文章摘要
帕洛诺司琼静脉注射联合地塞米松足三里穴位注射预防术后恶心呕吐的效果
Effect of palonosetron intravenous injection combined with dexamethasone Zusanli acupoint injection on preventing postoperative nausea and vomiting
  
DOI：10.12089/jca.2020.08.002
中文关键词: 术后恶心呕吐  开腹手术  地塞米松  穴位注射  足三里  帕洛诺司琼
英文关键词: Postoperative nausea and vomiting  Laparotomy  Dexamethasone  Acupoint injection  Zusanli  Paronosetron
基金项目:陕西省卫生厅科研项目(2016D014)；陕西省重点研发项目(2017SF-180, 2018SF-010)；西安交通大学第二附属医院科研基金(G0093)
作者单位E-mail
牛晓丽 710004,西安交通大学第二附属医院麻醉科  
杨毅猛 710004,西安交通大学第二附属医院麻醉科  
蒋文军 710004,西安交通大学第二附属医院麻醉科  
赵茜娟 710004,西安交通大学第二附属医院麻醉科  
刘鸿涛 710004,西安交通大学第二附属医院麻醉科  
郑思敏 710004,西安交通大学第二附属医院麻醉科  
乔敏 710004,西安交通大学第二附属医院麻醉科  
张新侠 710004,西安交通大学第二附属医院麻醉科  
王倩茹 710004,西安交通大学第二附属医院麻醉科  
李思远 710004,西安交通大学第二附属医院麻醉科 foxlsy@163.com 
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中文摘要:
      
目的 观察帕洛诺司琼静脉注射联合地塞米松足三里穴位注射对术后恶心呕吐（PONV）发生率的影响。
方法 选择全身麻醉下行开腹胃肠道手术的女性患者320例，年龄18~75岁，BMI 21.5~27.1 kg/m2，ASAⅠ—Ⅲ级。所有患者在术前均进行Apfel危险分级。采用随机数字表法将患者随机分为四组：帕洛诺司琼静脉注射联合地塞米松足三里穴位注射组（PD组），帕洛诺司琼静脉注射组（P组），地塞米松足三里穴位注射组（D组）和空白对照组（C组），每组80例。PD组麻醉前静脉注射帕洛诺司琼0.25 mg，足三里穴位注射地塞米松5 mg；P组麻醉前静脉注射帕洛诺司琼0.25 mg；D组麻醉前足三里穴位注射地塞米松5 mg；C组麻醉前静脉注射生理盐水2 ml。所有患者均行静-吸复合麻醉，术后所有患者均使用静脉自控镇痛泵，镇痛泵的配方为舒芬太尼3 μg/kg。记录术后48 h内恶心、呕吐的发生情况。麻醉诱导前和术后4 h检测血清胃动素（MTL）浓度。记录术后48 h内头痛、眩晕和疲乏等不良反应的发生情况。
结果 术后0~8 h PD组恶心发生率明显低于P组（P<0.05）。术后0~8 h和8~24 h PD组呕吐发生率明显低于P组（P<0.05），P组、D组和C组术后4 h血清MTL浓度明显高于麻醉诱导前（P<0.05）。P组术后头痛和眩晕发生率均明显高于PD组、D组和C组（P<0.05），而疲乏发生率明显低于PD组、D组和C组（P<0.05）。
结论 帕洛诺司琼静脉注射联合地塞米松足三里穴位注射预处理，在PONV高风险女性患者开腹术后能够有效降低恶心呕吐的发生率，且不良反应更少。
英文摘要:
      
Objective To observe the effect of palonosetron intravenous injection combined with dexamethasone Zusanli acupoint injection on reducing the incidence and severity of postoperative nausea and vomiting (PONV).
Methods A total of 320 female patients underwent laparotomy surgery under general anesthesia, aged 18-75 years, falling into ASA physical status Ⅰ-Ⅲ, were recruited in this study. All patients underwent Apfel risk classification before surgery. The patients were randomly divided into four groups (n = 80 in each group): intravenous injection of palonosetron combined with dexamethasone Zusanli acupoint injection group (group PD), intravenous injection of palonosetron group (group P), dexamethasone Zusanli acupoint injection group (group D) and blank control group (group C). Before general anesthesia induction, patients in group PD were administered with paronosetron 0.25 mg intravenously combined with dexamethasone 5 mg injection at Zusanli point; patients in group P received paronosetron 0.25 mg intravenous injection; patients in group D were injected with dexamethasone 5 mg at the Zusanli acupoint; patients in group C were injected with normal saline 2 ml intravenously. All patients underwent intravenous-inhalation combined anesthesia and received intravenous self-controlled analgesia pump with sufentanil 3 μg/kg after surgery. Intravenous blood samples were collected before induction of anesthesia and 4 hours after surgery for motilin (MTL) levels determination. The incidence of nausea and vomiting was recorded at 0-48 h after surgery.
Results The incidence of nausea in group PD was significantly lower than that in group P at 0-8 h after surgery (P < 0.05). The incidence of nausea in group PD was significantly lower than that in group D (P < 0.05). The incidence of vomiting in group PD was significantly lower than that in group P at 0-8 h and 8-24 h after surgery (P < 0.05). Serum MTL concentration in group P, group D and group C at 4 h after operation was significantly higher than that before anesthesia induction (P < 0.05), respectively. There was no significant change in serum MTL concentration in group PD. The incidence of headache and vertigo in group PD was significantly lower than that in group P, group D and group C (P < 0.05).
Conclusion Palonosetron intravenous administration combined with dexamethasone injection at zusanli acupoint can effectively reduce the incidence of PONV in high-risk patients after laparotomy.
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