[罂粟摘要]5-羟色胺-3受体拮抗剂对全麻诱导期间低血压及术后恶心呕吐的预防作用：一项双盲随机对照试验

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5-羟色胺-3受体拮抗剂对全麻诱导期间低血压及术后恶心呕吐的预防作用：一项双盲随机对照试验

贵州医科大学  麻醉与心脏电生理课题

翻译 :  陈锐

编辑 :  严旭

审校 : 曹莹

研究目的：在麻醉诱导时给予 5-羟色胺-3 受体（5-HT3） 可能有助于维持在使用阿片类药物诱导的全身麻醉中的血流动力学稳定。因此，我们旨在评估雷莫司琼（一种5-HT3拮抗剂）在使用丙泊酚酚和瑞芬太尼诱导的全凭静脉麻醉（TIVA）对低血压的影响。此外，还研究比较麻醉诱导时手术结束时给予雷莫司琼对术后恶心呕吐（PONV）的影响。

方法：患者被随机分配到诱导组（麻醉诱导时给予雷莫司琼[0.3mg/5ml]，手术结束时给予生理盐水[5ml]）或结束组（麻醉诱导时给予生理盐水[5ml]，手术结束时给予雷莫司琼[0.3mg / 5ml]）。评估血流动力学状态、术后恶心呕吐与术后疼痛。

地点：手术室、麻醉后复苏室和普通病房。病人：该研究共纳入了176名没有任何既往病史的非吸烟患者，他们在全凭静脉麻醉下接受了腹腔镜妇科手术。

测量指标：血压（BP）、心率、术后恶心呕吐、疼痛视觉模拟量表 （VAS）。

主要成果：与结束组相比，诱导组在麻醉诱导时表现出更高的血压，并且在麻醉期间需要的去氧肾上腺素和麻黄碱的剂量明显低于终末组。然而，两组之间的术后恶心呕吐和术后疼痛相似。

结论：与手术结束时给药相比，在麻醉诱导时给予雷莫司琼能保持更好的血流动力学稳定性，对去氧肾上腺素和麻黄碱的需求显著减少。因此，我们建议在麻醉诱导时给予雷莫司琼,而不是手术结束时给药，以预防丙泊酚和瑞芬太尼在TIVA期间PONV和平均血压降低。

原始文献来源  ：

Hong S-W, Kim S-H. The preventive effect of 5-hydroxytryptamine-3 receptor antagonist on blood pressure reduction and postoperative nausea and vomiting during general anesthesia induction: a double-blinded, randomized controlled trial [J]. Journal of Clinical Anesthesia, 2023, 90: 111232.

英文原文：

The preventive effect of 5-hydroxytryptamine-3 receptor antagonist on blood pressure reduction and postoperative nausea and vomiting during general anesthesia induction: a double-blinded, randomized controlled trial

Study objective: Administering a 5-hydroxytryptamine-3 receptor (5-HT3) at anesthesia induction may aid in achieving hemodynamic stability during general anesthesia induced using opioids. Therefore, we aimed to evaluate the effect of ramosetron, a 5-HT3 antagonist, administered on hypotension at the induction of total intravenous anesthesia (TIVA) with propofol and remifentanil. Additionally, we aimed to compare the impact of ramosetron administration at anesthesia induction versus that at the end of the surgery on postoperative nausea and vomiting (PONV).

Design: Patients were randomly allocated to the Induction group (administration of ramosetron [0.3 mg/5 ml] at anesthesia induction and normal saline [5 ml] at the end of the surgery) or End group (administration of normal saline [5 ml] at anesthesia induction and ramosetron [0.3 mg/5 ml] at the end of the surgery). Hemodynamic status, PONV, and postoperative pain were assessed.

Setting: Operating room, post-anesthetic care unit, and general ward.

Patients: In total, 176 non-smoking patients without any past medical history undergoing laparoscopic gynecological surgeries under TIVA were included in the study.

Measurements: Blood pressure (BP), heart rate, PONV, visual analog scale (VAS).

Main results: The Induction group exhibited significantly higher BP at anesthesia induction and required significantly lower doses of phenylephrine and ephedrine during anesthesia than the End group had. However, PONV and postoperative pain were similar between the two groups.

Conclusions: Administering ramosetron at anesthesia induction resulted in significantly better hemodynamic stability with significantly lesser requirement of phenylephrine and ephedrine than administering at the end of the surgery did. Therefore, we recommend ramosetron administration at anesthesia induction rather than at the end of the surgery to prevent PONV and the decrease in the mean BP during TIVA with propofol and remifentanil.

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