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。

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．

目的 对比颈动脉内膜剥脱术（CEA）不同时间预处理对患者术后应激反应及神经功能的影响。方法 回顾性收集2019年12月—2022年12月在我院择期行CEA术治疗的74例颈动脉狭窄（CS）患者临床资料,按远隔缺血预处理（RIPC）时间不同分成2组,其中A组37例（术前1 h进行预处理）、B组37例（术前24 h进行预处理）。对比2组术前1 d、麻醉诱导后、切皮时交感神经反应指标[收缩压（SBP）、心率（HR）、舒张压（DBP）]变化及手术前后简易精神状态评价量表（MMSE）评分、应激指标[去甲肾上腺素（NE）、白细胞介素-6（IL-6）、皮质醇（Cor）]、神经功能指标[脑源性神经营养因子（BDNF）、神经元特异性烯醇化酶（NSE）、中枢神经特异蛋白（S-100β）]水平。结果 与A组相比,麻醉诱导后B组SBP、HR、DBP水平更高,切皮时SBP、HR、DBP水平更低（P<0.05）;与A组相比,B组术后7 d、30 d MMSE评分更高（P<0.05）;术后12 h、24 h 2组血清NE、Cor、IL-6水平均较术前1 d升高（P<0.05）,但2组比较差异无统计学意义（P>0.05）;与A组相比,B组术后12 h、24 h血清S-100β、NSE水平更低,血清BDNF水平更高（P<0.05）。结论 CEA术前实施RIPC可减轻脑损伤,发挥脑保护作用,但与术前1 h实施RIPC相比,于术前24 h实施RIPC更有助于维持机体血流动力学稳定,促进认知功能及预后恢复。

Objective To compare the effects of different time preconditioning of carotid endarterectomy（CEA）on postoperative stress response and neurological function．Methods From December 2019 to December 2022,74 patients with carotid stenosis（CS）who were selected for CEA treatment in our hospital were retrospectively collected and divided into two groups according to the time of remote ischemic preconditioning（RIPC）,including 37 cases in group A（preconditioning at 1 hour before surgery）and 37 cases in group B（preconditioning at 24 hours before surgery）．The changes of sympathetic response indexes [systolic blood pressure（SBP）,heart rate（HR）,diastolic blood pressure（DBP）] in the 2 groups at 1 d before surgery,after the anesthesia induction,and at the time of skin incision before and after surgery,and the scores of the Mini-Mental State Examination（MMSE）,stress indexes [norepinephrine（NE）,interleukin-6（IL-6）,cortisol（Cor）],and neurological function indexes [brain-derived neurotrophic factor（BDNF）,neuron specific enolase（NSE）,central nervous specific protein（S-100β）]．Results Compared with group A,the levels of SBP,HR and DBP in group B after anesthesia induction were higher,and the levels of SBP,HR and DBP were lower during skin resection（P<0.05）．Compared with group A,group B had higher MMSE scores at 7 and 30 days after surgery（P<0.05）．The serum levels of NE,Cor and IL-6 in the 2 groups were increased 12 h and 24 h after surgery compared with 1 day before surgery（P<0.05）,but there was no significant difference between the 2 groups（P>0.05）．Compared with group A,serum S-100β and NSE levels in group B were lower at 12 h and 24 h after surgery,and serum BDNF level was higher in group B（P<0.05）．Conclusions The administration of RIPC before CEA can reduce brain injury and play a protective role in brain．However,compared with the administration of RIPC 1 h before surgery,the administration of RIPC 24 h before surgery is more conducive to maintaining hemodynamic stability,promoting cognitive function and prognostic recovery．