戊乙奎醚预防丙泊酚-瑞芬太尼全凭静脉麻醉下甲状腺切除术患者术后恶心呕吐的效果评价

戊乙奎醚预防丙泊酚-瑞芬太尼全凭静脉麻醉下甲状腺切除术患者术后恶心呕吐的效果评价

贵州医科大学     麻醉与心脏电生理课题组

翻译：张中伟  编辑：陈锐  审核：曹莹

罂 粟 摘 要 

背景：术后恶心呕吐(PONV)是全麻下甲状腺切除术后最常见的并发症之一。全凭静脉麻醉(TIVA)已被证明可以预防接受全甲状腺切除术的患者发生PONV。戊乙奎醚是一种消除半衰期超过10小时的抗胆碱能药物，临床上被广泛用于减少患者的腺体分泌。本研究旨在探讨戊乙奎醚复合丙泊酚-瑞芬太尼全凭静脉麻醉对甲状腺切除术患者术后PONV的预防作用。

方法：将100例接受甲状腺切除术的患者随机分为戊乙奎醚组和TIVA组，每组各50例。所有患者均采用丙泊酚-瑞芬太尼全凭静脉麻醉，且不予麻醉前用药。麻醉诱导后立即给患者注射5毫升生理盐水或0.5毫克戊乙奎醚。观察术后24h内(0~2 h和2~24h)患者恶心呕吐的发生率、发生程度、止吐药物的使用情况及不良反应。

结果：戊乙奎醚组患者术后24 h内PONV的总发生率(12%)明显低于TIVA组(36%)(P<0.005)。术后2~24 h，戊乙奎醚组恶心、呕吐发生率明显低于TIVA组。术后0~2 h两组间差异无统计学意义。

结论：丙泊酚-瑞芬太尼TIVA下应用戊乙奎醚预防PONV较单纯TIVA更有效，尤其在全甲状腺切除术后2~24小时之间。

原始文献来源：Ting Lu, Rongrong Li, Jiacheng Sun,et al. Evaluation of penehyclidine for prevention of post operative nausea and vomitting in patients undergoing total thyroidectomy under total intravenous anaesthesia with propofol-remifentanil.[J]. BMC Anesthesiology (2022) 22:317

英文原文

Evaluation of penehyclidine for prevention of post operative nausea and vomitting in patients undergoing total thyroidectomy under total intravenous anaesthesia with propofol-remifentanil

Abstract

BACKGROUND：Postoperative nausea and vomiting (PONV) is one of the most common complications after total thyroidectomy under general anesthesia. Total intravenous anesthesia (TIVA) has been documented to prevent PONV in patients undergoing total thyroidectomy. Penehyclidine, an anticholinergic agent with an elimination half-life of over 10 h, is widely used as premedication to reduce glandular secretion. This study aimed to explore the preventa-tive effects of penehyclidine with propofol-remifentanil-TIVA to single-TIVA on PONV in patients undergoing total thyroidectomy.

Methods: A total of 100 patients scheduled for total thyroidectomy were randomly assigned to either the penehyclidine group (n = 50) or TIVA group (n = 50). Propofol and remifentanil were was used for TIVA in all patients. No patients who received premedication. Patients were administrated with either 5 ml of normal saline or 0.5 mg of penehyclidine soon after anesthesia induction. The incidence of nausea and vomiting, the severity of nausea, the requirement of rescue antiemetics, and adverse effects were investigated during the first 24 h in two time periods (0–2 h and 2–24 h).

RESULTS：The overall PONV incidence during the 24 h after surgery was significantly lower in the penehyclidine group compared with the TIVA group (12% vs 36%, P < 0.005). Besides, the incidence of nausea and the incidence of vomiting were significantly lower in the penehyclidine group compared with the TIVA group at 2–24 h after surgery. However, there was no significant difference between the two groups at 0–2 h after surgery.

CONCLUSION：Administration of penehyclidine under TIVA with propofol-remifentanil is more effective for prevention of PONV than TIVA alone, especially 2–24 h after total thyroidectomy.

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