緒 言 PONV(postoperative nausea and vomiting) の明確な定義はないが、概ね術後24時間以内の悪 心・嘔吐を指す。婦人科腹腔鏡手術はPONVのリ スクファクター 1) の多くに当てはまり(表1)、 PONV発生頻度は高いが、重大な合併症とする認 識が希薄である。 開腹手術と比較し、低侵襲である腹腔鏡手術に より術後疼痛は改善し、美容的にも患者の満足度 は高い。しかし、PONVの対策が遅れているため に、患者は術後に不快な思いをし、離床や経口摂 取が遅れることがある。当科でも今までPONV予 防をほとんど行わず、患者が嘔気・嘔吐を訴えた 時にメトクロプラミドを適宜投与していた。今回、 腹腔鏡手術後のQOL上昇のために、デキサメタ ゾンとドロペリドール併用によるPONV予防効果 を検討した。 対象および方法 2017年11月から2018年2月までに当科で行った 腹腔鏡手術122例のうち、前半2ケ月間をデキサ メタゾンとドロペリドール投与群 44例、後半2 ケ月間を非投与群 78例に振り分け、デキサメタ ゾンとドロペリドール併用によるPONV改善効果 を前向きに検討した。対象患者には、デキサメタ ゾンとドロペリドールの使用がPONV予防に対し て適用外使用であることを説明し同意を得た。麻 酔導入時にデキサメタゾン6.6 mg、手術終了時に ドロペリドール1.25 mgを投与した。デキサメタ 224 ― ― 2019 December 日産婦内視鏡学会 第35巻第2号 原 著 Effects of dexamethasone and droperidol on postoperative nausea and vomiting (PONV) after laparoscopic gynecological surgery Takako Kusanishi, Nobuhisa Honda, Shoko Sano, Kayoko Furukawa Tokyo Bay Urayasu Ichikawa Medical Center Abstract Objective: Laparoscopic gynecological surgery is associated with a high incidence of PONV. In this study, we comparatively investigated the efficacy of combination therapy with dexamethasone plus droperidol versus no therapy in the prevention of PONV following laparoscopic gynecological surgery. Design: In total, 122 patients who underwent laparoscopic gynecological surgery under general anesthesia at our institution from November 2017 to February 2018 were included in the study and assigned to two groups: the dexamethasone plus droperidol group (n=44) and the control group (n=78). Dexamethasone 6.6 mg was administered after the induction of anesthesia, and droperidol 1.25 mg was administered at the end of the surgery. The incidence of PONV and doses of administered rescue antiemetics were recorded on the first postoperative day. Results: Combination therapy significantly reduced PONV compared with no therapy and required less rescue antiemetic treatment (P<0.05). No clinically important adverse effects were observed in either group. Conclusion: Pretreatment with dexamethasone plus droperidol is more effective than no therapy in preventing PONV following laparoscopic gynecological surgery. Keywords: PONV, dexamethasone, droperidol 婦人科腹腔鏡手術に伴うPONVに対する デキサメタゾン・ドロペリドールの改善効果の検討 東京ベイ・浦安市川医療センター 産婦人科 草西多香子、本田能久、佐野祥子、古川佳容子
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緒 言
PONV(postoperative nausea and vomiting)の明確な定義はないが、概ね術後24時間以内の悪心・嘔吐を指す。婦人科腹腔鏡手術はPONVのリスクファクター1)の多くに当てはまり(表1)、 PONV発生頻度は高いが、重大な合併症とする認識が希薄である。 開腹手術と比較し、低侵襲である腹腔鏡手術により術後疼痛は改善し、美容的にも患者の満足度は高い。しかし、PONVの対策が遅れているために、患者は術後に不快な思いをし、離床や経口摂取が遅れることがある。当科でも今までPONV予防をほとんど行わず、患者が嘔気・嘔吐を訴えた時にメトクロプラミドを適宜投与していた。今回、
Effects of dexamethasone and droperidol on postoperative nausea and vomiting (PONV) after laparoscopic gynecological surgery
Takako Kusanishi, Nobuhisa Honda, Shoko Sano, Kayoko FurukawaTokyo Bay Urayasu Ichikawa Medical Center
AbstractObjective: Laparoscopic gynecological surgery is associated with a high incidence of PONV. In this study, we comparatively investigated the efficacy of combination therapy with dexamethasone plus droperidol versus no therapy in the prevention of PONV following laparoscopic gynecological surgery.Design: In total, 122 patients who underwent laparoscopic gynecological surgery under general anesthesia at our institution from November 2017 to February 2018 were included in the study and assigned to two groups: the dexamethasone plus droperidol group (n=44) and the control group (n=78). Dexamethasone 6.6 mg was administered after the induction of anesthesia, and droperidol 1.25 mg was administered at the end of the surgery. The incidence of PONV and doses of administered rescue antiemetics were recorded on the first postoperative day.Results: Combination therapy significantly reduced PONV compared with no therapy and required less rescue antiemetic treatment (P<0.05). No clinically important adverse effects were observed in either group.Conclusion: Pretreatment with dexamethasone plus droperidol is more effective than no therapy in preventing PONV following laparoscopic gynecological surgery.
mgの投与のみとした。 差の検定は、データの正規性をShapiro-Wilk testにて確認した後、Mann-whitneyʼs U testを用い、2群間の比較にはFisherʼs exact testを用いた。統計解析はEZR Version 1.35を用い、有意水準は5%とした。 本研究は、「人を対象とする医学系研究に関する倫理指針」を遵守して実施し、当院の倫理審査委員会の承認を得て行った(承認番号296)。
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