恩丹西酮预防腹部术后恶心呕吐的临床研究解放军第解放军第323323医院麻醉科医院麻醉科 薛璋明薛璋明 毛学文毛学文 樊鸿鸾樊鸿鸾 本文旨在研究恩丹西酮(Ondansetron)对腹部术后 恶心呕吐的防治作用。资料与方法1、 病例选择 ASA级择期行腹部手术病人90例（其中胆囊切除术40例；胃大部切除术10例；脾切除术6例；子宫全切术15例；肠梗阻8例；肝叶切除术2例；阑尾切除术9例）。男40例，女50例，年龄22-65岁，平均体重（605.6）Kg，手术时间3h。 所有病人术前均无恶心呕吐病史，术前均未接受过抗恶心呕吐药物治疗。随机分为恩丹西酮组（简称恩组）、氟哌利多组（简称氟组）和生理盐水组（简称生组）各30例。2 、方法 麻醉前半小时肌注苯巴比妥钠0.1g，阿托品0.5mg。为了增强可比性，所有病人均采用硬膜外麻醉。硬膜外平面出现后，各组均静注哌替啶0.8mg/kg.咪达唑仑1-2mg，吸入99%氧，监测HR、BP、ECG、SpO2。术中发生牵拉反应时，以1%盐酸利多卡因局部封闭。手术结束缝皮时，恩组静注恩丹西酮（西南合成制药厂）8mg；氟组静注氟哌利多（上海旭东海普药业）2.5mg；生组静注生理盐水2ml。并告知病人给予止吐药。术后观察24h，每2h记录一次HR、BP、SpO2和病人恶心、呕吐发生的次数和程度。呕吐剧烈时肌注胃复安10mg，疼痛剧烈时肌注哌替啶50mg。3、恶心、呕吐分级 0级：恶心、呕吐1级：诉不适或恶心，无呕吐2级：自感轻度不适3级：病人安静无反应4、统计学方法使用SPSS 8.0软件，采用 检验。（建立数据文件 说明 频 数 变 量 检 验 ）P0.05为有显著性差异。结果 1、 术后三组病人恶心、呕吐二级以上者，恩丹西酮组占100%，氟哌利多组占70%，生理盐水组占50%。恶心、呕吐三级者，恩丹西酮组占93%，氟哌利多组占43%，生理盐水组占23%。三组病人术后恶心呕吐人数和程度（见表）均有显著性差异（P0.05) 三组病人术后恶心呕吐反应（例）n=30讨论 手术后恶心伴或不伴呕吐是常见的并发症，尤以腹部为著，给病人身心造成很大的痛苦。有效预防术后恶心呕吐对提高病人的康复质量意义重大。恶心呕吐是广泛性植物神经兴奋而引起的一种复杂的反射活动。目前机理尚不完全清楚，可能与围手术期各种刺激、创伤、麻醉药物、内脏牵拉、术后疼痛等综合因素有关。 以往临床预防术后恶心呕吐的药物较多，其中以氟哌利多作用最强。因其通过阻滞边缘系统、下丘脑和黑质纹状体系统等部位的多巴胺受体而发挥作用，虽有较好的镇吐作用，但不能有效抑制迷走神经兴奋 引起的严重的恶心呕吐反射3。 且其过度镇静和锥体外系反应等副作用而限制了其在临床上的广泛应用。 恩丹西酮是一种高选择性5-HT3受体拮抗剂。通过拮抗外周中枢神经元5-HT3受体，从而阻断因各种因素引起的小肠5-HT释放，阻断呕吐反射，选择性高。有较强的抑制恶心呕吐作用。 另外因恩丹西酮不改变多巴胺、肾上腺素或抗胆碱能受体的活性，所以避免了一些副作用如嗜睡、口干、锥体外系作用等3。 为了研究恩丹西酮对术后恶心呕吐的预防作用，选择择期行腹部手术病人90例，（因氟哌利多和恩丹西酮血浆半衰期均为3h，有可比性）分恩丹西酮组、氟哌利多组和生理盐水组。三组病人麻醉方法、术前用药、手术时间和性别无明显差异，但术后恶心呕吐数量和程度均有显著差异（P 0.001） 通过本组临床观察结果表明，恩丹西酮8mg不但能有效预防术后恶心呕吐，而且对血流动力学无影响，安全副作用少，是一种很好的术后镇吐药。值得推广使用。 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