托烷司琼预处理配合丙泊酚全身麻醉对预防PONV的价值

doi:10.3969/j.issn.1000-8535.2024.02.008

摘要/Abstract

摘要： 目的观察托烷司琼预处理配合丙泊酚全身麻醉对预防术后恶心呕吐（PONV）的应用价值。方法采用前瞻性研究,纳入融通集团信阳154医院在2021年6月—2022年12月期间收治的接受腹腔镜手术治疗的122例患者,所有患者均实施含丙泊酚的全身麻醉辅助手术,采用随机数字表法对入组患者进行分组,分别列为预处理组（61例）和常规组（61例）,常规组术后予以常规止吐,预处理组采用托烷司琼预处理,比较两组患者术后6 h、术后12 h、术后24 h及术后48 h等不同时间点的PONV发生率、呕吐症状改善情况,麻醉苏醒后的疼痛、镇静情况,以及术后48 h内的麻醉相关不良反应发生情况。结果预处理组术后6 h的PONV发生率为3.28%（2/61）,术后12 h的PONV发生率为4.92%（3/61）,术后24 h的PONV发生率为3.28%（2/61）,术后48 h的PONV发生率为0.00%（0/61）,均低于常规组[16.39%（10/61）、18.03%（11/61）、16.39%（10/61）、13.11%（8/61）],差异有统计学意义（P<0.05）。预处理组术后6 h的恶心呕吐干呕症状评估量表（INVR）评分为（20.15±5.41）分,术后12 h的INVR评分为（17.66±4.42）分,术后24 h的INVR评分为（13.29±4.17）分,术后48 h的INVR评分为（10.22±3.35）分,均低于常规组[（23.32±5.13）分、（20.12±4.35）分、（16.33±4.24）分、（12.75±3.06）分],差异有统计学意义（P<0.05）。预处理组苏醒后的视觉模拟疼痛量表（VAS）评分为（4.04±1.06）分,Ramsay镇静评分为（3.11±0.25）分,与常规组[（3.87±0.25）分、（3.06±0.35）分]比较差异无统计学意义（P>0.05）。术后48 h内,预处理组的麻醉相关不良反应发生率为9.84%（6/61）,与常规组8.20%（5/61）比较差异无统计学意义（P>0.05）。结论托烷司琼预处理辅助含丙泊酚腔镜全身麻醉腹手术可有效降低PONV发生风险并改善患者PONV相关症状,联合应用此药未对麻醉镇静、镇痛效果产生明显影响,且未明显增加术后麻醉相关不良反应发生风险,安全性较高。

关键词: 腹腔镜手术, 全身麻醉, 托烷司琼, 术后恶心呕吐, 麻醉效果

Abstract: Objective To observe the application value of tropisetron preconditioning combined with propofol general anesthesia in the prevention of postoperative nausea and vomiting（PONV）．Methods This is a prospective cohort study．The patients were included from June 2021 to December 2022．The subjects of the study were 122 patients who received laparoscopy．All patients received general anesthesia assisted surgery containing propofol．The enrolled patients were divided into preconditioning group（61 cases）and conventional group（61 cases）by random number table．The conventional group was given routine antiemesis after surgery,and the preconditioning group was given tropisetron preconditioning．The incidence of PONV,improvement of vomiting symptoms,pain and sedation after anesthesia awakening,and occurrence of anesthesia related adverse reactions within 48 hours after surgery were compared between two groups of patients at different time points,including 6 hours,12 hours,24 hours,and 48 hours after surgery．Results Under different treatment regimens,the PONV incidence rates in the preconditioning group were 3.28%（2/61）after 6 hours,4.92%（3/61）after 12 hours,3.28%（2/61）after 24 hours,and 0.00%（0/61）after 48 hours．Compared with the conventional group [16.39%（10/61）,18.03%（11/61）,16.39%（10/61）,and 13.11%（8/61）],the incidence rates were lower（P<0.05）．The preconditioning group had an Index of Nausea and Vomiting and Retching（INVR）score of（20.15±5.41）points after 6 hours,（17.66±4.42）points after 12 hours,（13.29±4.17）points after 24 hours,and（10.22±3.35）points after 48 hours．Compared with（23.32±5.13）points,（20.12±4.35）points,（16.33±4.24）points,and（12.75±3.06）points）of the preconditioning group ,the INVR score at each time point was lower（P<0.05）．Under different treatment regimens,the VAS score of the preconditioning group after awakening was（4.04±1.06）points,and the Ramsay score was（3.11±0.25）points,which was similar to the conventional group [（3.87±0.25）points,（3.06±0.35）points]（P>0.05）．Within 48 hours after surgery,the incidence of anesthesia related adverse reactions in the preconditioning group was 9.84%（6/61）,which was similar to 8.20%（5/61）in the conventional group（P>0.05）．Conclusions Tropisetron preconditioning assisted laparoscopy under general anesthesia with propofol can effectively reduce the risk of PONV and improve the PONV related symptoms of patients．The combined use of this drug has no significant impact on the sedation and analgesia effects of anesthesia,and does not significantly increase the risk of postoperative anesthesia related adverse reactions,with high safety．

Key words: laparoscopy, general anesthesia, tropisetron, postoperative nausea and vomiting, anesthetic effect

周辉, 徐振锋. 托烷司琼预处理配合丙泊酚全身麻醉对预防PONV的价值[J]. 广州医药, 2024, 55(2): 146-150.

ZHOU Hui, XU Zhenfeng. The value of tropisetron preconditioning combined with propofol general anesthesia in preventing PONV[J]. Guangzhou Medical Journal, 2024, 55(2): 146-150.

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