Granisetron (5-HT3 Receptor antagonist)抗噁心嘔吐藥用於婦產科常規手術接受全身麻醉後之療效

The Efficacy of Granisetron (5-HT3 Receptor antagonist) in scheduled gynecology and obstetric surgery under general anesthesia

葉良財(Liang-Tsai Yeh)

指導教授 ： 周明智教授

中山醫學大學/醫學院/醫學研究所/碩士(2017年)

摘要

研究目的：本研究旨在研究Granisetron (5-HT3 Receptor antagonist)抗噁心嘔吐藥用於婦產科常規手術接受全身麻醉後之療效，並嘗試瞭解其相關影響因子；改善病患的照顧品質及降低術後噁心嘔吐(post-operative nausea vomiting, PONV)之發生率。
研究方法及資料：本研究採回顧性病例分析，擷取彰化基督教醫院電腦資料庫自2015-01-01 ~ 2015-12-31，所有接受常規手術及全身麻醉的婦產科病患資料，總計1575筆。收集各種術後可能誘發噁心嘔吐(PONV)的相關因子，包含：年齡、有無使用Granisetron注射、手術的術式、「美國麻醉醫師學會」建議的身體狀況分類等級(American Society of Anesthesiologist patient physical status, ASA status)之分級、全身麻醉氣道處理方式、麻醉時間長短。我們使用單變項分析比較各組別的差異性，連續型的數據是使用獨立樣本t檢定，類別資料則使用卡方檢定，最後再以單一與多元邏輯斯迴歸分析探討誘發術後噁心嘔吐(PONV)的顯著相關因素。P值<0.05才認為統計學上有顯著之差異。
研究結果：經由單一迴歸分析結果發現個案年齡層介於20 ~ 40歲、無接受腹腔鏡經陰道子宮切除(LAVH)、有使用喉頭罩置入(LMA)全身麻醉方式、或是麻醉時間於120分鐘內者，其術後發生PONV的機率均較低(P值<0.05)。另一方面，注射Granisetron及ASA之分級為I ~ II，在統計上則無法看出有效降低發生PONV之比率。多元迴歸分析則發現，在控制年齡、手術方式與有無注射Granisetron之後，若患者的ASA分級為III~IV、麻醉方式為(GA)插管全身麻醉，以及麻醉時間超過120分鐘者，其術後發生PONV的勝算均顯著較高(P值<0.05)。
結論與建議：年齡、手術的術式、全身麻醉氣道處理方式及麻醉時間，為預測PONV相關影響因子。Granisetron (5-HT3 Receptor antagonist)抗噁心嘔吐藥已證實為有效之抗噁心嘔吐用藥於化學治療病患及手術接受全身麻醉後病患。雖然本回顧性研究於腹腔鏡補助經陰道子宮切除(LAVH)手術，不具臨床上顯著性的有效降低PONV之發生比率，但是於臨床上使用依舊有其一定之療效。因此，腹腔鏡手術，對使用Granisetron用以降低PONV之發生率，需要再進行前瞻性隨機對照之研究。

關鍵字

Granisetron ； 術後噁心嘔吐 ； 腹腔鏡經陰道子宮切除 ； 插管全身麻醉 ； 喉頭罩全身麻醉

並列摘要

Objective: The purpose of this study is to determine the anti-emetic effect of Granisetron (5-HT3 Receptor antagonist) in patients undergoing scheduled gynecological and obstetric surgeries under general anesthesia and to define the independent risk factors. Thus, we can provide effective and quality care to our postoperative patients by reducing the incidence of post-operative nausea vomiting (PONV).
Methods and Materials: This is a retrospective study. Changhua Christian Hospital Computer database from Jan 1, 2015 through Dec 31, 2015 was reviewed. A total of 1575 patients aged between 20 and 60 years old undergoing scheduled gynecological and obstetric surgeries under general anesthesia were collected.
Logistic regression analysis was used to evaluate if there are any independent risk factors which will induce PONV. The independent categorical variables included age, granisetron injection, type of operation, American Society of Anesthesiologist patient physical status (ASA status) classification of the patients, airway used in general anesthesia and duration of anesthesia. The patients were allocated according their age to 2 groups, age of 20-40 years old and 41-60 years old. The patients were also allocated to Granisetron injection group, who took granisetron intravenously before the end of operation, and No-Granisetron injection group, who took no granisetron injection during anesthesia. Types of operation were divided into laparoscopy assisted vaginal hysterectomy (LAVH) and other procedures, patients’ASA status into Grade I-II and grade III-IV, anesthesia methods into general anesthesia with endotracheal intubation and general anesthesia with laryngeal mask airway (LMA) insertion and durations of anesthesia into three groups, less than 120 minutes, 120-480 minutes and more than 480 minutes. Student’s T-test for continuous data and Chi square test to compare between groups were also calculated. P value < 0.05 is considered statistically significant.
Results: The result of the study revealed that the patients with younger age (20-40 years old), undergoing surgical procedures other than (Laparoscopy assisted vaginal hysterectomy) LAVH, with LMA for the airway tool during general anesthesia, or with duration of anesthesia less than 120 minutes had less incidence to suffer PONV (p-value = 0.041, <0.001, <0.001, <0.001 respectively). On the other hand, granisetron injection during anesthesia and better ASA status (I-II) could not offer the patients advantage regarding the incidence of PONV (0.063 and 0.058, respectively).
Conclusion and Suggestion: Age, type of surgery, airway use in general anesthesia and duration of anesthesia are significant factors to predict PONV. Granisetron (5-HT3 Receptor antagonist) has been proved to be a strong antiemetic to prevent nausea and vomiting in patients postoperatively or in patients who have received chemotherapy. This retrospective study did not show a remarkable effect of reducing the incidence of PONV by Granisetron administered intravenously on the patients undergoing laparoscopic surgeries; however, the patients really benefited from the procedure in terms of less PONV. A prospective randomized controlled study is needed to determine if granisetron has a significant role to reduce PONV in patients undergoing laparoscopic surgeries.

並列關鍵字

Granisetron ； post-operative nausea vomiting ； laparoscopy assisted vaginal hysterectomy ； Intubation general anesthesia ； LMA general anesthesia

參考文獻

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