帕洛诺司琼与托烷司琼对预防单节段腰椎减压植骨融合内固定手术后恶心呕吐的效果比较

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摘要目的比较单次注射帕洛诺司琼、托烷司琼对预防单节段腰椎减压植骨融合内固定术后恶心呕吐（PONV）的效果。方法选择2017年2～7月解放军第一一七医院行单节段腰椎后路减压植骨融合内固定术的70例患者，ASA评分为Ⅰ或Ⅱ级，Apfel评分≥3分，随机单盲将70例患者分为帕洛诺司琼组（P组）和托烷司琼组（T组），每组35例。麻醉采用静吸复合插管全身麻醉，手术皮肤缝合时，P组给予单次静注帕洛诺司琼0.25 mg，T组给予或托烷司琼5 mg，术后均用舒芬太尼50 μg+地佐辛20 mg自控镇痛（PCIA），随访72 h。观察并比较两组的术后恶心、呕吐发生率并计算完全有效率（CR）。结果术后0～24 h及＞24～48 h，P组患者的恶心发生率为25.7%（9/35）、8.6%（3/35），明显低于 T 组的 48.6%（17/35）、28.6%（10/35）；P 组患者的呕吐发生率为 14.3%（5/35）、5.7%（2/35），明显低于 T 组的 45.7%（16/35）、25.7%（9/35），差异均有统计学意义（P＜0.05）。术后＞48～72 h，两组患者的恶心呕吐发生率比较，差异无统计学意义（P＞0.05）。术后0～24 h、＞24～48 h及0～72 h，P组的达CR标准率为85.7%、94.3%和 80.0%，明显高于 T组的 54.3%、77.1%和 54.0%，差异有统计学意义（P＜0.05）；＞48～72 h的 P组、T组达CR标准率为100.0%和97.1%，差异无统计学意义（P＞0.05）。结论在腰椎术后镇痛期间防止恶心呕吐方面，手术结束时单次静注帕洛诺司琼0.25 mg止吐效果优于单次静注托烷司琼5 mg。

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	梁峻立
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关键词 ：帕洛诺司琼, 托烷司琼, 腰椎, 静脉自控镇痛, 恶心呕吐

Abstract：Objective To investigate the effect of single injection of Palonosetron and Tropisetron in the prevention of nausea and vomiting(PONV)after single-segment lumbar decompression,bone graft fusion and internal fixation.Methods A total of 70 patients of 117thHospital of PLA from February to July in 2017 underwent single segment posterior lumbar interbody fusion surgery,ASA score ofⅠorⅡgrade,Apfel score more than 3 points,and the patients who unwent elective lumbar posterior decompression and internal fixation surgery were selected as the research object.According to the random single blind,70 patients were divided into the palonosetron group(group P)and the tropisetron group(group T),35 cases in each group.Anesthesia with intravenous inhalational anesthesia,skin suture,group P was given intravenous Palonosetron 0.25 mg,group T was given Tropisetron or 5 mg,and were treated with Sufentanil 50 μg+Dezocine 20 mg analgesia (PCIA),the follow-up of 72 h.The incidence of nausea and vomiting after operation in the two groups was compared and the total effective rate(CR)was calculated.Results The incidence of nausea in group P at 0-24 h and＞24-48 h after operation was 25.7%(9/35),8.6%(3/35),which was significantly lower than that of group T of 48.6%(17/35),28.6%(10/35);the incidence of vomiting in group P was 14.3%(5/35),5.7%(2/35),which was significantly lower than that of group T of 45.7%(16/35),25.7%(9/35),the differences were statistically significant(P＜0.05).The incidence of nausea and vomiting in the two groups at＞48-72 h after operation was no significant difference (P＞0.05).After 0-24 h,＞24-48 h and 0-72 h,the CR standard rates of group P were 85.7%,94.3%and 80.0%,which were significantly higher than those in group T(54.3%,77.1%and 54.0%),the differences were statistically significant(P＜0.05).The CR standard rates of 48-72 h in group P and group T were 100.0%and 97.1%,and the difference was not statistically significant(P＞0.05).Conclusion In the prevention of nausea and vomiting during the postoperative analgesia of the lumbar surgery,the effect of single-dose intravenous injection of Palonosetron of 0.25 mg at the end of the operation is superior to that of the single intravenous injection of Tropisetron 5 mg.

Key words： Palonosetron Tropisetron Lumbar vertebra Patient controlled intravenous analgesia Nausea and vomiting

引用本文:

梁峻立;吕文艳. 帕洛诺司琼与托烷司琼对预防单节段腰椎减压植骨融合内固定手术后恶心呕吐的效果比较[J]. 中国当代医药, 2018, 25(10): 16-18转22.
LIANG Jun-li;LYU Wen-yan. Comparison of the effect of Palonosetron and Tropisetron in the prevention of nausea and vomiting after single segment lumbar decompression,bone graft fusion and internal fixation. 中国当代医药, 2018, 25(10): 16-18转22.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2018/V25/I10/16

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