| Object: The purpose of this study was to use the gynecologic laparoscopicuterine myomectomy patients as the research object, observe tropisetron,methylprednisolone and tropisetron combined with methylprednisolone in theprevention of the effects of PONV, discuss the reasonable scheme to prevent PONV.Method: One hundred and twenty gynecologic laparoscopic uterinemyomectomy patients, whose ASA is I-II, age is20~48and body weight is50~70kgwere assigned at random to4groups. C group is the contrast group. T group was thetropisetron group. M group was the methylprednisolone. TM group was thetropisetron combined with methylprednisolone group. The anesthesia wasintravenous combined anesthesia with tracheal intubation. Observe the BP, ECG andSPO2after the patients into the operation room. And open view access for the patients.The anesthesia was induced with induced with intravenous induction,0.05mg/kg ofmidazolam,4μg/kg of fentanyl,0.2mg/kg of etomidate-lipuro, and0.15mg/kg ofcisatracuriun. At the same time C group injected physiological saline3ml, T groupinjected tropisetron5mg, M group injected methylprednisolone40mg, TM groupinjected tropisetron5mg and methylprednisolone40mg. After the patients lostconsciousness, gave the patients manual ventilation, and pressing on the abdomen bythe assistant to ruduce gas into the stomach. After3minutes, connected to a ventilatorthrough the mouth for mechanical ventilation. Then fired the mechanical ventilationby setting the tidal volume(VT) at7ml/kg, respiratory rate(RR) at10-12times/min,fresh air velocity at2L/min, respiratory ratio(IE) at1:2. After pneumoperitoneum, adjust the VT, RR, and minute ventilation to keep the ETCO2at30-40mmHg.Continue to maintain anesthesia for abdominal operation on the basis of clinicalpractice. The maintain anesthesia of all groups were injected by continuousintravenous infusing remifentanil2μg·kg-1·h-1and propofol4-6mg·kg-1·h-1. Stopthe infusing of intravenous drugs at the end of the operation. Stay awake patients canbe called, breathing air fingertip blood saturation maintained tracheal extubation wererecorded in95%above, then extract the ventilator. Record the MAP of all patientsbefore Induction (T0),1min before laryngoscopy (T1), immediately when intubation(T2),1min after intubation(T3),3min after intubation(T4),5min after intubation(T5). Record the fingertip blood glucose before Induction (T0), at the end of theoperation(T1),1h after the operation(T2),2h after the operation(T3),6h after theoperation(T4),12h after the operation(T5). Record the degree of PONV and theadverse reactions and the degree of comfort of patients.Result：(1) There were no significant differences among four study groups withrespect to demographic data and baseline hemodynamic status (age, body weight,operation time, anesthesia time, oxytocin past medical history, preoperative anxiety,postoperative application of elements) before induction.(2) In four groups, MAPs andthe fingertip blood glucoses at the same time were no significant differences.(3) Thetwo two compared is found, there were significant difference between T group and Cgroup, M group and C group, TM group and T group, TM group and M group, TMgroup and C group.(4)Observation the adverse reaction found that, there were nosignificant difference among the four groups.(5)The observation of comfort foundthat, the comfort scores of T group, M group and TM group were all higher than Cgroup. And the comfort score of TM group was also higher than T group and M group.The score of T group was also higher than M group.Conclusion: The methylprednisolone does the function of preventive PONV.The tropisetron prevention PONV effect is superior to methylprednisolone. A singleinjection of small dose of methylprednisolone can’t cause the change of bloodpressure and the fingertip blood glucose. The tropisetron combined with methylprednisolone on the function of preventive PONV is superior to single use. Andthe tropisetron combined with methylprednisolone increase the comfort ofpostoperation. |
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