摘要[目的]观察昂丹司琼联合地塞米松、小剂量氟哌利多对妇科子宫切除术后硬膜外自控镇痛期间恶心呕吐的防治效果.[方法]随机将100例腰-硬联合麻醉下行腹式子宫全切术的妇科患者分为三组:对照组(C组)20例不给任何止吐药；昂丹司琼组(0组)40例手术结束前静脉注射昂丹司琼8 mg;昂丹司琼+地塞米松+氟哌利多组(O+D+F组)40例,手术开始后静脉注射地塞米松10mg,手术结束前注射昂丹司琼8 mg,术毕均行患者自控硬膜外镇痛(PCEA),C组与O组镇痛泵配方为0.238％甲磺酸罗哌卡因+0.004％芬太尼液共100ml,O+D+F组在镇痛液中加入2.5mg氟哌利多.观察术后48 h内患者的镇痛效果和恶心呕吐发生情况.[结果]三组镇痛效果VAS评分比较差异无统计学意义(P＞0.05),O组术后24h内恶心呕吐发生率低于C组(P＜0.05),O+D+F组术后48 h内恶心呕吐发生率低于C组(P＜0.01),O+D+F组术后48 h内恶心呕吐发生率显著低于0组(P＜0.01).[结论]昂丹司琼单独应用能减少术后24h内恶心呕吐的发生率,昂丹司琼+地塞米松+氟哌利多三药联合应用更能有效降低术后48 h内的恶心呕吐的发生率.

abstracts[Objective]To observe the preventive and curative effect of ondansetron combined with dexamethasone,and a small amount of droperidol on nausea and vomiting in patients with controlled epidural analgesia after gynecological hysterectomy.[Methods]Totally 100 patients underwent abdominal hysterectomy in combined spinal epidural anesthesia,were randomly divided into three groups:20 cases in control group ( Group C) were not given any antiemetics; 40 cases in ondansetron group (Group O)were given 8 mg ondansetron intraoperatively by intravenous injection; 40 cases in ondansetron,dexamethasone and droperidol group ( Group O + D + F) were given 10 mg dexamethasone intraoperatively by intravenous injection,8 mg ondansetron was injected at the end of operation,and patient controlled epidural analgesia ( PCEA )wasused postoperatively.In Group C and Group O,the analgesia formula were ropivacaine mesylate (0.238％) and fentanyl solution(0.004％) 100ml in all; In Group O + D + F,2.5mg droperidol was added to analgesic solution.In 48 hours after the operation,the effects of analgesia and incidences of nausea and vomiting were observed.[Results]There were no significant difference in the analgesic effect VAS scores between the three groups.The incidence of nausea and vomiting in Group O was significantly lower than that in Group C (P＜0.05) within 24 hours postoperatively.The incidence of nausea and vomiting in Group O + D + F was significantly lower than that in Group C (P＜0.01) within 48 hours postoperatively.And the incidence of nausea and vomiting in Group O + D + F was significantly lower than that in Group O (P＜0.01) within 48 hours postoperatively.[Conclusions]Ondansetron alone can reduce the of postoperative nausea and vomiting within 24 hours postoperatively.Combination of ondansetron,dexamethasone and droperidol can effectively reduce the incidence of postoperative nausea and vomiting within 48 hours postoperatively.