腹腔镜下宫颈癌根治术患者多模式镇吐的效果

摘要

目的：探讨多模式镇吐措施对腹腔镜下宫颈癌根治术患者术后恶心呕吐及胃动素水平的影响。方法将70例择期行腹腔镜手术的宫颈癌患者随机分为常规镇吐组(对照组)和多模式镇吐组(观察组)各35例。对照组术中持续吸入七氟烷及50%N2O维持麻醉，术毕前30 min静脉输注昂丹司琼4 mg。观察组术中采用瑞芬太尼、丙泊酚靶控输注维持麻醉，并于诱导麻醉后静脉输注地塞米松10 mg，术毕前30 min给予帕瑞昔布钠40 mg及托烷司琼4 mg。观察两组术后恶心呕吐发生情况、镇痛效果及血浆胃动素水平。结果观察组术后Ⅱ~Ⅳ级恶心呕吐发生率为20.00%，对照组Ⅱ~Ⅳ级恶呕吐发生率为65.71%，差异有统计学意义(P<0.05)。观察组术后2 h、6 h、24 h、48 h镇痛评分显著低于对照组，差异有统计学意义(P<0.05)。观察组术后6 h、12 h、24 h、48 h血浆胃动素水平显著低于对照组(P<0.05)。结论瑞芬太尼、丙泊酚静吸诱导麻醉，术前给予地塞米松10 mg，术毕给予COX-2抑制剂帕瑞昔布钠及长效止吐剂托烷司琼行多模式镇痛可有效降低腹腔镜手术患者术后恶心、呕吐的发生，且其作用可能与抑制血浆胃动素水平有关。%Objective To investigate the effects of different antiemetic patterns on postoperative nausea and vomiting in patients performed laparoscopic radical hysterectomy. Methods Seventy cases of elective laparoscopic surgery were randomly divided into routine cervical antiemetic group ( control group ) 35 cases, and the model anti-emetic group (observation group) 35 cases. The control group were used with inhaled sevoflurane and 50% N2O maintain anesthesia,intravenous infusion 30min before surgery ondansetron 4mg. Observation group were used with remifentanil and propofol target-controlled infusion to maintain anesthesia and intravenous infusion after the induc-tion of anesthesia dexamethasone 10 mg, 30 min before surgery given parecoxib sodium 40mg and 4mg tropisetron. The occurrence of postoperative nausea and vomiting, the effect of analgesic and the levels of motilin were observed. Results TheⅡ~Ⅳ grade of postoperative nausea and vomiting of control group was 20.00%, but the observation group was 65.71%. (P<0.05). The pain scores of observation group were lower than those of the control group after 2 h, 6 h, 24 h, 48 h (P<0.05). The levles of motilin of observation group after 6 h, 12 h, 24 h, 48 h were significantly lower than those in the control group (P<0.05). Conclusion Remifentanil and propofol inhalation induction of anes-thesia, preoperative dexamethasone 10 mg, surgery given COX-2 inhibitors parecoxib sodium and long-lasting anti-emetic tropisetron town line multi-mode laparoscopic surgery can effectively reduce pain and postoperative nausea and vomiting, and its effect may be related to the inhibition of plasma motilin levels.