摘要
【目的】观察长托宁术前肌注结合赛格恩术后经患者硬膜外自控镇痛(PECA)泵持续输注对妇科肿瘤术后丁丙诺啡PECA所致的恶心呕吐的影响。【方法】经腹妇科肿瘤手术患者160例随机均分为A、B、C、D四组,A组术前抗胆碱药采用阿托品,B、C、D组采用长托宁,术后PECA均采用丁丙诺啡,术毕A组不用止呕药,B组赛格恩5 mg单次静注,C组赛格恩5 mg静脉持续泵入,D组赛格恩5 mg加入PECA泵中持续泵入。观察各组术后4、244、0 h镇痛评分(VAS);Ramsay镇静评分(RSS);舒适评分(BCS);恶心、呕吐例数;因严重恶心、呕吐而要求终止PCA的例数;肛门首次排气时间。【结果】A组VAS术后各时点明显高于D组(P<0.05),组B、C术后244、0 h明显高于D组(P<0.05,P<0.01);A组各时点RSS明显低于B、C或D组(P<0.01);BCS A组术后24、40 h明显低于B、C或D组(P<0.01);术后恶心、呕吐例数及要求终止PCA的例数组A明显多于B组、C组或D组(P<0.05,P<0.01),恶心、呕吐例数B组亦明显多于C组或D组(P<0.05);肛门首次排气时间D组较组A短(P<0.05)。【结论】长托宁术前肌注结合赛格恩术后经患者PECA泵持续输注能明显减少妇科肿瘤术后丁丙诺啡PECA所致的恶心、呕吐,缩短肛门首次排气时间,且有较高的舒适评分和较好的术后镇痛、镇静效果。
[Objective]To observe the prophylaxis effect of Penehyclidine combined with Tropisetron on postoperative nausea and vomiting（PONV） caused by patient epidural controlled analgesia（PECA）with Buprenorphine after gynecological tumor surgery. [Methods]One hundred sixty patients undergoing elective intraabdominal gynecological tumor surgery under spinal combined epidural anesthesia were randomly divided into 4 equal groups（group A,B,C,D）. The preoperative antimuscarinic drug at group B,C,D used Penehyclidine instead of atropine which was used at group A . The PECA of all patients used Buprenorphine. At the end of the surgery group A did not use antiemetic, group B,C,D used Tropisetron （5 mg intravenous injection at group B, 5 mg continuous intravenous infusion by microinfusion bump at group C, 5 mg continuous intra-epidural infusion by PECA pump at group D） . The VAS,RSS,BCS at postoperative 4,24,40 hours, the cases of PONV and the cases of requesting for stopping PECA because of serious nausea and vomiting ,the first time of passgas by anus were observed. [Results]The VAS of group A was apparently higher than that of group D at every time point（ P 〈0.05）and VAS of group B,C was apparently higher than that of group D at postoperative 24, 40 hours（ P 〈0.05, P 〈0.01） ; At group A,the RSS at every time point and the BCS at postoperative 24,40 hours were apparently lower than those of other groups（ P 〈0.01）; The cases of PONV and requesting for stopping PECA because of serious nausea and vomiting of group A were more than those in other groups（ P〈0.05, P 〈0.01）, The cases of PONV of group B were also more than those in of group C,D（ P 〈0.05） ; The first time of pass-gas by anus of group D were apparently shorter than that of group A（ P 〈0.05）. [Conclusion]Penehyclidine preoperative intramuscular injection combined with Tropisetron postoperative continuous intra-epidural infusion by PECA bump can apparently decrease PONV caused by PECA with Buprenorphine after gynecological tumor surgery, shorten the time of pass-gas by anus, moreover, have higher BCS and better postoperative analgesic,sedative action.
出处
《医学临床研究》
CAS
2005年第8期1063-1066,共4页
Journal of Clinical Research
作者简介
杨金凤（1966-）．女，湖南安化人，副主任医师，主要从事临床麻醉工作。
