托烷司琼联合甲泼尼龙预防妇科腹腔镜术后恶心呕吐的临床观察

发布时间：2018-01-30 23:17

本文关键词： 托烷司琼甲泼尼龙术后恶心呕吐妇科腹腔镜　出处：《吉林大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：以妇科腹腔镜子宫肌瘤核除术患者为研究对象，观察托烷司琼、甲泼尼龙以及托烷司琼联合甲泼尼龙对预防PONV的效果，探讨科学的预防PONV的方案。方法：将120例择期行腹腔镜子宫肌瘤核除手术的ASAI-II级、年龄20~48岁、体重50-70kg的妇科患者随机分四组：C组（对照组)、T组（托烷司琼组）、M组（甲泼尼龙组）、TM组（托烷司琼联合甲泼尼龙组）。麻醉方式为静脉复合气管插管全麻。患者入室后监测血压、心电、血氧饱和度，开放静脉通路，麻醉诱导时静脉注射咪达唑仑0.05mg，芬太尼4μg/kg，依托咪酯0.2mg/kg，苯磺酸顺阿曲库铵0.15mg/kg。同时C组给予安慰剂生理盐水3ml，T组给予托烷司琼5mg，M组给予甲泼尼龙40mg，TM组给予托烷司琼5mg及甲泼尼龙40mg。待患者意识消失后进行手控通气，手控通气时由助手按压上腹部以减少胃部进气导致胃肠道扩张，3min后进行经口气管插管操作。插管成功后进行机械通气，潮气量为7ml·kg-1·，呼吸频率为10-12次/min，新鲜气体流速为2L·min-1，吸呼比为1:2，气腹后根据呼末调整呼吸频率、潮气量及分钟通气量，维持ETCO2于30-40mmHg。根据临床实践继续进行腹部手术的麻醉维持，各组麻醉维持均采用瑞芬太尼2μg·kg-1·h-1，丙泊酚4-6mg·kg-1·h-1，持续静脉泵注。手术结束时停用静脉维持药，待患者清醒，呼之能应，呼吸空气血氧饱和度维持在95%以上时拔除气管导管。记录入室后诱导前（T0)、插管前1min（T1）、插管即刻（T2)、插管后1min（T3）、插管后3min（T4)、插管后5min（T5)的平均动脉压MAP；入室后诱导前（T0）、手术结束时（T1）、术后1h（T2）、术后2h（T3）、术后6h（T4）、术后12h（T5）的指尖血糖；术后24小时内PONV程度及不良反应发生情况和患者舒适度。结果：（1）四组病人一般情况包括病人年龄、体重、手术时间、麻醉时间、既往病史、术前焦虑状态、术后应用缩宫素情况等，无显著性差异。（2）四组病人在诱导前（时间点T0）及插管前后（时间点T1-T5）同一时间点的MAP的差异均无统计学差异；四组病人在诱导前（时间点T0）及术后（时间点T1-T5）同一时间点的指尖血糖差异均无统计学差异。（3）四组病人两两比较发现，T组和C组，M组和C组，TM组分别和T、M、C组相比，PONV总发生率差异均有统计学意义。（4）患者不良反应观察发现，各组间均无统计学差异。（5）患者的舒适度调查发现，T、M、TM组的舒适度均高于C组，，且TM组比T组和M组的舒适度均高，而T组也略高于M组。结论：甲泼尼龙有预防PONV的作用；托烷司琼预防PONV的效果优于甲泼尼龙；甲泼尼龙单次小剂量应用不会引起血糖升高、血压变化；托烷司琼联合甲泼尼龙对预防PONV效果优于单独使用，并增加了患者术后舒适度。
[Abstract]:Objective: to observe the effect of tropisetron, methylprednisolone and tropisetron combined with methylprednisolone on the prevention of PONV. To probe into the scientific scheme of preventing PONV. Methods: one hundred and twenty gynecological patients, aged 20 to 48 years old and weighing 50-70 kg, were randomly divided into four groups: group C (control group). Group T (tropisetron group), group M (methylprednisolone group) and group TM (tropisetron combined with methylprednisolone group) were anesthetized by intravenous combined endotracheal intubation general anesthesia. The blood pressure and ECG were monitored after entering the room. Blood oxygen saturation, open vein pathway, intravenous injection of midazolam 0.05 mg, fentanyl 4 渭 g / kg, etomidate 0.2 mg / kg during anesthesia induction. The patients in group C were given placebo saline (3ml), group T was given tropisetron (5 mg / kg) and methylprednisolone (40 mg). TM group was given tropisetron 5mg and methylprednisolone 40mg. Manual ventilation was performed after consciousness disappeared. Assistant pressed upper abdomen to reduce gastroenteric dilatation during manual ventilation. After 3 minutes, the tracheal intubation was performed. Mechanical ventilation was performed after successful intubation. The tidal volume was 7ml 路kg-1 路, and the respiratory frequency was 10-12 times / min. The flow rate of fresh gas was 2L 路min-1 and the breathing ratio was 1: 2.After pneumoperitoneum, the respiratory rate, tidal volume and minute ventilation volume were adjusted according to the end of exhalation. The maintenance of ETCO2 was 30 ~ 40 mm Hg.According to the clinical practice, the anesthesia of abdominal operation was maintained with remifentanil 2 渭 g 路kg-1 路h-1. Propofol 4-6 mg 路kg-1 路h-1, continuous intravenous infusion. At the end of the operation, the intravenous maintenance drug was stopped. The trachea catheter was removed when the oxygen saturation of the breathing air was maintained above 95%. Before induction was recorded, T0 was recorded, and T1 was taken 1 minute before intubation, and T2 was immediately inserted). The mean arterial pressure (MAPP) was 1 min after intubation, 3 min after intubation, and 5 min after intubation. The blood sugar at the fingertips of T0 was induced at the end of the operation, T1 at the end of operation, T2 at 1 hour after operation, T3 at 2 h after operation, T4 at 6 h after operation, and T5 at 12 h after operation. The degree of PONV, the incidence of adverse reactions and the comfort of the patients within 24 hours after operation. Results (1) the general conditions of the four groups included age, weight, operation time, anaesthesia time, previous medical history, anxiety state before operation, postoperative application of oxytocin and so on. There was no significant difference in MAP between the four groups before induction (time point T0) and before and after intubation (time point T1-T5) at the same time point. Four groups of patients before induction (time point T0) and post-operation (time point T1-T5) at the same time point of blood glucose differences were not statistically significant. There were significant differences in total incidence of PONV between group M and group C (P < 0.05). There was no statistical difference among the three groups. The results showed that the comfort degree of TM group was higher than that of C group, and that of TM group was higher than that of T group and M group, and that of T group was slightly higher than that of M group. Conclusion: methylprednisolone can prevent PONV. Tropisetron was more effective than methylprednisolone in preventing PONV. Low dose methylprednisolone did not cause hyperglycemia and blood pressure change. Tropisetron combined with methylprednisolone was more effective in preventing PONV and increased postoperative comfort.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R614

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