目的 观察盐酸帕洛诺司琼对腹腔镜低位保肛直肠癌根治术联合氟尿嘧啶缓释剂植入综合治疗后恶心、呕吐的有效性与安全性。方法 选择采用腹腔镜低位保肛直肠癌根治术联合氟尿嘧啶缓释剂植入综合治疗的进展期低位直肠癌患者200例,按照随机数表法分为盐酸帕洛诺司琼组(P组)和托烷司琼组(T组),每组100例。腹腔镜直肠癌根治术中植入氟尿嘧啶缓释剂前30min,经周围静脉缓慢注射帕洛诺司琼0.25mg(P组)和托烷司琼5mg(T组)。术后自麻醉唤醒过程开始计时,观察患者腹胀、恶心、呕吐的发生情况;心电监护记录心率、血氧、心律、呼吸频度;记录患者精神、神经症状;24h、72h复查血常规、肝、肾功能、电解质。结果 P组和T组各有3例和5例患者因术后要求使用静脉自控镇痛泵退出研究。P组术后0~24h、0~72h恶心发生率显著低于T组(P<0.05);两组术后呕吐发生率比较,差异无统计学意义(P>0.05)。P组眩晕发生率显著低于T组(P<0.05),头痛、便秘和腹胀发生率与T组无显著差异(P>0.05)。结论 帕洛诺司琼对腹腔镜低位保肛直肠癌根治术联合氟尿嘧啶缓释剂植入综合治疗所致恶心、呕吐的治疗效果和安全性均明显优于托烷司琼,对于促进患者康复具有积极的意义。
Objective To observe the effect and safety of palonosetron in laparoscopic rectectomy combined with fluorouracil treatment. Methods Two hundred patients with advanced low rectal cancer were selected for the combined treatment of laparoscopic radical resection with fluorouracil sustained-release agent. They were randomly divided into two groups, palonosetron group (Group P) and tropisetron group (Group T). Before operation, patients in Group P got 0.25 mg palonosetron, while those in Group T got 5 mg tropisetron. From awakening after operation, the incidence of abdominal distension, nausea and vomiting were observed. The ECG, blood oxygen, heart rate and respiratory frequency were recorded, and mental and neurological symptoms were assessed. The blood routine, liver and nephric function and electrolytes were rechecked at 24 hours and 72 hours after operation. Results Three patients in group P and five patients in group T withdrew from the study due to the requirement of using the intravenous controlled analgesia pump. The incidence of nausea at 0~24 h and 0~72 h after operation in group P was significantly lower than that in group T (P<0.05). There was no statistically significant difference in the incidence of postoperative vomiting between the two groups (P>0.05). The incidence of dizziness in group P was significantly lower than that in group T (P<0.05), yet the incidence of headache, constipation and abdominal distension was not significantly different from that in group T (P>0.05). Conclusion Palonosetron had better efficacy and safety than torisetron in the treatment of nausea and vomiting caused by laparoscopic radical resection of low rectal cancer combined with fluorouracil sustained release agent implantation. It had positive significance in reducing anastomotic fistula and other serious complications and promoting the recovery of patients.