摘要目的 探讨甲泼尼龙联合托烷司琼对预防腹腔镜术后恶心呕吐（PONV）的效果。方法 回顾性分析2014年9月～2016年9月在我院行全身麻醉下腹腔镜手术的患者180例。按麻醉诱导前不同的处理方法分三组，各60例，A组：诱导前静脉滴注甲泼尼龙40 mg；B组：诱导前静脉滴注地塞米松8 mg；C组：诱导前静脉滴注生理盐水2 ml；所有患者手术结束时均静脉滴注托烷司琼5 mg，比较三组术后0、6 h及24 h PONV发生率及术后24 h不良反应发生率。结果A、B组和C组术后0 h PONV发生率分别为6.67%、20.00%、36.67%；术后6 h PONV的发生率分别为13.33%、31.67%、53.33%；术后24 h PONV发生率分别为8.33%、21.67%、38.33%；三组组间两两比较，差异均有统计学意义 （P<0.05）；A、B组和C组术后24 h不良反应发生率分别为10.00%、18.33%、40.00%；A组与B组比较，差异无统计学意义（P>0.05），A、B组分别与C组比较，差异有统计学意义（P<0.05）。结论 甲泼尼龙与托烷司琼联合应用可有效预防腹腔镜PONV，值得临床进一步推广。
Abstract：Objective To explore the effect of Methylprednisolone combined with Tropisetron for preventing postoperative nausea and vomiting(PONV)in patients with laparoscopic operation.Methods A total of 180 patients in our hospital from September 2014 to September 2016 received general anesthesia in laparoscopic surgery were retrospectively analyzed.By different processing methods before induction of anesthesia were divided into three groups,60 cases in each group.dirp A(methylprednisolone,40 mg),group B(dexamethasone,8 mg),and group C(saline,2 ml),they were given intravenouse dirp all before induction of anesthesia.At the end of operations,all the patients would be Tropisetron(5 mg)by injection.The incidence of PONV in three groups of 0,6 h and 24 h,and 24 h dirp postoperative incidence of adverse reactions were compared.Results In group A,group B and group C,postoperative 0 h the incidence of PONV respectively were 6.67%,20.00%,36.67%,postoperative 6 h the incidence of PONV respectively were 13.33%,31.67%,53.33%,postoperative 24 h the incidence of PONV respectively were 8.33%,21.67%,38.33%.there were significant difference between the three groups(P<0.05).In group A,group B and group C postoperative 24 h adverse reactions incidence respectively were 10.00%,18.33.00%,40.00%.While group A was compared with group B did not significant difference (P>0.05),group A and B were compared with group C,with significant difference(P<0.05).Conclusion It appeares to be effective of methylprednisolone combined with tropisetron in preventing PONV,which is worth further promotion in the clinical practice.
方建勤;陆有明;叶伟标;郑建宇;何健芳. 甲泼尼龙联合托烷司琼预防腹腔镜术后恶心呕吐的临床研究[J]. 中国当代医药, 2017, 24(9): 71-74.
FANG Jian-qin;LU You-ming;YE Wei-biao;ZHENG Jian-yu;HE Jian-fang. The clinical research of Methylprednisolone combined with Tropisetron for prevention of postoperative nausea and vomiting in laparoscopic operation. 中国当代医药, 2017, 24(9): 71-74.
Sandhu T，Tanvatcharaphan D，Cheunjongkolkul V，et al. Ondansetron versus metoclopramide in prophylaxis of nausea and vomiting for laparoscopic cholecystectomy：a prospective double-blind randomized study[J].Asian J Surg，2008，31 （2）：50-54．
[2]
Rnsch D，Becke K，Eberhart LH，et al.Postoperative nausea and vomiting（PONV）-recommendatlons for risk assessment，prophy-laxis and therapy-results of an expert panel meet ing[J].Anesthesiol Intensivmed Notfallmed Schmerzther，2011，46（3）：158-170．
[3]
Habib AS，Gan TJ.Combination therapy for postoperative nausea and vomiting-a more effective prophylaxis?[J].Ambul Surg，2001，9（2）：59-71.
Wang JJ，Ho ST，Liu YH，et al.Dexanethasone reduces nausea and vomiting after laparoscopic cholecystectomy[J].Br J Anaesth，1999，83（5）：772-775.
[5]
Naguid M，Bakry AKEL，Khoshim MHB，et al.Prophylactic antiemetic therapy with ondansetron，tropieston，granisetron and metoclopramide in patients undergoing laparoseopic cholecystectomy：a randomized，double-blinde comparison with placebo[J].Can J Anaesth，1996，43（3）：226-331.
[6]
Gan TJ.Mechnisms underlying postoperative nausea and vomiting and neurotransmitter receptor antagonist-based pharmacotherapy[J].CNS Drugs，2007，21（10）：813-833.
[8]
Tramer MR，Reynolds DJ，Moore RA，et al.Efficiacy，doseresponse，and safety of ondansetron in prevention of postoperative nausea and vomiting：a quantitative systematic review of randomized placebocontrolled trials[J].Anesthesiology，1997，87（16）：1277-1289.
[9]
Kazemi-Kjellberg F，Henzi I，Tramer MR.Treatment of established postoperative nausea and vomiting：a quantitative systematic review[J].BMC Anesthesio，2001，1（1）：2.
[12]
Apfel CC，Korttila K，Abdalla M，et al.A factorial trial of six interventions for the prevention of postoperative nausea and vomiting[J].N Engl J Med，2004，350（24）：2441-2451.
[13]
Aouad MT，Nasr VG，Yazbeck-Karam VG，et al.A comparison between dexamethasone and methylprednisolone for vomiting prophylaxis after tonsillectomy in inpatient children：a randomized trial[J].Anesth Analg，2012，115（4）：913-920.
[14]
Murphy GS，Szokol JW，Greenberg SB，et al.Preoperative dexamethasone enhances quality of recovery after laparoscopic cholecystectomy：effect on in-hospital and postdischarge recovery outcomes[J].Anesthesiology，2011，114（4）：882-890.
[15]
De Oliveira GS Jr，Almeida MD，Benzon HT，et al.Perioperative single dose systemic dexamethasone for postoperative pain：a meta-analysis of randomized controlled trials[J]. Anesthesiology，2011，115（3）：575-588.
[16]
Percival VG，Riddell J，Corcoran TB.Single dose dexamethasone for postoperative nausea and vomiting-a matched case-control study of postoperative infection risk[J].Anaesth Intensive Care，2010，38（4）：661-666.
[17]
Eberhart LH，Graf J，Morin AM，et al.Randomised controlled trial of the effect of oral premedication with dexamethasone on hyperglycaemic response to abdominal hyste rectomy[J].Eur J Anaesthesiol，2011，28（3）：195-201.
Kleisbauer JP，Garcia-Giron C，Antimi M，et al.Granisetron plus methylprednisolone for the control of high-dose cisplatin-induced emesis[J].Anticancer Drugs，1998，9（5）：387-392.
京公网安备 11010502046607号