目的:探讨利多卡因联合地塞米松对甲状腺手术患者术后恶心呕吐(Postoperative Nausea and Vomiting, PONV)的影响。方法:选择2023年9月~2024年8月在右江民族医学院附属医院住院并择期行单侧甲状腺次全切除术的女性患者120例,随机分为L ...目的:探讨利多卡因联合地塞米松对甲状腺手术患者术后恶心呕吐(Postoperative Nausea and Vomiting, PONV)的影响。方法:选择2023年9月~2024年8月在右江民族医学院附属医院住院并择期行单侧甲状腺次全切除术的女性患者120例,随机分为L (利多卡因)组、D (地塞米松)组、LD (利多卡因联合地塞米松)组和N (生理盐水)组四组,每组30例。对比四组术后T1 (0~2 h)、T2 (2~6 h)、T3 (6~12 h)、T4 (12~24 h)时间段PONV发生情况和术后24 h内PONV的级别;患者一般情况、麻醉时间、手术时间和输液量;术后2 h、6 h、12 h和24 h的静息VAS疼痛评分;入室时(t0)、气管插管时(t1)及拔除气管导管时(t2)的平均动脉压(MAP)和心率(HR);术中阿片类药物用量、术后首次排气时间、术后24 h氟比洛芬酯(凯纷)补救镇痛和补救止吐胃复安的例数及患者总体满意率;围术期发生的不良反应。结果:四组患者在年龄、BMI、麻醉时间和输液量等一般资料比较上,无统计学差异(P > 0.05);与其他三组相比,LD组术后24 h内的恶心和呕吐程度最低(P 0.05);在T1、T2、T3和T4各时间段,与其他三组相比,LD组恶心发生率明显降低(P 1、T2和T3各时间段,与L组和D组相比,LD组呕吐发生率明显降低(P 0.05);与其他三组相比,LD组术后2 h、6 h、12 h和24 h VAS评分最低(P 0.05);组间比较:t0时刻,四组患者MAP和HR之间的差异无统计学意义(P > 0.05);在t1、t2时刻,与其他三组相比,LD组的MAP和HR显著低(P 0.05);组内比较:与t0时刻比,N组在t1和t2时刻的MAP、HR明显增高(P 1和t2时刻的MAP、HR与t0时刻之间的差异无统计学意义(P > 0.05);舒芬太尼用量在各组之间的差异无统计学意义(P > 0.05),与其他三组相比,LD组的瑞芬太尼用量最少、术后首次排气时间缩短、补救镇痛和止吐的例数最少及总体满意率最高(P 0.05),L组和D组的瑞芬太尼用量和术后各指标之间的差异无统计学意义(P > 0.05);各组不良反应发生率之间的差异无统计学意义(P > 0.05)。结论:1) 利多卡因联合地塞米松能显著降低甲状腺手术患者PONV的发生率。2) 利多卡因联合地塞米松能增强术后镇痛效果,增加血流动力学的稳定性,减少补救镇痛和止吐药物的使用,促进术后康复。Objective: To investigate the effects of lidocaine combined with dexamethasone on postoperative nausea and vomiting (PONV) in patients undergoing thyroid surgery. Methods: A total of 120 female patients hospitalized in the Affiliated Hospital of Youjiang Medical University for Nationalities from September 2023 to August 2024 who underwent unilateral subtotal thyroidectomy were selected and randomly divided into four groups: L (lidocaine) group, D (dexamethasone) group, LD (lidocaine combined with dexamethasone) group and N (normal saline) group, with 30 cases in each group. We compared the occurrence of PONV at T1 (0~2 h), T2 (2~6 h), T3 (6~12 h), and T4 (12~24 h) and the grade of PONV within 24 h after surgery among the four groups;patient’s general condition, anesthesia time, operation time and infusion volume;resting VAS pain scores at 2 h, 6 h, 12 h and 24 h after surgery;Mean Arterial Pressure (MAP) and Heart Rate (HR) at entry (t0), tracheal intubation (t1), and tracheal catheter removal (t2);intraoperative opioid dosage, the first postoperative exhaust time, the number of cases of flurbiprofen axetil (Kefon) for analgesia and metoclopramide for emetic relief 24 h after surgery, and the overall satisfaction rate of patients;adverse reactions occurred during perioperative period. Results: There were no significant differences in age, BMI, anesthesia time and infusion volume among the four groups (P > 0.05). Compared with the other three groups, LD group had the lowest degree of nausea and vomiting within 24 h after surgery (P 0.05). In each time period of T1, T2, T3 and T4, the incidence of nausea in LD group was significantly decreased compared with the other three groups (P 1, T2 and T3 time periods, the incidence of vomiting in LD group was significantly lower than that in L and D groups (P 0.05). Compared with the other three groups, the LD group had the lowest VAS scores at 2 h, 6 h, 12 h and 24 h after surgery (P 0.05). Inter-group comparison: at t0, there was no significant difference in MAP and HR among the four groups (P > 0.05). At t1 and t2, compared with the other three groups, MAP and HR in LD group were significantly lower (P 0.05). Intra-group comparison: Compared with t0 moment, MAP and HR in group N were significantly increased at t1 and t2 moments (P 0 in L, D and LD groups at t1 and t2 (P > 0.05). There was no statistically significant difference in the dosage of sufentanil among all groups (P > 0.05). Compared with the other three groups, the dosage of remifentanil in LD group was the least, the first postoperative exhaust time was shortened, the number of cases of relief analgesia and antiemetics was the least, and the overall satisfaction rate was the highest (P 0.05). There was no statistically significant difference between the dosage of remifentanil and postoperative indexes in groups L and D (P > 0.05). There was no significant difference in the incidence of adverse reactions among all groups (P > 0.05). Conclusion: 1) Lidocaine combined with dexamethasone can significantly reduce the incidence of PONV in patients undergoing thyroid surgery. 2) Lidocaine combined with dexamethasone can enhance postoperative analgesia, increase hemodynamic stability, reduce the use of remedial analgesia and antiemetic drugs, and promote postoperative rehabilitation.展开更多
恶性肿瘤患者在接受化疗、放疗、靶向治疗及免疫治疗等抗肿瘤治疗时都可能引发恶心呕吐。化疗所致恶心呕吐(chemotherapy-induced nausea and vomiting,CINV)是最为常见也是目前研究最为深入的不良反应;放疗所致恶心呕吐(radiation-indu...恶性肿瘤患者在接受化疗、放疗、靶向治疗及免疫治疗等抗肿瘤治疗时都可能引发恶心呕吐。化疗所致恶心呕吐(chemotherapy-induced nausea and vomiting,CINV)是最为常见也是目前研究最为深入的不良反应;放疗所致恶心呕吐(radiation-induced nausea and vomiting,RINV)、靶向治疗及免疫治疗所致恶心呕吐(targeted therapy and immunotherapyinduced nausea and vomiting,TIINV)也越来越受到关注。本专家组在《化疗所致恶心呕吐全程管理上海专家共识(2018年版)》的基础上,根据近年来抗肿瘤治疗所致恶心呕吐(antineoplastic-induced nausea and vomiting,AINV)领域的循证医学新证据,结合上海一线肿瘤治疗专家的实际临床经验,最终形成《抗肿瘤治疗所致恶心呕吐全程管理上海专家共识(2024年版)》,以便进一步在上海地区积极、合理、规范、全程地预防和处理AINV,保障患者的治疗强度和医疗安全。展开更多
美国国家癌症研究所(NCI)在进行癌症的长期回顾性调查时证实癌症的发生率和死亡率均呈现上升趋势,大约是1990年的两倍。中晚期肿瘤患者在接受治疗时,较为有效的其中一种方式为化疗;由有关研究成果及证实的证据显示,患者在治疗期间,发生...美国国家癌症研究所(NCI)在进行癌症的长期回顾性调查时证实癌症的发生率和死亡率均呈现上升趋势,大约是1990年的两倍。中晚期肿瘤患者在接受治疗时,较为有效的其中一种方式为化疗;由有关研究成果及证实的证据显示,患者在治疗期间,发生率较高的其中一类不良反应为化疗相关性恶心呕吐(Chemotherapy-Induced Nausea and Vomiting,CINV,以下简称CINV),化疗时若未进行镇吐处理,CINV的发生率可高达70%~80%,对患者身体、心理造成巨大损害,且对患者后续治疗有很大的影响。目前对CINV的治疗,并无特效治疗方式,西医治疗CINV不仅价格昂贵,且会引起便秘、腹泻、头痛、肝肾功能损害等不良反应。通过对近年来的相关文献的阅读与分析,发现中医在CINV的治疗上取得了较明显的效果,因此,对中医治疗CINV的临床进展进行了大致总结。展开更多
迄今为止,术后恶心呕吐(postoperative nausea and vomiting, PONV)仍然是围术期间严重的并发症之一,它增加了患者手术切口破裂,出血的风险并可能导致吸入性肺炎,电解质紊乱,脱水等不良事件的发生,增加了患者的住院时间以及费用,在一定...迄今为止,术后恶心呕吐(postoperative nausea and vomiting, PONV)仍然是围术期间严重的并发症之一,它增加了患者手术切口破裂,出血的风险并可能导致吸入性肺炎,电解质紊乱,脱水等不良事件的发生,增加了患者的住院时间以及费用,在一定程度上影响了患者术后的生活品质。预防术后恶心呕吐仍然是临床上热议的话题之一,特别是预防儿童术后恶心呕吐更应该得到大众的关注。这篇文章综述了最近几十年对于预防儿童PONV的研究进展的总结。To date, postoperative nausea and vomiting (PONV) is still one of the serious complications during perioperative surgery, which increases the risk of surgical incision rupture and bleeding and may lead to aspiration pneumonia, electrolyte imbalance, dehydration and other adverse events, increases the length of hospital stay and costs, and affects the quality of life of patients after surgery to a certain extent. The prevention of postoperative nausea and vomiting is still one of the hot topics in clinical practice, especially the prevention of postoperative nausea and vomiting in children should receive more public attention. This article summarizes recent advances in research on the prevention of PONV in children.展开更多
文摘目的:探讨利多卡因联合地塞米松对甲状腺手术患者术后恶心呕吐(Postoperative Nausea and Vomiting, PONV)的影响。方法:选择2023年9月~2024年8月在右江民族医学院附属医院住院并择期行单侧甲状腺次全切除术的女性患者120例,随机分为L (利多卡因)组、D (地塞米松)组、LD (利多卡因联合地塞米松)组和N (生理盐水)组四组,每组30例。对比四组术后T1 (0~2 h)、T2 (2~6 h)、T3 (6~12 h)、T4 (12~24 h)时间段PONV发生情况和术后24 h内PONV的级别;患者一般情况、麻醉时间、手术时间和输液量;术后2 h、6 h、12 h和24 h的静息VAS疼痛评分;入室时(t0)、气管插管时(t1)及拔除气管导管时(t2)的平均动脉压(MAP)和心率(HR);术中阿片类药物用量、术后首次排气时间、术后24 h氟比洛芬酯(凯纷)补救镇痛和补救止吐胃复安的例数及患者总体满意率;围术期发生的不良反应。结果:四组患者在年龄、BMI、麻醉时间和输液量等一般资料比较上,无统计学差异(P > 0.05);与其他三组相比,LD组术后24 h内的恶心和呕吐程度最低(P 0.05);在T1、T2、T3和T4各时间段,与其他三组相比,LD组恶心发生率明显降低(P 1、T2和T3各时间段,与L组和D组相比,LD组呕吐发生率明显降低(P 0.05);与其他三组相比,LD组术后2 h、6 h、12 h和24 h VAS评分最低(P 0.05);组间比较:t0时刻,四组患者MAP和HR之间的差异无统计学意义(P > 0.05);在t1、t2时刻,与其他三组相比,LD组的MAP和HR显著低(P 0.05);组内比较:与t0时刻比,N组在t1和t2时刻的MAP、HR明显增高(P 1和t2时刻的MAP、HR与t0时刻之间的差异无统计学意义(P > 0.05);舒芬太尼用量在各组之间的差异无统计学意义(P > 0.05),与其他三组相比,LD组的瑞芬太尼用量最少、术后首次排气时间缩短、补救镇痛和止吐的例数最少及总体满意率最高(P 0.05),L组和D组的瑞芬太尼用量和术后各指标之间的差异无统计学意义(P > 0.05);各组不良反应发生率之间的差异无统计学意义(P > 0.05)。结论:1) 利多卡因联合地塞米松能显著降低甲状腺手术患者PONV的发生率。2) 利多卡因联合地塞米松能增强术后镇痛效果,增加血流动力学的稳定性,减少补救镇痛和止吐药物的使用,促进术后康复。Objective: To investigate the effects of lidocaine combined with dexamethasone on postoperative nausea and vomiting (PONV) in patients undergoing thyroid surgery. Methods: A total of 120 female patients hospitalized in the Affiliated Hospital of Youjiang Medical University for Nationalities from September 2023 to August 2024 who underwent unilateral subtotal thyroidectomy were selected and randomly divided into four groups: L (lidocaine) group, D (dexamethasone) group, LD (lidocaine combined with dexamethasone) group and N (normal saline) group, with 30 cases in each group. We compared the occurrence of PONV at T1 (0~2 h), T2 (2~6 h), T3 (6~12 h), and T4 (12~24 h) and the grade of PONV within 24 h after surgery among the four groups;patient’s general condition, anesthesia time, operation time and infusion volume;resting VAS pain scores at 2 h, 6 h, 12 h and 24 h after surgery;Mean Arterial Pressure (MAP) and Heart Rate (HR) at entry (t0), tracheal intubation (t1), and tracheal catheter removal (t2);intraoperative opioid dosage, the first postoperative exhaust time, the number of cases of flurbiprofen axetil (Kefon) for analgesia and metoclopramide for emetic relief 24 h after surgery, and the overall satisfaction rate of patients;adverse reactions occurred during perioperative period. Results: There were no significant differences in age, BMI, anesthesia time and infusion volume among the four groups (P > 0.05). Compared with the other three groups, LD group had the lowest degree of nausea and vomiting within 24 h after surgery (P 0.05). In each time period of T1, T2, T3 and T4, the incidence of nausea in LD group was significantly decreased compared with the other three groups (P 1, T2 and T3 time periods, the incidence of vomiting in LD group was significantly lower than that in L and D groups (P 0.05). Compared with the other three groups, the LD group had the lowest VAS scores at 2 h, 6 h, 12 h and 24 h after surgery (P 0.05). Inter-group comparison: at t0, there was no significant difference in MAP and HR among the four groups (P > 0.05). At t1 and t2, compared with the other three groups, MAP and HR in LD group were significantly lower (P 0.05). Intra-group comparison: Compared with t0 moment, MAP and HR in group N were significantly increased at t1 and t2 moments (P 0 in L, D and LD groups at t1 and t2 (P > 0.05). There was no statistically significant difference in the dosage of sufentanil among all groups (P > 0.05). Compared with the other three groups, the dosage of remifentanil in LD group was the least, the first postoperative exhaust time was shortened, the number of cases of relief analgesia and antiemetics was the least, and the overall satisfaction rate was the highest (P 0.05). There was no statistically significant difference between the dosage of remifentanil and postoperative indexes in groups L and D (P > 0.05). There was no significant difference in the incidence of adverse reactions among all groups (P > 0.05). Conclusion: 1) Lidocaine combined with dexamethasone can significantly reduce the incidence of PONV in patients undergoing thyroid surgery. 2) Lidocaine combined with dexamethasone can enhance postoperative analgesia, increase hemodynamic stability, reduce the use of remedial analgesia and antiemetic drugs, and promote postoperative rehabilitation.
文摘恶性肿瘤患者在接受化疗、放疗、靶向治疗及免疫治疗等抗肿瘤治疗时都可能引发恶心呕吐。化疗所致恶心呕吐(chemotherapy-induced nausea and vomiting,CINV)是最为常见也是目前研究最为深入的不良反应;放疗所致恶心呕吐(radiation-induced nausea and vomiting,RINV)、靶向治疗及免疫治疗所致恶心呕吐(targeted therapy and immunotherapyinduced nausea and vomiting,TIINV)也越来越受到关注。本专家组在《化疗所致恶心呕吐全程管理上海专家共识(2018年版)》的基础上,根据近年来抗肿瘤治疗所致恶心呕吐(antineoplastic-induced nausea and vomiting,AINV)领域的循证医学新证据,结合上海一线肿瘤治疗专家的实际临床经验,最终形成《抗肿瘤治疗所致恶心呕吐全程管理上海专家共识(2024年版)》,以便进一步在上海地区积极、合理、规范、全程地预防和处理AINV,保障患者的治疗强度和医疗安全。
文摘美国国家癌症研究所(NCI)在进行癌症的长期回顾性调查时证实癌症的发生率和死亡率均呈现上升趋势,大约是1990年的两倍。中晚期肿瘤患者在接受治疗时,较为有效的其中一种方式为化疗;由有关研究成果及证实的证据显示,患者在治疗期间,发生率较高的其中一类不良反应为化疗相关性恶心呕吐(Chemotherapy-Induced Nausea and Vomiting,CINV,以下简称CINV),化疗时若未进行镇吐处理,CINV的发生率可高达70%~80%,对患者身体、心理造成巨大损害,且对患者后续治疗有很大的影响。目前对CINV的治疗,并无特效治疗方式,西医治疗CINV不仅价格昂贵,且会引起便秘、腹泻、头痛、肝肾功能损害等不良反应。通过对近年来的相关文献的阅读与分析,发现中医在CINV的治疗上取得了较明显的效果,因此,对中医治疗CINV的临床进展进行了大致总结。
文摘迄今为止,术后恶心呕吐(postoperative nausea and vomiting, PONV)仍然是围术期间严重的并发症之一,它增加了患者手术切口破裂,出血的风险并可能导致吸入性肺炎,电解质紊乱,脱水等不良事件的发生,增加了患者的住院时间以及费用,在一定程度上影响了患者术后的生活品质。预防术后恶心呕吐仍然是临床上热议的话题之一,特别是预防儿童术后恶心呕吐更应该得到大众的关注。这篇文章综述了最近几十年对于预防儿童PONV的研究进展的总结。To date, postoperative nausea and vomiting (PONV) is still one of the serious complications during perioperative surgery, which increases the risk of surgical incision rupture and bleeding and may lead to aspiration pneumonia, electrolyte imbalance, dehydration and other adverse events, increases the length of hospital stay and costs, and affects the quality of life of patients after surgery to a certain extent. The prevention of postoperative nausea and vomiting is still one of the hot topics in clinical practice, especially the prevention of postoperative nausea and vomiting in children should receive more public attention. This article summarizes recent advances in research on the prevention of PONV in children.
