地塞米松与托烷司琼预防腹腔镜手术后恶心及呕吐作用的性别差异研究

发布时间：2018-05-30 15:19

本文选题：手术后恶心呕吐 + 性别　；参考：《中国全科医学》2017年29期

【摘要】：目的探讨地塞米松、托烷司琼对腹腔镜手术后恶心、呕吐(PONV)预防作用的性别差异。方法选取2014年12月—2015年12月于天津医科大学总医院拟行腹腔镜手术(胆囊切除术、阑尾切除术、子宫切除术及附件切除术)患者382例为研究对象,采用随机数字表法,将不同性别患者随机分为男性地塞米松(MD)组、男性托烷司琼(MT)组、男性对照(MC)组、女性地塞米松(FD)组、女性托烷司琼(FT)组、女性对照(FC)组。排除术中、术后不符者22例,各组均纳入60例。MD、FD组分别于麻醉诱导前即刻静脉滴注地塞米松0.15 mg/kg,MT、FT组分别于麻醉诱导前即刻静脉滴注托烷司琼5 mg,MC、FC组于麻醉诱导前即刻静脉滴注5 ml 0.9%氯化钠溶液。记录从拔管开始至术后24 h各组患者发生恶心、呕吐的例数及其分级,需使用止吐药物治疗的例数,以及术后首次恶心、呕吐发生时间。结果术后24 h内,MD、MT组PONV分级、总PONV发生率、使用止吐药物比例均低于MC组(P0.01),FT组PONV分级、总PONV发生率、使用止吐药物比例均低于FC组(P0.01);FD组与FC组PONV分级、总PONV发生率、使用止吐药物比例比较,差异无统计学意义(P0.01)。术后24 h内,MD、MT组术后首次恶心、呕吐发生时间长于MC组(P0.05),FT组术后首次恶心、呕吐发生时间长于FC组(P0.05);FD组与FC组术后首次恶心、呕吐发生时间比较,差异无统计学意义(P0.05)。结论腹腔镜手术麻醉诱导前应用地塞米松预防PONV,可以降低男性患者PONV发生率,并延长男性患者术后首次恶心、呕吐发生时间,但对女性患者预防PONV的效果不明显。而托烷司琼可同时降低男性、女性患者PONV发生率,且延长术后首次恶心、呕吐发生时间。
[Abstract]:Objective to investigate the effect of dexamethasone and tropisetron on postoperative nausea and vomiting after laparoscopic surgery. Methods A total of 382 patients undergoing laparoscopic surgery (cholecystectomy, appendectomy, hysterectomy and adnexectomy) from December 2014 to December 2015 in the General Hospital of Tianjin Medical University were selected as subjects. Patients of different genders were randomly divided into three groups: male dexamethasone (MDD) group, male tropisetron (MTM) group, male control group (MCM), female dexamethasone (FDD) group, female tropisetron (FTFT) group and female control group (FC). 22 cases were excluded during the operation, and 22 cases were not in accordance with the operation. 60 cases of MDN FD group were treated with dexamethasone 0.15 mg / kg MTT immediately before anesthesia induction, and 5 ml 0.9% sodium chloride solution was intravenously infused immediately before anesthesia induction in the tropisetron 5 mg / kg MCN MCFC group immediately before anesthesia induction, respectively, in the group with dexamethasone 0.15 mg 路kg ~ (-1) 路kg ~ (-1) MTT immediately before anesthesia induction. From the beginning of extubation to 24 hours after operation, the number and grade of nausea and vomiting, the number of patients who needed to be treated with antiemetic drugs, and the time of the first time of nausea and vomiting after operation were recorded. Results within 24 hours after operation, the incidence of PONV, total PONV, the proportion of antiemetic drugs were lower than those of MC group (P 0.01 / FT), the incidence of total PONV and the proportion of antiemetic drugs were lower than that of FC group (P 0.01) and FC group (PONV grade), and the total PONV incidence rate was lower than that of FC group (P 0.01). There was no significant difference in the proportion of antiemetic drugs used (P 0.01). Within 24 hours after operation, the first time of nausea and vomiting in MDMT group was longer than that in group MC (P 0.05) and the time of vomiting was longer than that in group FC (P 0.05) and FC group (P 0.05). There was no significant difference in the time of nausea and vomiting between FC group and FC group. Conclusion Dexamethasone before anesthesia induction can reduce the incidence of PONV in male patients and prolong the first time of nausea and vomiting in male patients, but it is not effective in preventing PONV in female patients. Tropisetron also reduced the incidence of PONV in both male and female patients, and prolonged the time of first postoperative nausea and vomiting.
【作者单位】：天津市西青医院麻醉科;天津医科大学总医院麻醉科;
【分类号】：R614

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