腹腔镜手术|【罂粟摘要】咪达唑仑与地塞米松联合昂丹司琼预防腹腔镜手术后恶心呕吐的比较抗疫|医疗队|河北大学|毕朝煜

咪达唑仑与地塞米松联合昂丹司琼预防腹腔镜手术后恶心呕吐的比较

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贵州医科大学麻醉与心脏电生理课题组
【 腹腔镜手术|【罂粟摘要】咪达唑仑与地塞米松联合昂丹司琼预防腹腔镜手术后恶心呕吐的比较】翻译：马艳燕编辑：张中伟审校：曹莹
背景
咪达唑仑与安慰剂相比或作为其他止吐药物的辅助药时，可减少术后恶心呕吐(PONV)。本研究旨在比较咪达唑仑与地塞米松联合昂丹司琼预防PONV的效果。
方法
120名接受腹腔镜手术并有两个或两个以上发生PONV危险因素(简化Apfel评分)的患者被随机分成两组，每组60人。D组患者给予地塞米松8 mg和昂丹司琼4 mg预防PONV, M组患者在手术结束时给予咪达唑仑2 mg。在术后24小时内，分别在0- 2小时、2- 24小时和0- 24小时内记录PONV、术后恶心(PON)和术后呕吐(POV)患者的比例(频率)。
结果
术后24 h PONV的发生率D组为30%，M组为33.3%，差异无统计学意义(P = 0.7 )。两组患者麻醉后出院评分≥9分的时间无差异{ D组5 min (5,5)；M组5 min(1.25,5)，P =0 .48}。D组有10例患者，M组有11例患者需要超过24小时的抢救止吐药物(P=0.81)。在所有时间段内PON，POV和PONV的发生率以及PONV评分的中位数相似。

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结论
与地塞米松联合昂丹司琼相比，咪达唑仑不会导致PONV发生率显著不同。
原始文献来源
Prakash K,Meshram T,Jain P. Midazolam versus dexamethasone- ondansetron in preventing post- operative nausea- vomiting in patients undergoing laparoscopic surgeries. Acta Anaesthesiol Scand. 2021;00:1– 7.

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Midazolam versus dexamethasone-ondansetron in preventing
post-operative nausea-vomiting in patients undergoing
laparoscopic surgeries
Abstract
Background:Midazolam reduces post-operative nausea and vomiting (PONV) whencompared to a placebo or when used as an adjuvant to other antiemetics. The present study was designed to compare midazolam with a combination of dexamethasone ondansetron in preventing PONV.
Methods:One hundred and twenty patients undergoing laparoscopic surgeries having 2 or more risk factors for PONV (simplified Apfel score) were randomised into 2 groups of 60 each. Patients in group D received 8-mg dexamethasone and 4-mg ondansetron for PONV prophylaxis while those in group M received 2-mg midazolam towards the end of surgery. The proportion of patients (frequency) who had PONV, post-operative nausea (PON) and post-operative vomiting (POV) was noted over 24 hours over the following intervals: 0-2 hours, 2-24 hours and 0-24 hours.
Results:The frequency of PONV at 24 hours in group D and group M was 30% and 33.3% respectively and was not significantly different (P = .70). There was no difference in the time to achieve post-anaesthesia discharge score of ≥9 between the two groups {5 minutes (5, 5) in group D; 5 minutes (1.25, 5) in group M, P = .48}. Ten patients in group D and 11 in group M required a rescue antiemetic over 24 hours (P = .81). The frequency of PON, POV and PONV as well as the median PONV score was similar at all time periods.
Conclusion:Midazolam does not result in significantly different frequency of PONV than a combination of dexamethasone-ondansetron.
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