翻譯：馮玉蓉  編輯：馮玉蓉  審校：曹瑩

背景：子宮切除術(shù)是一種廣泛應(yīng)用的手術(shù)方式，腰麻聯(lián)合硬膜外注射嗎啡可提高術(shù)后恢復(fù)質(zhì)量。術(shù)后惡心嘔吐（PONV）是硬膜外注射嗎啡的常見問題。雖然帕洛諾司瓊對(duì)預(yù)防全麻后PONV有效，但其在腰麻后的有效性尚未明確。本研究旨在比較帕洛諾司瓊與昂丹司瓊在硬膜外注射嗎啡聯(lián)合腰麻下行經(jīng)腹全子宮切除術(shù)（TAH）中預(yù)防PONV的效果。

方法：本項(xiàng)前瞻性、隨機(jī)、雙盲研究在S?o Rafael 醫(yī)院進(jìn)行，受試者為140名ASA 分級(jí)I或II級(jí)的女性，在腰麻聯(lián)合硬膜外注射嗎啡下接受TAH手術(shù)，并且根據(jù)Apfel簡(jiǎn)化評(píng)分至少有3個(gè)PONV危險(xiǎn)因素。患者被隨機(jī)分為兩組：一組接受帕洛諾司瓊治療，另一組接受昂丹司瓊治療。所有患者均接受腰麻聯(lián)合硬膜外注射嗎啡麻醉，以及地塞米松加帕洛諾司瓊或昂丹司瓊預(yù)防PONV。記錄PONV的總發(fā)生率、早發(fā)型和遲發(fā)型惡心嘔吐的發(fā)生率、惡心的嚴(yán)重程度以及搶救性止吐藥的使用情況。

結(jié)果：帕洛諾司瓊組PONV總發(fā)生率為42.9%，昂丹司瓊組為52.9%（p>0.05）。兩組間早發(fā)型和遲發(fā)型惡心或早發(fā)型嘔吐的發(fā)生率無顯著性差異。帕洛諾司瓊組遲發(fā)型嘔吐的發(fā)生率明顯較低。

結(jié)論：腰麻聯(lián)合硬膜外注射嗎啡行TAH術(shù)后，帕洛諾司瓊與昂丹司瓊在降低PONV的總體發(fā)生率方面療效相似，但帕洛諾司瓊在降低遲發(fā)型嘔吐的發(fā)生率方面明顯優(yōu)于昂丹司瓊。

原始文獻(xiàn)來源：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 S?o 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.