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研究生:蕭鴻宗
研究生(外文):Hung-tsung Hsiao
論文名稱:以Dexamethasone預防減輕直腸門診手術使用麻醉氣體Sevoflurane導致病患嘔吐的副作用
論文名稱(外文):The antiemetic prophylaxis of dexamethasone improved the anesthetic efficacy of sevoflurane in spontaneously breathing patients undergoing outpatient anorectal surgery
指導教授:戴明泓
指導教授(外文):Ming-Hong Tai
學位類別:碩士
校院名稱:國立中山大學
系所名稱:生物科學系研究所
學門:生命科學學門
學類:生物學類
論文種類:學術論文
論文出版年:2007
畢業學年度:95
語文別:英文
論文頁數:41
中文關鍵詞:手術後噁心嘔吐止吐劑七氟烷地塞米松
外文關鍵詞:sevofluraneantiemeticsdexamethasonepostoperative nausea and vomiting
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摘要
目的:Dexamethasone提供有效的止痛和止吐的作用,而麻醉氣體Sevoflurane相對於Propofol的藥物比較起來,與手術後的噁心和嘔吐相關性明顯增加。這個實驗的設計目的,就是評估預防性的使用dexamethasone是否能減少sevoflurane引起手術後噁心嘔吐的副作用,並且使病人在門診的直腸手術之後能夠提早恢復。
方法:四十個接受門診直腸手術的病患,被隨機的分成二組。實驗組有二十個病患在麻醉之前,接受dexamethasone 5 毫克靜脈注射,對照組二十個病患則以等量的生理食鹽水代替。所使用的麻醉誘導方式為揮發性的麻醉氣體Sevoflurane加上笑氣67%混合在每分鐘6公升氧氣流量之中,呼吸道的維持則以置入喉頭氣道呼吸管執行。麻醉的過程保持sevoflurane潮氣末端濃度為2%到4%,合併有50%笑氣在每分鐘3公升的氧氣流量之中。所有接受麻醉的病患手術過程都有自發性的呼吸。對手術後的噁心嘔吐的次數和疼痛指數以及滿意度作確實記錄。
結果:在用dexamethasone治療的病患相對於用食鹽水的對照組,其術後噁心嘔吐的次數和疼痛指數程度有明顯的降低。而所需要的恢復出院的時間也明顯縮短。除此之外,病人對麻醉的滿意度亦增加。但是在恢復過程中,眼睛打開的時間,開始對指令反應的時間,方向感及行動能力的恢復時間,並沒有顯著差異。
結論:在門診直腸手術的麻醉執行過程,用喉頭氣罩式呼吸道並使麻醉病患採行自發性呼吸的麻醉處置,預防性的給予Dexamethasone確實能減少手術後的噁心嘔吐機會及降低疼痛指數,並促進病人的恢復和提高對麻醉的滿意度。
ABSTRACT
Purpose: Dexamethasone provides potent analgesic and antiemetic effects. Sevoflurane are associated with an increased incidence of postoperative nausea and vomiting (PONV) and delayed patient discharge compared to propofol. This study was designed to evaluate whether the prophylatic use of dexamethasone with sevoflurane could minimize the incidence of PONV and facilitate early recovery after outpatient anorectal surgery.
Methods: Forty outpatients undergoing anorectal surgery were randomly assigned to receive either dexamethasone (5 mg IV; n=20) or an equal volume of saline (n=20) before the induction of anesthesia. Anesthesia was induced with sevoflurane 8% and N2O 67% in oxygen (at 6 L/min) followed by placement of laryngeal mask. Anesthesia was maintained with sevoflurane 2-4% end-tidal in combination with N2O 50% in oxygen 3 L/min. All patients were allowed to breathe spontaneously during the operation. The postoperative nausea and vomiting (PONV), VAS pain score and patient satisfaction were recorded.
Results: The incidence of PONV and VAS pain score were significant lower in dexamethasone-treated patients compared with saline-treated ones. The time required for discharge was significantly shorter in dexamethasone-treated patients. Above all, the dexamethasone-treated patients expressed higher satisfaction index. There was no significant difference in recovery time for eye opening, response to commands, orientation, and ambulatory.
Conclusions: The prophylactic administration of dexamethasone reduces the incidence of PONV andVAS pain score, promotes recovery to home readiness, and improves the satisfaction after the anesthesia with spontaneously breathing of sevoflurane through laryngeal mask in outpatients undergoing anorectal surgery.
感謝……………………………………………………3
縮寫表…………………………………………………4
中文摘要………………………………………………5
英文摘要………………………………………………7
介紹……………………………………………………9
方法……………………………………………………12
結果……………………………………………………15
討論……………………………………………………18
參考資料………………………………………………27
表格……………………………………………………33
圖………………………………………………………36
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