帕洛诺司琼与昂丹司琼预防腰麻联合硬膜外注射吗啡行经腹全子宫切除术后恶心呕吐的作用：双盲随机对照试验

翻译：冯玉蓉  编辑：冯玉蓉  审校：曹莹

背景：子宫切除术是一种广泛应用的手术方式，腰麻联合硬膜外注射吗啡可提高术后恢复质量。术后恶心呕吐（PONV）是硬膜外注射吗啡的常见问题。虽然帕洛诺司琼对预防全麻后PONV有效，但其在腰麻后的有效性尚未明确。本研究旨在比较帕洛诺司琼与昂丹司琼在硬膜外注射吗啡联合腰麻下行经腹全子宫切除术（TAH）中预防PONV的效果。

方法：本项前瞻性、随机、双盲研究在São Rafael 医院进行，受试者为140名ASA 分级I或II级的女性，在腰麻联合硬膜外注射吗啡下接受TAH手术，并且根据Apfel简化评分至少有3个PONV危险因素。患者被随机分为两组：一组接受帕洛诺司琼治疗，另一组接受昂丹司琼治疗。所有患者均接受腰麻联合硬膜外注射吗啡麻醉，以及地塞米松加帕洛诺司琼或昂丹司琼预防PONV。记录PONV的总发生率、早发型和迟发型恶心呕吐的发生率、恶心的严重程度以及抢救性止吐药的使用情况。

结果：帕洛诺司琼组PONV总发生率为42.9%，昂丹司琼组为52.9%（p>0.05）。两组间早发型和迟发型恶心或早发型呕吐的发生率无显著性差异。帕洛诺司琼组迟发型呕吐的发生率明显较低。

结论：腰麻联合硬膜外注射吗啡行TAH术后，帕洛诺司琼与昂丹司琼在降低PONV的总体发生率方面疗效相似，但帕洛诺司琼在降低迟发型呕吐的发生率方面明显优于昂丹司琼。

原始文献来源：Campos GO, de Jesus Martins M, Jesus GN, et al. Palonosetron versus ondansetron for prevention of nausea and vomiting after total abdominal hysterectomy under spinal anesthesia with intrathecal morphine: a double-blind, randomized controlled trial.[J].BMC Anesthesiol. 2019 Aug 17;19(1):159. doi: 10.1186/s12871-019-0830-7.

Palonosetron versus ondansetron for prevention of nausea and vomiting after total abdominal hysterectomy under spinal anesthesia with intrathecal morphine: a double-blind, randomized controlled trial

Abstract

Background: Hysterectomy is a widely performed surgery and neuraxial anesthesia with intrathecal morphine provides superior quality of recovery. Postoperative nausea and vomiting (PONV) is a frequent problem with intrathecal morphine use. Although palonosetron is effective for prevention of PONV after general anesthesia, its efficacy after neuraxial anesthesia has not been established. This study was conducted to compare the use of palonosetron with ondansetron for PONV prophylaxis in patients at a high risk of PONV during total abdominal hysterectomy (TAH) under spinal anesthesia with intrathecal morphine.

Methods: This prospective, randomized double-blind study conducted at São Rafael Hospital involved 140 American Society of Anesthesiologists physical status I or II women who underwent TAH under spinal anesthesia with intrathecal morphine and who had at least 3 risk factors for PONV based on Apfel’s simplified score. The patients were randomized into two groups: one received palonosetron whereas the other received ondansetron. All patients received spinal anesthesia with intrathecal morphine, as well as dexamethasone plus palonosetron or ondansetron for PONV prophylaxis. The overall incidence of PONV, incidence of early- and late-onset nausea and vomiting, severity of nausea, and use of rescue antiemetics were recorded.

Results: The overall incidence of PONV was 42.9% in the palonosetron group and 52.9% in the ondansetron group (p > 0.05). No significant differences existed in the incidence of early- and late-onset nausea or early-onset vomiting between the two groups. The incidence of late-onset vomiting was significantly lower in the palonosetron group.

Conclusions: Palonosetron exhibited efficacy similar to that of ondansetron for reducing the overall incidence of PONV after TAH under spinal anesthesia with intrathecal morphine; however, palonosetron reduced the incidence of late-onset vomiting significantly better than ondansetron.