本文關(guān)鍵詞： 托烷司瓊 甲潑尼龍 術(shù)后惡心嘔吐 婦科 腹腔鏡　出處：《吉林大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：以婦科腹腔鏡子宮肌瘤核除術(shù)患者為研究對(duì)象，觀察托烷司瓊、甲潑尼龍以及托烷司瓊聯(lián)合甲潑尼龍對(duì)預(yù)防PONV的效果，探討科學(xué)的預(yù)防PONV的方案。 方法：將120例擇期行腹腔鏡子宮肌瘤核除手術(shù)的ASAI-II級(jí)、年齡20~48歲、體重50-70kg的婦科患者隨機(jī)分四組：C組（對(duì)照組)、T組（托烷司瓊組）、M組（甲潑尼龍組）、TM組（托烷司瓊聯(lián)合甲潑尼龍組）。麻醉方式為靜脈復(fù)合氣管插管全麻�；颊呷胧液蟊O(jiān)測(cè)血壓、心電、血氧飽和度，開放靜脈通路，麻醉誘導(dǎo)時(shí)靜脈注射咪達(dá)唑侖0.05mg，芬太尼4μg/kg，依托咪酯0.2mg/kg，苯磺酸順阿曲庫銨0.15mg/kg。同時(shí)C組給予安慰劑生理鹽水3ml，T組給予托烷司瓊5mg，M組給予甲潑尼龍40mg，TM組給予托烷司瓊5mg及甲潑尼龍40mg。待患者意識(shí)消失后進(jìn)行手控通氣，手控通氣時(shí)由助手按壓上腹部以減少胃部進(jìn)氣導(dǎo)致胃腸道擴(kuò)張，3min后進(jìn)行經(jīng)口氣管插管操作。插管成功后進(jìn)行機(jī)械通氣，潮氣量為7ml·kg-1·，呼吸頻率為10-12次/min，新鮮氣體流速為2L·min-1，吸呼比為1:2，氣腹后根據(jù)呼末調(diào)整呼吸頻率、潮氣量及分鐘通氣量，維持ETCO2于30-40mmHg。根據(jù)臨床實(shí)踐繼續(xù)進(jìn)行腹部手術(shù)的麻醉維持，各組麻醉維持均采用瑞芬太尼2μg·kg-1·h-1，丙泊酚4-6mg·kg-1·h-1，持續(xù)靜脈泵注。手術(shù)結(jié)束時(shí)停用靜脈維持藥，待患者清醒，呼之能應(yīng)，呼吸空氣血氧飽和度維持在95%以上時(shí)拔除氣管導(dǎo)管。記錄入室后誘導(dǎo)前（T0)、插管前1min（T1）、插管即刻（T2)、插管后1min（T3）、插管后3min（T4)、插管后5min（T5)的平均動(dòng)脈壓MAP；入室后誘導(dǎo)前（T0）、手術(shù)結(jié)束時(shí)（T1）、術(shù)后1h（T2）、術(shù)后2h（T3）、術(shù)后6h（T4）、術(shù)后12h（T5）的指尖血糖；術(shù)后24小時(shí)內(nèi)PONV程度及不良反應(yīng)發(fā)生情況和患者舒適度。 結(jié)果：（1）四組病人一般情況包括病人年齡、體重、手術(shù)時(shí)間、麻醉時(shí)間、既往病史、術(shù)前焦慮狀態(tài)、術(shù)后應(yīng)用縮宮素情況等，無顯著性差異。（2）四組病人在誘導(dǎo)前（時(shí)間點(diǎn)T0）及插管前后（時(shí)間點(diǎn)T1-T5）同一時(shí)間點(diǎn)的MAP的差異均無統(tǒng)計(jì)學(xué)差異；四組病人在誘導(dǎo)前（時(shí)間點(diǎn)T0）及術(shù)后（時(shí)間點(diǎn)T1-T5）同一時(shí)間點(diǎn)的指尖血糖差異均無統(tǒng)計(jì)學(xué)差異。（3）四組病人兩兩比較發(fā)現(xiàn)，T組和C組，M組和C組，TM組分別和T、M、C組相比，PONV總發(fā)生率差異均有統(tǒng)計(jì)學(xué)意義。（4）患者不良反應(yīng)觀察發(fā)現(xiàn)，各組間均無統(tǒng)計(jì)學(xué)差異。（5）患者的舒適度調(diào)查發(fā)現(xiàn)，T、M、TM組的舒適度均高于C組，，且TM組比T組和M組的舒適度均高，而T組也略高于M組。 結(jié)論：甲潑尼龍有預(yù)防PONV的作用；托烷司瓊預(yù)防PONV的效果優(yōu)于甲潑尼龍；甲潑尼龍單次小劑量應(yīng)用不會(huì)引起血糖升高、血壓變化；托烷司瓊聯(lián)合甲潑尼龍對(duì)預(yù)防PONV效果優(yōu)于單獨(dú)使用，并增加了患者術(shù)后舒適度。
[Abstract]:Objective: to observe the effect of tropisetron, methylprednisolone and tropisetron combined with methylprednisolone on the prevention of PONV. To probe into the scientific scheme of preventing PONV. Methods: one hundred and twenty gynecological patients, aged 20 to 48 years old and weighing 50-70 kg, were randomly divided into four groups: group C (control group). Group T (tropisetron group), group M (methylprednisolone group) and group TM (tropisetron combined with methylprednisolone group) were anesthetized by intravenous combined endotracheal intubation general anesthesia. The blood pressure and ECG were monitored after entering the room. Blood oxygen saturation, open vein pathway, intravenous injection of midazolam 0.05 mg, fentanyl 4 渭 g / kg, etomidate 0.2 mg / kg during anesthesia induction. The patients in group C were given placebo saline (3ml), group T was given tropisetron (5 mg / kg) and methylprednisolone (40 mg). TM group was given tropisetron 5mg and methylprednisolone 40mg. Manual ventilation was performed after consciousness disappeared. Assistant pressed upper abdomen to reduce gastroenteric dilatation during manual ventilation. After 3 minutes, the tracheal intubation was performed. Mechanical ventilation was performed after successful intubation. The tidal volume was 7ml 路kg-1 路, and the respiratory frequency was 10-12 times / min. The flow rate of fresh gas was 2L 路min-1 and the breathing ratio was 1: 2.After pneumoperitoneum, the respiratory rate, tidal volume and minute ventilation volume were adjusted according to the end of exhalation. The maintenance of ETCO2 was 30 ~ 40 mm Hg.According to the clinical practice, the anesthesia of abdominal operation was maintained with remifentanil 2 渭 g 路kg-1 路h-1. Propofol 4-6 mg 路kg-1 路h-1, continuous intravenous infusion. At the end of the operation, the intravenous maintenance drug was stopped. The trachea catheter was removed when the oxygen saturation of the breathing air was maintained above 95%. Before induction was recorded, T0 was recorded, and T1 was taken 1 minute before intubation, and T2 was immediately inserted). The mean arterial pressure (MAPP) was 1 min after intubation, 3 min after intubation, and 5 min after intubation. The blood sugar at the fingertips of T0 was induced at the end of the operation, T1 at the end of operation, T2 at 1 hour after operation, T3 at 2 h after operation, T4 at 6 h after operation, and T5 at 12 h after operation. The degree of PONV, the incidence of adverse reactions and the comfort of the patients within 24 hours after operation. Results (1) the general conditions of the four groups included age, weight, operation time, anaesthesia time, previous medical history, anxiety state before operation, postoperative application of oxytocin and so on. There was no significant difference in MAP between the four groups before induction (time point T0) and before and after intubation (time point T1-T5) at the same time point. Four groups of patients before induction (time point T0) and post-operation (time point T1-T5) at the same time point of blood glucose differences were not statistically significant. There were significant differences in total incidence of PONV between group M and group C (P < 0.05). There was no statistical difference among the three groups. The results showed that the comfort degree of TM group was higher than that of C group, and that of TM group was higher than that of T group and M group, and that of T group was slightly higher than that of M group. Conclusion: methylprednisolone can prevent PONV. Tropisetron was more effective than methylprednisolone in preventing PONV. Low dose methylprednisolone did not cause hyperglycemia and blood pressure change. Tropisetron combined with methylprednisolone was more effective in preventing PONV and increased postoperative comfort.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R614

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