摘要
目的比较格拉司琼、托烷司琼和昂丹司琼在接受芬太尼自控静脉镇痛泵(IV-PCA)患者中对于术后恶心呕吐(PONV)的预防作用,并进一步评估PONV的风险预测因素。方法连续纳入492例接受外科手术并采用芬太尼IV-PCA术后镇痛的患者,分别采用格拉司琼(n=152)、托烷司琼(n=117)或昂丹司琼(n=223)预防PONV。于术前(基线)及术后2、6、12、24、36、48 h评估患者PONV发生率及严重程度,以及疼痛程度(VAS评分)。结果格拉司琼组在12、24 h时恶心事件发生率显著低于托烷司琼组和昂丹司琼组(P<0.05),在术后2、6、36和48 h时恶心事件发生率3组间差异无统计学意义。呕吐事件发生率和VAS评分在任何时间点3组间差异均无统计学意义。在整个研究过程中,格拉司琼组共有30例患者发生PONV(19.7%),低于托烷司琼组(33例,28.2%)和昂丹司琼组(70例,31.4%),而紧急止吐药物的使用率在3组间差异无统计学意义。多元Logistic回归分析显示,格拉司琼vs托烷司琼/昂丹司琼可以独立预测低的PONV风险,而女性、晕动病、麻醉时间长和术中阿片类药物输注可以独立预测高的PONV风险。结论与托烷司琼和昂丹司琼相比,格拉司琼对术后使用芬太尼IV-PCA镇痛的患者能更有效地预防PONV发生风险。
AIM To compare the effect of granisetron in postoperative nausea and vomiting(PONV)prevention with tropisetron and ondansetron,and to evaluate the prognostic factors for PONV in patients with fentanyl based intravenous patient-controlled analgesia(IV-PCA).METHODS A total of 492 patients underwent surgery and followed fentanyl-based IV-PCA were consecutively enrolled.And patients received granisetron(n=152),tropisetron(n=117)or ondansetron(n=223)treatment for prevention of PONV.PONV and pain VAS scores were evaluated before operation(baseline)and at 2,6,12,24,36 and 48 h post operation.RESULTS Nausea event rate was significantly decreased in granisetron group compared to tropisetron group and ondansetron group at 12 h and 24 h,while there was no significant difference among 3 groups at 2,6,36 and 48 h.Vomiting event rate and pain VAS scores were of no difference among 3 groups at each time point.During the whole study,30 patients(19.7%)occurred PONV in granisetron group,which was lower than tropisetron group(33 patients,28.2%)and ondansetron group(70 patients,31.4%).While no difference was observed in rescue antiemetic drug using rate among 3 groups.In addition,univariate and multivariate logistic regression analysis revealed that granisetron(vs tropisetron and ondansetron)predicted lower risk of PONV independently,while female,motion sickness,longer duration of anesthesia and intraoperative opioid infusion were independent risk factors for PONV.CONCLUSION Granisetron is more effective on preventing PONV in patients with fentanyl based IV-PCA compared to tropisetron and ondansetron,and female,motion sickness,longer duration of analgesia as well as intraoperative opioid infusion are independent risk factors for PONV.
作者
马敏明
李盈科
袁红斌
MA Minming;LI Yingke;YUAN Hongbin(Department of Anesthesiology,Changzheng Hospital,Naval Medical University,Shanghai 200003,China)
出处
《中国临床药学杂志》
CAS
2020年第4期248-253,共6页
Chinese Journal of Clinical Pharmacy
关键词
格拉司琼
托烷司琼
昂丹司琼
术后恶心呕吐
芬太尼
自控静脉镇痛泵
granisetron
tropisetron
ondansetron
postoperative nausea and vomiting
fentanyl
intravenous patient-controlled analgesia
