昂丹司琼用于预防术中术后呕吐的临床观察

目的减少术中、术后恶心、呕吐率,降低手术、麻醉的风险,提高患者术后顺应性。方法自2008年1月起,对实行妇科手术的80例患者于术中、术后应用昂丹司琼预防恶心、呕吐为观察组,并与2007年同期实行妇科手术的100例没有预防性使用止吐药的患者相比较。结果观察组术中、术后恶心、呕吐率明显降低,P<0.01。结论应用昂丹司琼预防术中、术后恶心、呕吐的发生疗效确切,不良反应小,是较安全、有效预防恶心、呕吐的方法。     

骨科手术患者全麻后恢复室常见并发症的观察与护理

目的观察骨科手术患者全麻术后常见并发症及处理效果。方法回顾我院2014年6月1日至2014年7月31日行全麻骨科手术患者,排除未进入麻醉恢复室(PACU)观察者,余下患者完全苏醒后即进行疼痛评分,记录VAS>3分、恶心呕吐、寒战、嗜睡、谵妄、液体脱落、低氧血症等并计算发生率,根据不同麻醉方式、不同手术、性别、年龄分类分析常见不良事件的发生率及护理措施。结果 1437例患者中83%的患者采用全身麻醉联合神经阻滞麻醉(GN组),17%的患者采用全身麻醉(G组)。两组患者手术构成情况明显不同,G组(全身麻醉)以脊柱手术为主,GN组(全身麻醉联合神经阻滞麻醉)以四肢手术为主(P<0.05)。G组患者术后疼痛、寒战、谵妄的发生率明显高于GN组(P<0.05),其他不良反应发生率两组比较无统计学差异。脊柱手术术后疼痛发生率最高(56.91%),其次为肩关节、髋关节及骨盆手术(分别为37.5%、35.44%、25%),明显高于上下肢手术的4.42%、5.67%(P<0.05)。女性患者寒战发生率明显高于男性(P<0.05)。老年患者疼痛、瞻望、嗜睡、低氧血症、液体脱落发生率均明显高于其他年龄阶段患者(P<0.05)。结论全身麻醉联合神经阻滞麻醉可显著减少PACU内不良反应的发生率;术后不良反应类型及发生率与患者性别、年龄、手术部位有关。加强麻醉恢复室观察与护理,可使骨科手术患者平稳度过围手术期。     

腰硬联合麻醉与全身麻醉在老年股骨颈骨折手术中的应用作用比较

目的探讨腰硬联合麻醉与全身麻醉在老年股骨颈骨折手术中的应用作用。方法选择2015年3月至2016年3月我院收治的100例股骨颈骨折的老年患者作为研究对象,按照麻醉方式的不同将患者分为两组,对照组48例,进行全身麻醉;观察组52例,进行腰硬联合麻醉,比较两组患者的麻醉效果。结果观察组患者术后麻醉起效时间、术后意识恢复时间以及术后完全清醒时间均短于对照组;观察组患者在麻醉结束后24 h MMS评分恢复原有水平,对照组患者则在麻醉后72 h才恢复,相同时间内两组患者MMS评分恢复程度差异具有统计学意义(P<0.05);观察组患者VAS评分显著低于对照组,且恶心呕吐、头晕嗜睡以及肺部感染等并发症的发生率也显著低于对照组(P<0.05)。结论腰硬联合麻醉比全身麻醉在老年股骨颈骨折手术中的应用效果更好,起效快术后恢复好,且术后并发症的发生率更低,安全性高,实用性强,值得临床推荐。     

术中液体治疗量对100例妇科腔镜患者术后恶心呕吐的观察

目的　比较术中补充30 ml/kg乳酸林格液与10 ml/kg乳酸林格液的妇科腔镜患者术后恶心呕吐的发生率。方法　选择100名ASAⅠ~Ⅱ级择期行妇科腔镜不孕查因的患者, 随机分为两组, Ⅰ组患者入手术室至手术结束出麻醉恢复室前共接受30 ml/kg 乳酸林格液, Ⅱ组患者入手术室至手术结束出麻醉恢复室前接受10 ml/kg乳酸林格液, 观察术后发生恶心呕吐的患者例数及需要补救止吐药例数。结果　两组患者年龄、体重、禁食时间、手术操作时间差异无显著性; 术后48h恶心呕吐发生率, 30 ml/kg组较10 ml/kg组明显降低(P<0 05),需要补救止吐药人数30 ml/kg组较10 ml/kg组明显降低(P<0 05)。结论　与输注10 ml/kg乳酸林格液相比,术中输注30 ml/kg乳酸林格液可以降低妇科腔镜患者术后恶心呕吐的发生率。     

昂丹司琼与地塞米松联用对腹腔镜妇科手术术后恶心呕吐疗效分析

<正>术后恶心呕吐(PONV)是术后常见的并发症之一。随着外科和麻醉技术的进步,PONV的发生率有所降低,但依然存在。影响PONV的因素有患者特征、麻醉技术、手术类型和术后护理,其中腹腔镜手术和女性为PONV的高危因素~([1,2])。昂丹司琼是临床常用的一类止吐药,其作用机制为选择性阻断神经末梢的5-羟色胺3(5-HT3)受体,从而达到     

硬膜外麻醉与全身麻醉对老年骨科手术患者短期认知功能的影响对比

目的：对比硬膜外麻醉与全身麻醉对老年骨科手术患者短期认知功能的影响。方法老年骨科手术患者148例随机分成两组,74例观察组予硬膜外麻醉,74例对照组予全身麻醉,比较两组麻醉前、麻醉后术前、术中及术后的心率情况,以及术后12、24、72 h的MMSE评分。结果观察组麻醉前、麻醉后术前、术中及术后的心率均低于对照组(P<0.05);且观察组术后12、24、72 h的MMSE评分均高于对照组(P<0.05)。结论硬膜外麻醉较全身麻醉对老年骨科手术患者短期认知功能的影响更小。     

硬膜外麻醉和气管插管全身麻醉在老年患者髋部骨折手术中的应用效果比较

目的探讨硬膜外麻醉和气管插管全身麻醉在老年患者髋部骨折手术中的应用效果比较。方法将68例髋部骨折老年患者随机均分为实验组和对照组,实验组采用硬膜外麻醉,对照组则采用气管插管全身麻醉,比较两组患者的镇痛效果,及其术后并发症发生情况,并记录所得数据。结果相比于对照组,实验组低血压发生率较高(P<0.05),高血压发生率则较低(P<0.05);与对照组比较,实验组术后镇痛效果更优,不良反应发生率明显低(P<0.05)。结论在进行髋部骨折手术中,硬膜外麻醉和气管插管全身麻醉都可以起到较好的麻醉及术后镇痛效果,但硬膜外麻醉的术后镇痛效果更佳,且不良反应率更低,值得在临床上进一步应用。     

比较三种麻醉方式下乳腺癌改良根治术后恶心呕吐的发生率

目的探讨比较三种麻醉方式下乳腺癌改良根治术后恶心呕吐的发生率。方法本次医学观察选择150例2009年1月至2011年12月之间在我院就诊的乳腺癌改良根治术患者为观察对象,随机将其分为E、P、S三组,并分别行硬膜外麻醉、静脉全身麻醉和吸入全麻醉,对比三组患者术后恶心呕吐发生率。结果三组患者PONV发生率、止吐药使用率、镇痛药使用率、手术时间和麻醉时间等手术指标对比均具有明显的统计学意义(P<0.05)。结论由本次临床研究结果可见,乳腺癌改良根治术患者行单纯的硬膜外麻醉,具有较为满意的麻醉效果,因而临床应用价值较高。     

老年骨科手术患者行全身麻醉和硬膜外麻醉对术后认知功能的影响

目的观察老年骨科手术患者行全身麻醉和硬膜外麻醉对术后认知功能的影响。方法选择200例行骨科大手术的老年患者,分为观察组和对照组各100例,观察组行硬膜外麻醉,对照组行全身麻醉,使用简易精神状况检查量表(MMSE)对2组老年患者麻醉前后的不同时间点认知功能进行评估。结果两组患者麻醉前MMSE评分无统计学差异(P>0.05);对照组麻醉后6、12、24 h的MMSE评分与本组麻醉前比较存在明显差异(均P<0.01);观察组麻醉后6、12 h的MMSE评分与本组麻醉前比较存在明显差异(均P<0.01);两组患者麻醉后12、24 h的MMSE评分存在明显差异(P<0.01)。结论老年骨科手术患者行全身麻醉和硬膜外麻醉后24 h内均出现认知功能障碍,全身麻醉对术后认知功能的影响更明显。     

全身麻醉与腰硬联合麻醉对老年患者术后认知功能的影响比较

目的探讨全身麻醉和腰硬联合麻醉对老年手术患者术后认知功能的影响。方法回顾性分析我院2012年~2014年收治的90例老年手术患者的资料,按照患者麻醉方式分为观察组与对照组,各45例,观察组患者采用腰硬联合麻醉,对照组患者采用全身麻醉,两组患者术前、术后即刻、术后3 d、术后7 d,采用简易智力状态检查(MSE)方法对患者认知功能进行评定。比较两组患者术后认知功能障碍发生率。结果观察组患者术后认知功能障碍发生率低,与对照组患者比较差异有统计学意义(P<0.05);观察组患者术后即刻、术后3 d MMSE评分高于对照组,比较差异有统计学意义(P<0.05),两组患者术后7d MMSE评分比较无明显差异,无统计学意义(P>0.05)。结论老年手术患者全身麻醉后早期MMSE评分降低,容易出现认知功能障碍,腰硬联合麻醉患者术后能早期恢复认知功能,在临床工作中,要根据患者的具体情况及手术方案,制定麻醉方法。     

Current review of ramosetron in the prevention of postoperative nausea and vomiting

Postoperative nausea and vomiting (PONV) are distressing and frequent adverse events of anesthesia and surgery. Serotonin receptor antagonists (SRAs), including ondansetron, granisetron, tropisetron, dolasetron, and ramosetron, effectively decrease the incidence of PONV. Among these SRAs, ramosetron is the most effective antiemetic for the prophylaxis against PONV in terms of the inhibitory potency, binding rate, and stabilizing its pharmacological activity. This review article focused on the efficacy of ramosetron for preventing PONV in adults and postoperative vomiting (POV) in children. Because of young age of pediatric patients, nausea was not assessed a separate entity. MEDLINE (PubMED) and EMBASE (January 1990 - September 2010) were searched for randomized, double-blind, (placebo-controlled), studies (written in English) of ramosetron for preventing PONV in adults and POV in children. The incidence of PONV during 0-24 h after anesthesia was less in patients receiving ramosetron 0.3 mg than in those receiving placebo, in adults undergoing gynecologic surgery, dilatation and curettage, laparoscopic cholecystectomy, middle ear surgery, thyroidectomy, and total hip/knee replacement. The incidence of POV during 0-24 h after anesthesia was less in pediatric patients receiving ramosetron 6 mcg kg(-1) than in those receiving placebo, in children undergoing strabismus surgery and tonsillectomy. In adults, the most commonly reported adverse effect was headache (5-20%). In children, clinically serious adverse events, such as excessive sedation and extrapyramidal symptoms, were not observed. Prophylactic therapy with ramosetron is effective for preventing PONV in adults and POV in children without clinically serious adverse effects.     

The benefits and risks of different therapies in preventing postoperative nausea and vomiting in patients undergoing thyroid surgery

Postoperative nausea and vomiting (PONV) are distressing and frequent adverse events of anesthesia and surgery, with a relatively high incidence following thyroidectomy. These symptoms predispose to aspiration of gastric contents, increased intraocular pressure, psychological distress, and delayed recovery and discharge times. Numerous antiemetics have been studied for the prevention and treatment of PONV following thyroidectomy. These drugs include butyrophenones (e.g., droperidol), benzamides (e.g., metoclopramide), antihistamines (e.g., dimenhydrinate), corticosteroids (e.g., dexamethasone), propofol, oxygen, and serotonon receptor antagonists (e.g., ondansetron). Most of published trials indicate improved prophylaxis against PONV by avoiding risk factors and/or by using effective antiemetic therapy in patients scheduled for thyroid surgery. Traditional antiemetics (droperidol, metoclopramide, and alizapride), non-traditional antiemetics (propofol and dexamethasone), and serotonin receptor antagonists (ondansetron, granisetron, tropisetron, dolasetron, and ramosetron) have been studied for the prevention of PONV. Serotonin receptor antagonists are more effective than traditional antiemetics. Combination antiemetic therapy with granisetron plus droperidol or granisetron plus dexamethasone is highly effective in preventing PONV. The benefits and risks of different therapies are needed to prevent PONV following thyroid surgery.     

托烷司琼对老年患者行妇科腹腔镜术后恶心呕吐的预防作用

目的观察新型5-羟色胺(5-HT3)受体拮抗剂托烷司琼预防老年患者行妇科腹腔镜术后恶心呕吐的临床效果。方法采用随机、安慰剂对照和双盲的研究方法,将90例择期行腹腔镜下妇科手术老年患者分成3组:托烷司琼5mg组(T组)、格拉司琼3mg组(G组)和0.9%氯化钠注射液对照组(S组),每组30例。麻醉诱导均采用咪达唑仑、舒芬太尼、罗库溴铵、丙泊酚,气管插管后接麻醉机行机械通气。麻醉维持采用持续泵注丙泊酚,间断静脉滴注罗库溴铵、舒芬太尼维持。术毕入麻醉复苏室(PACU),专人负责观察患者,记录术后恶心、呕吐程度评分。结果 T组和G组恶心呕吐发生率明显低于S组(P<0.05),而T组和G组2组之间则差异无统计学意义(P>0.05)。结论托烷司琼能够有效预防妇科腹腔镜手术老年患者恶心呕吐发生,并降低其严重程度。     

小剂量氟哌利多在预防妇科腹腔镜术后恶心呕吐的效果观察

目的:探讨腹腔镜手术中给予小剂量氟哌利多对术后恶心呕吐(postoperative nausea and vomiting,PONV)的预防效果.方法:选择200例ASA Ⅰ～Ⅱ级择期妇科腹腔镜手术患者,随机分为两组:术中给予氟哌利多组(F组)和对照组(D组).两组患者的麻醉诱导方法、麻醉维持药物及术中输液管理方法均相同,F组术毕前30 min给予氟哌利多1 mg,D组术毕前30 min给予生理盐水1mL.观察术后24h内恶心呕吐的发生情况、氟哌利多不良反应及其他全麻并发症.术中心电图监测有异常者和术后苏醒延迟、呼吸道梗阻、血流动力学不稳定(低血压或高血压)、术中知晓等并发症者剔除本研究.结果:两组患者均未出现锥体外系反应等氟哌利多的不良反应,两组患者PONV发生率F组为12.9％,D组为38.5％,比较两组差异有极显著性(P＜0.01);PONV程度分级构成比比较两组差异有极显著性(P＜0.01).结论:术中给予小剂量氟哌利多能显著降低PONV发生率,减轻恶心呕吐的程度,是一种安全、有效、经济的预防PONV的措施,值得在基层医院推广应用.     

瑞芬太尼联合异丙酚或依托咪酯全麻对腹腔镜妇科手术后恶心呕吐的影响

目的：观察瑞芬太尼联合异丙酚或依托咪酯全麻对腹腔镜妇科手术后恶心呕吐的影响。方法：择期全麻下行腹腔镜妇科手术病人80例,ASA分级Ⅰ～Ⅱ级,心肺功能正常。随机分成瑞芬太尼-异丙酚组（RP组）和瑞芬太尼-依托咪酯组（RE组）各40例。两组全麻诱导用药相同,维持麻醉RP组采用瑞芬太尼联合异丙酚,RE组采用瑞芬太尼联合依托咪酯。术后24h内观察并评估术后恶心呕吐（PONV）发生率及程度;记录需要昂丹司酮止吐治疗的病人例数。结果：RP组术后PONV发生率为20.0%,RE组为37.5%,两组比较差异有统计学意义（P〈0.05）。结论：气管内插管全麻行腹腔镜妇科手术时,瑞芬太尼联合异丙酚能降低PONV的发生率。     

地塞米松对矫形术后患者吗啡自控镇痛引起恶心呕吐的影响

目的:研究静注地塞米松10 mg对矫形术后患者吗啡自控镇痛(PCA)相关的恶心呕吐的影响.方法:87名女性矫形手术患者随机分成静注地塞米松10 mg组和静注 0.9%氯化钠注射液组,观察术后24 h内恶心呕吐和对抗吐药需求、反应情况.结果:静注地塞米松组非常显著地减轻了由PCA引起的恶心呕吐(P<0.001)和对抗吐药的需求(P<0.01),并且抗吐药对病人比 0.9%氯化钠注射液组有显著性疗效 (无恶心呕吐和术后24 h不再需求应用抗吐药)(P<0.05).结论:在女性矫形手术后24 h,地塞米松10 mg可用于预防PCA相关的恶心呕吐.     

The utility of antiemetics in the prevention and treatment of postoperative nausea and vomiting in patients scheduled for laparoscopic cholecystectomy

Postoperative nausea and vomiting (PONV) are distressing and frequent adverse events of anesthesia and surgery, with a relatively high incidence after laparoscopic cholecystectomy. Numerous antiemetics have been studied for the prevention and treatment of PONV in patients scheduled for laparoscopic cholecystectomy. Traditional antiemetics, including anticholinergics (e.g., scopolamine), antihistamines (e.g., dimenhydrinate), phenothiazines (e.g., promethazine), butyrophenones (e.g., droperidol), and benzamide (e.g., metoclopramide), are used for the control of PONV. The available nontraditional antiemetics for the prophylaxis against PONV are dexamethasone and propofol. Serotonin receptor antagonists (ondansetron, granisetron, tropisetron, dolasetron, and ramosetron), compared with traditional antiemetics, are highly efficacious for PONV. The prophylactic ondansetron, granisetron, tropisetron, and dolasetron in antiemetic efficacy are comparable. Ramosetron is effective for the long-term prevention of PONV. None of the available antiemetics is entirely effective, perhaps because most of them act through the blockade on one type of receptor. There is a possibility that combined antiemetics with different sites of activity would be more effective than one drug alone for the prophylaxis against PONV. Combination antiemetic therapy is often effective for the prevention of PONV following laparoscopic cholecystectomy. The efficacy of a combination of serotonin receptor antagonists (ondansetron and granisetron) and droperidol is superior to monotherapy with a serotonin receptor antagonist or droperidol. Similarly, adding dexamethasone to ondansetron or granisetron improves antiemetic efficacy in PONV. Knowledge regarding antiemetics is necessary to completely prevent and treatment of PONV in patients scheduled for laparoscopic cholecystectomy.     

帕洛诺司琼对舒芬太尼胸腔镜术后镇痛期呕吐的防治

目的探讨帕洛诺司琼对舒芬太尼胸腔镜术后镇痛期恶心呕吐的防治效果。方法将80例胸腔镜手术患者按照随机数字表法均分为观察组和对照组,2组患者麻醉方法相同,观察组于切皮前10min静脉注射帕洛诺司琼0.25mg,对照组切皮前10min静脉注射托烷司琼5mg,比较2组患者手术的一般情况、血流动力学变化及术后恶心呕吐(PONV)发生率。结果 2组患者手术时间、麻醉时间和镇痛药用量等比较,差异均无统计学意义;2组患者手术各时段平均动脉压(MAP)和心率(HR)的变化差异无统计学意义。2组患者术后视觉模拟疼痛(VAS)评分呈先升高后降低趋势,其中2组t2、t3、t4时VAS评分显著高于t1时段(P<0.05),2组间术后各时段VAS评分比较,差异无统计学意义;2组患者t1~t4时PONV发生率逐渐升高,观察组t3、t4时PONV发生率显著低于对照组(P<0.05),2组t1、t2时PONV发生率比较,差异无统计学意义(P<0.05);2组患者不良反应发生率比较,差异无统计学意义(χ~2=2.222,P=0.136)。结论帕洛诺司琼和托烷司琼能够降低舒芬太尼胸腔镜术后镇痛期恶心呕吐的发生率,且不良反应发生率低;帕洛诺司琼对延迟性呕吐效果更明显。     

Fosaprepitant for the Treatment of Refractory Postoperative Nausea and Vomiting

Postoperative nausea and vomiting (PONV) is a debilitating condition that occurs in approximately 30% of patients undergoing general anesthesia. Premedication with 5-HT3 receptor antagonists and glucocorticoids is effective in clinical practice; however, 10% to 20% of patients still develop PONV. Currently, little is known about the treatment of refractory PONV. We present a case that illustrates the use of fosaprepitant for the treatment of refractory postoperative nausea and vomiting.Key Words: breakthrough, Emend, fosaprepitant, nausea, postoperative, refractory, vomitingPostoperative nausea and vomiting (PONV) occurs in approximately 30% of patients undergoing general anesthesia without antiemetic prophylaxis.¹ With antiemetic prophylaxis, 10% to 20% of patients experience PONV. With placebo, 65% to 86% of patients experience emetic symptoms after the first incident of PONV.² The prevention of PONV has been well studied; however, there is little knowledge available for the treatment of PONV. The main pharmacological classes of drugs used in the treatment of PONV as single agents or combination therapy include 5-HT3 receptor antagonists, glucocorticoids, antihistamines, cholinergic antagonists, butyrophenone, phenothiazines, and benzamides.³ In general, a drug possessing a different mechanism of action from the prophylactic regimen should be used for the treatment of PONV. As demonstrated by Kovac and colleagues, in patients who received ondansetron for the prevention of PONV, additional ondansetron for the treatment of PONV was ineffective.⁴ Furthermore, less is known about the treatment of refractory PONV, and it has yet to be studied. We present a case of fosaprepitant used in the treatment of refractory PONV.     

瑞芬太尼与沙菲在腹腔镜胆囊切除术患者呕吐防治中的作用

目的：探讨瑞芬太尼术中、沙菲术后镇痛在腹腔镜胆囊切除术（LC）患者,用氟哌利多、地塞米松预防术后恶心呕吐（PONV）中的作用。方法：收集非吸烟、中青年女性LC患者,即PPONV的高危人群。全组氟哌利多、地塞米松预防性给药。Ⅰ组术中瑞芬太尼镇痛,术后沙菲镇痛;Ⅱ组术中、术后都用芬太尼镇痛。结果：两组异氟醚吸入,24hPONV的VAS评分（3．6±1．0）分与（6．4±1．2）分;麻醉满意度评分（8．8±1．1）分与（6．8＋1．3）分。差异均有显著性（P〈0．01）。结论：在LC恶心呕吐的高危人群,采用氟哌利多、地塞米松预防PONV时,瑞芬太尼、沙菲术中、术后镇痛较芬太尼术中术后镇痛,在预防PONV中更具有优势。