Combination of droperidol and ondansetron effectively reduces postoperative nausea and vomiting after ketamine-lidocaine anesthesia for pediatric strabotomy<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

盛开花*　硕士　　孙燕霞△　硕士

张炳熙△　教授　　陈雪华*　教授

* 北京潞河医院麻醉科， 北京101149

△首都医科大学附属北京同仁医院麻醉科，北京 100730

Kai-hua Sheng*,  Yan-xia Sun△, Bing-xi Zhang△, Xue-hua Chen*.

* Department of Anesthesiology, Luhe Hospital, Beijing 101149

△ Department of Anesthesiology, Beijing Tongren Hospital, Affiliate of Capital University of Medical Sciences, Beijing 100730, China

ABSTRACT

Objective: To compare the effect of ondansetron alone with the combination of droperidol and ondansetron on the incidence of postoperative nausea and vomiting (PONV) after ketamine-lidocaine anesthesia for pediatric strabotomy.
Methods: 90 children of ASA physical status I-II, aged 2-12 years were enrolled in this study. A standardized ketamine-lidocaine anesthesia technique was used for all children, and none of them received any premedication. They were randomized into three groups. Patients in Group N received ondansetron 100mg•kg^-1 intravenously after induction, in Group NF received droperidol 15mg•kg^-1 after induction and ondansetron 100mg•kg^-1 at the end of the operation, and in Group S received saline after induction. All incidences of nausea and vomiting occurring within 24 hours after surgery were recorded.
Results: Group NF resulted in a lower incidence of postoperative nausea (16.7%) than Group S (60%, P=0.001), and a lower incidence of postoperative vomiting (23.3%) than Group S (53.3%, P=0.033) and Group N (43.3%, P=0.031). The severity of PONV in Group NF was lower than that of Group S (P=0.000). There was no significant reduction in the incidence of PONV in Group N (P>0.05).
Conclusion: Combination of droperidol and ondansetron is more effective than ondansetron alone in reducing the incidence of PONV after ketamine-lidocaine anesthesia for pediatric strabotomy.
Key words: Nausea and vomiting; Strabotomy; Ondansetron; Droperidol.
Corresponding author: Bing-xi Zhang; E-mail: trbx-zh@263.net

　　手术后恶心呕吐(postoperative nausea and vomiting, PONV)是一常见的术后并发症。小儿 PONV的发生率约是成人的2倍。斜视手术PONV有很高的发生率(40%～80%)。PONV能延迟病人离院时间，增加突发入院事件，增加医疗护理费用，降低患者满意度。因此对其进行有效的预防和治疗极为重要。本研究旨在观察比较恩丹西酮、恩丹西酮和氟哌利多对小儿斜视手术氯胺酮利多卡因静脉麻醉后恶心呕吐的预防和治疗效果，以寻求一种更加有效的预防PONV的方法。
一、资料和方法<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

1. 一般资料
选择90例2～12岁ASA I-II 级行择期斜视矫正术的患儿作为观察对象。术前除专科疾病外，其余各脏器功能均正常。术前有运动性眩晕史(晕车史)或PONV史的患儿不被排除。患儿术前晚禁饮食饮水8～10小时。将90例患儿随机分为三组: N组诱导后静脉给恩丹西酮100mg/kg，NF组诱导后静脉给氟哌利多15μg/kg，手术结束后给恩丹西酮100mg/kg, S组诱导后给盐水。
2. 麻醉方法
　　所有患儿均不用术前药。患儿入室后开放静脉，用国产华翔监护仪监测心率、血压、血氧饱和度。用咪唑安定(瑞士罗氏公司生产)25mg/kg和氯胺酮利多卡因合剂(氯胺酮利多卡因各100mg)1.5mg/kg诱导。术中利氯合剂维持麻醉，追加量约为1mg/kg(利氯合剂总量达100mg后追加单纯氯胺酮)。每个患儿诱导后静脉给阿托品0.01mg/kg。术中均用鼻导管吸氧。记录术中患儿心率、血压、血氧饱和度、呼吸及手术时间和苏醒时间。术后患儿送到恢复室(postanaesthesia care unit, PACU)，用OAA/S评分^[1]进行评估，3分以上呼之有反应后即可送回病房。观察各组患儿术后0-2h、2-6h、6-24h及0-24h恶心呕吐的情况。对呕吐的程度进行评分(0-无恶心呕吐，1-恶心但无呕吐，2-呕吐1-2次，3-呕吐超过2次)^[2]。3分为严重呕吐。对恶心的程度也进行评分(0-无恶心，1-轻微恶心，2-恶心，3-恶心严重要呕吐)^[3]。3分为严重恶心。
3. 统计分析
　　用SPSS10.0统计软件进行数据处理。所得数据用均数±标准差表示。一般资料用F检验和秩和检验分析。PONV的发生率和严重程度用卡方检验和四格表(Fisher)确切概率法进行评估。一般资料对恶心呕吐发生率的影响用logistic回归分析。P<0.05有统计学意义。

二、结　果<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

　　三组患儿年龄、体重、性别比率、苏醒时间、麻醉时间、麻醉用药量、眼肌操作数目等一般资料均无显著性差异(P>0.05)(见表1)。
NF组术后2-6h、6-24h、0-24h恶心的发生率明显低于S组(P<0.05)(表2), 术后2-6h、0-24h呕吐的发生率也明显低于S组(P<0.05)(表4)。N组术后各个时间段恶心和呕吐的发生率与S组均无显著性差异(P>0.05)(表2，4)。NF组术后0-24h呕吐的发生率明显低于N组(P=0.031)(表3)。

　　NF组，术后2-6h、0-24h严重恶心的发生率明显低于S组(P<0.01)(表2), 术后0-24h严重呕吐的发生率也明显低于S组(P=0.000)(表3)。在N组术后0-24h严重恶心的发生率明显低于S组(P=0.019)(表2),而各个时间段严重呕吐的发生率与S组无显著性差异(P>0.05)(表3)。
　　术后24h恶心，N组NNT(numbers-needed-to-treat)为4.29，NF组NNT为2.31。术后24h呕吐，N组NNT为5.99，NF组NNT为3.33。

三组均未出现头痛头晕、锥体外系等不良反应。

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