| Postoperative nausea and vomiting (PONV) are the most common and unpleasant side effects following anesthesia and surgery. Datum reveals that the incidence of PONV has come to 30% while in certain high-risk patients it is as high as 70%. It is estimated that approximately 0.2% of all patients may experience intractable PONV leading to a delay in recovery. Mental influences brought by PONV are unease, pain, awkwardness, weariness and dread for more surgeries. It also involves complications of wind dehiscence, electrolytic disorder, dehydration, activities delay and aspiration pneumonia which may cause certain mortality. How to deal with PONV becomes extremely urgent.It is considered currently that two areas of central nervous system are closely related to vomiting. Reasons of vomiting are complicated. It may be activated by accepting information from the following 4 areas by the vomiting center in the brain stem: (1) Chemoreceptor vomiting; (2) Vestibular labyrinth system; (3) Cortical center; (4) Gastrointestinal pneumogastric nerve system. Impact factors are universal. One certain antiemetic therapy would not prevent a single receptor from vomiting effectively. Though the impact of two kinds of combination antiemetic therapy is obviously better than one, it is still not so satisfying for high vomiting risk patients. The combining injection of three kinds of antiemetic therapies involved in three receptors is being studied abroad. Factors which would cause nausea vomiting during the laparoscopic cholecystectomy would be more than those in the other operations. Researches on the prophylactic therapy of PONV especially for high vomiting risk women undergoing LC are still less.Objective: This article aims to apply different combinations of antiemetic drugs to determine concentration changes of serum 5-HT of patients undergoing laparoscopic gallbladder surgery and to observe nausea and vomiting state after 24 hours. This helps to explore how the combined application of three kinds of antiemetic drugs would influence high vomiting risk female patients after laparoscopic cholecystectomy in serum 5-HT and post-operative nausea and vomiting.Approaches: To operate laparoscopic cholecystectomy (LC) on 60 female patients who are suffering chronic cholecystitis and gall-stone or gallbladder polyps. Nausea and vomiting risk grade of all of them are greater than 3. Operations should be under anesthesia. Double-blind patients are randomized and divided into three groups of 20 each. Patients of the first group are given ondansetron 0.08mglkg 30 minutes before suture; those of the second are given ondansetron 0.08mglk with dexamethasone 0.08mglkg30 minutes before suture; Ondansetron 0.08mglk with dexamethasone 0.08mglkg and droperidol 0.025mglkg are given to those of the third group was given 30 minutes before suture en Dancy one 0.08mglkg + dexamethasone 0.08mglkg. Take 5ml radial vein respectively at 4 time points: after entering the operation room (T0), after the surgery immediately(T1), 30 minutes after the surgery (T2), 3 hours after the surgery (T3). Put them into 4 procoagulant test tubes each to rotate 3000 turns for 1 minute under nomal temperature and make them centrifuge for 5 minutes. To take 1ml of serum to save at 70 degrees below zero. To measure the serum concentration by ELISA method inside 5-HT kits. Patients need to be visited 3 and 24 hours after surgery. To assess the grade of PONV according to WHO criteria: no nausea and vomiting would be 0 grade; mild nausea, abdominal discomfort, but no vomiting, grade 1; obvious nausea and vomiting, but no stomach contents spitting, grade 2; severe vomiting, gastric contents splitting such as gastric juice and drug control necessarily, grade 3.Results: There were no significant differences among the three group patients at their age, weight, operative time and transfusion quantity (P> 0.05). For postoperative nausea and vomiting, the third group was obviously different from the first and second one (P<0.05). At T0, there's almost no significant differences about 5-HT concentrations among these three groups (P>0.05); while at T1, T2 and T3, 5-HT concentrations of the third group was lower than the other two groups and differences were significant (P<0.05). T1, T2 and T3 were significantly higher compared with T0. T1 increased the most obviously and T2, T3 dropped slightly but was still higher than T0.Conclusion: The clinical effect is positive when applying three kinds of antiemetic drugs in combination to prevent high risk vomiting patients from postoperative nausea and vomiting in laparoscopic cholecystectomy. No adverse reaction such as anxiety and extrapyramidal symptoms on patients when being applied three kinds of antiemetic drugs in combination confirmed that ondansetron, droperidol and dexamethasone are effective. They greatly reduced the incidence of PONV with the lightest adverse reactions after abdominal surgery. They are much better than the single drug application,... |
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