不同时机静注阿扎司琼对术后静脉镇痛恶心呕吐的预防效果

目的 探讨阿扎司琼不同时机给药对术后静脉镇痛恶心呕吐(PONV) 的预防效果。方法 120 例ASA Ⅰ ~ Ⅱ级全麻下行腹部手术、术后自愿接受静脉镇痛的患者, 随机分为A 、B 、C 、D 四组, 每组30 例:A 组麻醉诱导前静脉注射阿扎司琼10 mg;B 组进腹探查后静脉注射阿扎司琼10 mg;C 组手术结束接镇痛泵之前静脉注射阿扎司琼10 mg;D 组作为对照组, 不使用阿扎司琼。四组镇痛泵药物配方均为芬太尼按20μg kg 加生理盐水至100 mL, 背景剂量、单次追加剂量、锁定时间均相同。分别于术后4 、8 、12 、24 、48 h 观察并记录患者的疼痛视觉模拟评分(VAS) 及Ramsay镇静状态评分、恶心呕吐评分及PONV 发生率。结果 各组镇痛后12 ~ 48 h 的VAS 与4 h 相比较差异有统计学意义(Ρ<0.01 或Ρ<0.05);无嗜睡或镇静过深;PONV 发生率, 镇痛后A 组各时段与D 组相比较差异有统计学意义(Ρ<0.01 或Ρ<0.05), C 组仅0 ~ 4 h 和4 ~ 24 h 与D 组相比较差异有统计学意义(Ρ<0.05), B 组各时段与D组相比较差异均无统计学意义(Ρ>0.05)。结论 全麻诱导前静注阿扎司琼能有效地预防术后静脉镇痛恶心呕吐的发生。

Clinical observation on azasetron in different juncture injection for preventing postoperative nausea and vomiting

AIM: To evaluate the prophylactic effect of azasetron in different juncture injection on postoperative nausea and vomiting (PONV) during patients controlled intravenous ananlgesia (PCIA).METHODS: One hundred and twenty patients, scheduled for selective abdominal operations, were randomly divided into four groups:patients received an preoperative intravenous injection of 10 mg azasetron (Group A, n= 30), patients received an intravenous injection of 10 mg azasetron during abdominal cavity (Group B, n=30), patients received an intravenous injection of 10 mg azasetron when the operation were finished (Group C, n=30), patients with no azasetron as control (Group D, n=30).The incidence rate and score of PONV, the visual analogue scales (VAS) and Ramsay scores were recorded at 4, 8, 12, 24, 48 h postoperatively.RESULTS: There was significant difference between the postoperative VAS during 12 to 48 h and that of 4 h postoperatively(Ρ<0.01 or Ρ<0.05).There was no somnolence and deep calm happening.The incidence of PONV in Group A was significantly lower than that in Group D(Ρ<0.01 or Ρ<0.05).The incidences of PONV in Group C in postoperative 0 to 4 h and 4 to 24 h were significantly lower than that in Group D(Ρ <0.05).There was no significant difference between Group B and D(Ρ>0.05).CONCLUSION: A preoperative intravenous injection of 10 mg azasetron can be used effectively to prevent PONV during PCIA.