Effect of Dolisetron Mesylate Combined with Dexmedetomidine on Plasma Motilin and Postoperative Nausea and Vomiting in Patients Undergoing Laparoscopic Sleeve Gastrectomy
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摘要:
目的 观察右美托咪定联合甲磺酸多拉司琼对腹腔镜袖状胃切除术患者血浆胃动素水平及术后恶心呕吐的影响。 方法 择期行腹腔镜袖状胃切除术患者120例，年龄 18～60 岁，ASA 分级为Ⅰ～Ⅱ级，随机分为4组，每组30例。A组：右美托咪定+甲磺酸多拉司琼组；B组：右美托咪定组；C组：甲磺酸多拉司琼组；D组：盐水对照组。 记录4组患者一般情况及手术时间、出血量、液体输注量，分别于术前（ T0 ） 、术后 24 h（ T1 ）抽静脉学检测血浆胃动素水平，记录患者术后24 h、48 h 术后恶心呕吐的程度及发生率。 结果 （1）4组患者年龄、性别、BMI、手术时间、术中出血量、术中输液量比较差异无统计学意义；（2）A、B、C 3组患者术后24、48 h Ⅲ、Ⅳ级术后恶心呕吐患者发生率及术后止吐药使用率分别低于D组，差异有统计学意义（P < 0.01）；（3）A、B、C 3组患者术后24 h血浆胃动素水平分别低于同组术前水平，差异有统计学意义（P < 0.05）；组间比较，A、B、C 3组患者术后24 h胃动素水平分别低于D组，差异有统计学意义（P < 0.05）。 结论 右美托咪定联合甲磺酸多拉司琼可显著降低腹腔镜袖状胃切除术患者的术后24 h血浆胃动素水平，并有效降低术后恶心呕吐严重程度及发生率，值得临床推广应用。 Abstract:Objective To observe the effect of dolisetron mesylate combined with dexmedetomidine on plasma motilin levels and postoperative complications nausea and vomiting in patients undergoing laparoscopic sleeve gastrectomy. Methods One hundred and twenty ASA Ⅰ-Ⅱ patients, aged 18-60 years, scheduled for elective laparoscopic sleeve gastrectomy, were randomly divided into four groups, each group of 30 patients. Group A: dexmedetomidine+dolasetron mesylate group; Group B: dexmedetomidine group; Group C: dolasetron mesylate group; group D: Saline control group. The general situation, time of operation, blood loss and fluid infusion volume of the four groups were recorded. The plasma motilin level was detected by phletometry before operation （T0） and 24 hours after operation （T1）. The degree and incidence rate of nausea and vomiting after 24 hours and 48 hours were recorded. Results （1） There were no obvious differences in age, gender, BMI, operation time, intraoperative blood loss and intraoperative infusion volume among the four groups. （2） The incidence of grade III and IV postoperative nausea and vomiting and the use of postoperative antiemetics in group A, B and C were lower than those in group D at 24 and 48 hours after operation, and the differences among the four groups were statistically significant （P < 0.01）. （3） The plasma motilin levels in groups A, B and C 24 h after operation were lower than those before operation, and the differences among the three groups were statistically significant （P < 0.01, P < 0.05, P < 0.05）. The motilin levels in groups A, B and C were lower than those in group D 24 hours after operation, and the differences were statistically significant （P < 0.01, P < 0.05, P < 0.05）. Conclusion Dolasetron mesylate combined with dexmedetomidine can significantly reduce the plasma motilin level 24 hours after laparoscopic sleeve gastrectomy, and effectively reduce the severity and incidence of postoperative nausea and vomiting, and is worthy of clinical application. -
表 1 4组患者一般情况比较（
$\bar x \pm s $ ）Table 1. Comparison of general conditions of 4 groups of patients （
$\bar x \pm s $ ）组别 n 年龄（岁） 男/女（例） BMI（kg /m2） 手术时间（ min ） 术中出血量（ mL ） 术中输液量（ mL ） A组 30 32.8 ± 7.5 8/22 34.1 ± 6.9 134 ± 12 20 ± 7 1 500 ± 200 B组 30 33.6 ± 7.1 7/23 35.2 ± 5.5 132 ± 14 18 ± 5 1 500 ± 180 C组 30 31.5 ± 9.1 8/22 34.8 ± 7.5 136 ± 19 22 ± 8 1 500 ± 150 D组 30 34.5 ± 7.5 9/21 36.1 ± 5.7 130 ± 20 20 ± 6 1 500 ± 160 效应值 2.677 0.587 0.505 0.404 1.299 2.134 P 0.062 0.945 0.681 0.751 0.290 0.113 
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表 2 4组患者术后24、48 h PONV发生级别比较[n = 30，n（%）]
Table 2. Comparison of the PONV occurrence levels at 24 h and 48 h after operation among four groups [n = 30，n（%）]
组别 n 术后24 h 术后48 h Ⅰ级 II级 III级 IV级 Ⅰ级 II级 III级 IV级 A组 30 20（66.7） 8（26.7） 2（6.7）** 0 ** 24（80） 6（20） 0 ** 0 ** B组 30 14（46.7） 12（40） 2（6.7）** 2（6.7）** 23（76.7） 7（23.3） 0 ** 0 ** C组 30 14（46.7） 11（36.7） 4（13.3）** 1（3.3）** 24（80） 6（20） 0 ** 0 ** D组 30 1（3.3） 12（40） 11（36.7） 6（20） 8（26.7） 15（50） 5（16.7） 2（6.7） 与D组比较，**P < 0.01。
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表 3 4组患者术后24、48 h应急止吐药使用率比较[n = 30，n（%）]
Table 3. Comparison of the incidence of requiring rescue at 24 h and 48 h after operation among four groups [n = 30，n（%）]
组别 n 术后24 h 术后48 h 止吐药使用 止吐药使用 A组 30 2（6.7）## 0（0）## B组 30 4（13.3）## 0（0）## C组 30 5（16.7）## 0（0）## D组 30 17（56.7） 7（23.3） 与 D组比较，##P < 0.01。
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表 4 4组患者不同时点血浆胃动素水平比较（
$\bar x \pm s $ ，pg /mL）Table 4. Comparison of the plasma motilin levels at different points of time among four groups （
$\bar x \pm s $ ，pg /mL）组别 n 术前（T0） 术后24 h（T1） 效应值 P值 A组 30 169.08 ± 73.84 90.47 ± 47.6#* 5.379 <0.001 B组 30 171.13 ± 64.93 98.29 ± 52.23#* 2.531 0.017 C组 30 170.81 ± 76.76 101.48 ± 57.27#* 4.068 <0.001 D组 30 171.38 ± 69.66 138.56 ± 62.82# 3.565 0.001 与 T0比较，#P < 0.05；与D组比较， *P < 0.05。
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