68例，胆囊结石52例。术前各项临床及辅助检查无明显麻醉禁忌，无心肺功能异常及电解质紊乱病史。排除既往眩晕、术前恶心呕吐史的病人及手术时间超过lh的病例。随机分为三组:对照组

8、（A组）40例，单纯昂丹司琼组40例（B组）和昂丹司琼联合地塞米松组40例（C组）。三组病例在年龄、性别、体重等方面无明显统计学差异（P>0.05）o1.2方法所有患者术前诊断明确，完善相关检查，无明显麻醉禁忌。术前常规禁食、水，麻醉前在无禁忌下常规肌注苯巴比妥钠100mg和阿托品0.5mg。各组麻醉方式相同，均采用全凭静脉全身麻醉，麻醉诱导采用芬太尼（3~4）ug/kg>异丙酚2mg/kg>维库漠鞍0.15mg/kg,待快速诱导完全后行气