術中連續標靶控制輸注Propofol對乳房手術 術後噁心嘔吐之效用

Antiemetic Effect of Intraoperative Propofol Using Target-Controlled Infusion (TCI) in Patients Receiving Breast Surgery

李侑軒(Yu-Hsuan Lee)

指導教授 ： 陳大樑

共同指導教授 ： 廖媛美(Yuan-Mei Liao)

臺北醫學大學/護理學院/護理學研究所/碩士(2008年)

摘要

乳房手術術後噁心嘔吐發生率高達60-84%，本研究探討女性乳房手術病人接受全身麻醉，術中不同時段補充使用連續標靶控制輸注低劑量propofol（0.8ug/ml），對減少術後噁心嘔吐之效用。
本研究為前瞻、隨機、單盲及有控制組之臨床研究，將120位女性乳房手術病人隨機分配至四組；A組為控制組，不使用連續標靶控制輸注低劑量propofol；其它三組術中分不同時段，分別補充使用標靶控制輸注低劑量propofol（0.8μg/ml），B組從麻醉誘導後至手術結束（全程），C組從麻醉誘導後至誘導後一個半小時（前半），D組從麻醉誘導後一個半小時開始至手術結束（後半）。噁心嘔吐評估時間點，包括術後1、6、12和24小時。

結果顯示四組在人口學基本屬性（年齡、體重、身高、曾有PONV史、動暈史）、術中術後影響PONV因素（麻醉時間、MAC小時、opioid使用）在統計上皆無顯著差異。B組較A組在術後0-1小時，噁心發生率（10.0% vs. 36.7%, p＜.05），嚴重噁心發生率（0 vs. 16.7%, p＜.05），和嚴重嘔吐發生率（0 vs. 13.3%, p＜.05）都低。D組術後0-1小時嚴重嘔吐發生率（0 vs. 13.3%, p＜.05），也較A組低。C組和A組在術後0-1小時，噁心、嘔吐發生率和嚴重度皆沒有顯著差異。
結論：術中全程補充使用連續標靶控制輸注低劑量propofol（0.8ug/ml），可降低女性乳房手術病人接受全身麻醉，術後1小時內之噁心發生率，但無法降低術後24小時內噁心嘔吐發生率。

關鍵字

術後噁心與嘔吐；連續標靶控制輸注；乳房手術

並列摘要

Background: The incidence of postoperative nausea and vomiting (PONV) in women undergoing breast surgery is reported as high as 60-84%. This study aimed to investigate the prophylactic antiemetic efficacy of subhypnotic-dose propofol given as a target-controlled infusion (TCI) intraoperatively in women receiving breast surgery under general anesthesia.
Materials and Methods: Following a standard general anesthesia in this prospective, single-blind study, 120 women undergoing breast surgery were randomized to one of four groups as receiving no propofol intraoperatively (Group A), propofol administered after anesthetic induction throughout the surgery (Group B), propofol administered after anesthetic induction to the midway of the surgery (Group C), and propofol administered from the midway to the end of the surgery (Group D). For the latter three treatment groups, propofol was given as a TCI set at 0.8 ug/ml. The incidence and severity of PONV was recorded at 1,6,12 and 24-h postoperatively.

Results: All the patients completed the study. Patient demographics (age, weight, height, history of PONV, motion sickness) and intraoperative data (duration of anesthesia, MAC hours, opioid use) were all similar among the four groups. At 0-1 h postoperatively, the incidence of nausea (10.0% vs. 36.7%, p＜.05), the number of patients reporting severe nausea (0 vs.16.7%, p＜.05)and severe vomiting (0 vs.13.3%, p＜.05) were lower in Group B compared to Group A. In addition, at 0-1 h postoperatively, the number of patients reporting severe vomiting was lower in Group D compared to Group A (0 vs.13.3%, p＜.05). However, there were no significant differences with regard to the incidence or severity of PONV at the first 1-h postoperatively between Group C and Group A.
Conclusion: In women receiving breast surgery under general anesthesia, prophylactic use of propofol via TCI set at 0.8 ug/ml throughout the surgery can effectively decrease the incidence of nausea for the first 1-h postoperatively. However, this antiemetic efficacy is not demonstrable at 24 hours postoperatively.

並列關鍵字

postoperative nausea and vomiting (PONV) ； Target-Controlled Infusion (TCI) ； breast surgery

參考文獻

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