异丙酚在妇科腹腔镜手术中预防恶心呕吐的疗效观察.doc

异丙酚在妇科腹腔镜手术中预防恶心呕吐的疗效观察【摘要】目的评价异丙酚预防妇科腹腔镜手术术后恶心呕吐的效果。本研究通过对70例择期腹腔镜下妇科手术患者的观察，了解其对术后恶心呕吐的预防作用。 方法70例ASAIII级择期腹腔镜下妇科手术患者，随机分为实验组和对照组，实验组在麻醉苏醒后静脉注入异丙酚0.4 mg/kg，对照组使用生理盐水2 ml。观察麻醉苏醒后24h内两组患者恶心呕吐的发生率。结果实验组在麻醉清醒后24h内恶心呕吐发生率(54.3)明显低于对照组(74.3)，P0.05。结论亚催眠量的异丙酚用于预防术后恶心呕吐有一定的疗效。 【关键词】 异丙酚妇科腹腔镜手术预防术后恶心呕吐Effect of Antiemetic Propofol on Postoperative Nausea and Vomitting. Zhan Yuru,et al. （Department of Anesthesiology,Harbin Medical University,Harbin 150086 China）【Abstract】 Objective To evaluate the effect of propofol in preventing patients from nausea and vomit which were caused by performing the operation of gynecological laparoscopy.70 patients with surgery of gynecological laparoscopy were involved in this study,and the effect of antie-metic propofol on PONV was observed.Methods 70 ASA grade I-II patients were randomly divided into 2 groupsPropofol group and control group 0.4 mg/kg propofol was administrated intravenous when the patient was awaken from an esthesia,as to the control group,2 mL saline was administrated as placeboPONV was recorded in the 24 hrs after surgery Results Nausea and vomit in the propofol group was 54.3 in 24hrs,it was significantly lower than the control group (74.3),P5次。1.3 统计方法 计量资料采用（xs） 表示，组间比较采用单因素方差分析；计数资料采用χ2检验，P0.05认为差异有统计学意义。统计软件采用SPSS 11.0版本。2 结果经统计，两组患者在年龄、体重、手术时间上无显著性差异。麻醉苏醒返回病房后24h内两组患者恶心呕吐发生情况见表2，实验组恶心呕吐发生率54.3，较对照组(74.3%)有明显降低(P0.05)。表1 两组患者一般资料比较（略）表2 术后24 h内两组患者恶心呕吐发生情况略3 讨论调查显示女性患者术后发生恶心呕吐的危险性远远高于男性患者，其发生率大约为男性患者的两倍：这与女性体内促性腺激素以及其他激素水平有关1，3。异丙酚为镇静催眠类静脉麻醉药，研究发现它具有镇吐作用。但是异丙酚的抗吐作用机制尚未完全明了。其机制可能是4：1)通过增强大脑皮质GABA能神经元对多巴胺能神经元的调控及降低脑内5-HT3浓度；2)直接抑制催吐化学感受区、迷走神经核及其它与恶心、呕吐有关的中枢；3)通过降低皮质嗅区的突触传递。减少象天门冬氨酸和谷氨酸等兴奋性氨基酸的释放。该作用不是通过其镇静作用来实现的。因其镇吐作用时间远远超过其镇静作用时间。Peduto等5认为是异丙酚增强了GABA能神经元对DA能神经元的调控，异丙酚抑制PR神经元活动的ED50不远低于临床麻醉所需计量范围，这可能在不同程度上解释了异丙酚的镇吐作用。Brogeat6证明亚催眠量的异丙酚有直接明显的抗呕吐作用。因此本实验通过观察亚催眠量异丙酚对妇科腹腔镜手术患者术后恶心呕吐的发生情况，证明亚催眠量异丙酚对术后恶心呕吐的发生有一定的预防作用，但在给药时机和剂量方面仍需进一步的探讨和研究。【参考文献】 1Wateha MF,White PF.Postoperativenausea andvomiting. Its etiology,treatment and preventionJ.Anesthesio logy,1992,77(1)：1622Ronald,Harter.Postoperative nausea and vomiting prevention and therapyJ.Current Opinion In Anesthesiology,2000.13(4):469-4733Korttfla K The study of postoperative nausea and vomitingJBr J Anaesth,1992,69(Suppl 1):204DiFlofio T.Is propofol a dopamine antagonist?J.AnesthAnalg, 1993,77(1)： 2005Peduto AC et al.Anesthesiology,1991,75:10006Borgeat A.Subhypnotic doses of propofol possess direct antie-m