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DANH GIA HIEU QUA DIEU TRI NON VA BUON NON SAU MO NQI SOI PHU KHOA C O A ONDANSETRON VA DEXAMETHASON
Nguyen Dinh Long*, Vu Van Du*, Nguyen Du'c Lam*
T6M TAT
Muc tieu: 6mh gia hieu qua dieu tn non va bu&n non sau mo npi soi phu khoa cua ondansetron va dexamethason. £kn tu'dng, phu'dhg phap: tien cuti, thuf nghiem lam sang ngau nhien co dcH chiihg tren 100 benh nhan tren 16 tuoi, khoe m?nh, co chi djnh phau thuat npi soi phu khoa, chia lam hai nhom b^ng nhaii'lnhom OsCrdung 4 mg ondansetron, nhom D sit dung 8 mg dexamethason, tiem tinh mach tru'dc khi khdi m%. Cac benh nhan dupc theo doi iien tuc trong 24 gid dau sau mo, khi benh nhan bi buon non, non thi diTdc ^ u tri ISn 1 blng tiem tfnh mach 4 mg ondansetron 6 nhom O hoac 8 mg dexametiiason 6 nhom D; sau dieu tn lan 1 khong d9 se du'dc dieu tri i n 2 bang thuoc khac; 8 mg dexamethason & nhom 0 va 4 mg ondansetron cf nhom D. Ketqua: khi dieu trj lan 1, nhom ondansetron co ty lethanh cong cao hdn nhom dexameHiason (71,4%' so vdi 26,7%); khi dieu trj lan 2, ty le tiianh cong ciia nhom dexametiiason cao hdn nhom ondansetron (54,5% so vdi 25%); ly le cap cij\j thanh cong sau hai lan dieu trj cua thuoc ondansetron la 64% so vdi tiiuoc dexamethason la 26,3%. Kit luan: ondansetron cd tac dung dieu trj non, budn ndn sau mo ngi sol phu khoa tot hdn so vdi dexamethason.
Tiy khoa: dieu h i non, budn non sau mo phu Idioa, ondansetron, dexamethason
S U M M A R Y
EVALUATION T H E T R E A T M E N T EFFECnVENESSOF NAUSEA, V O M H I N G A n ' E R GYNAECOLOGICAL LAPAROSCOPIC
SURGERY OF ONDANSETRON A N D DEXAMETHASON
*Binh viin Phu san Trung ddng
**Tru'dng Dai hqc y Ha Ngi Chju trach nhi&n chinh: Vu Van Du Email: [email protected] Ngay nhan bai: 8.10.2016 Ngay phan bien khoa hoc: 9.12.2016 Ngay duyet b i i : 16.12.2016
Objective: To evaluate the efficacy of treatment nausea, vomiting after gynecological laparoscopic surgery of ondansetron and dexametiiasone.
Subject and methods: prospective, randomized clinical trials were identified in 100 patients over 16 years old, healthy, indicated gyneo^logical laparoscopic surgery, divided Into two equal groups:
Group O uses ondansetron 4 mg, 8 mg group D uang dexamethasone intravenously before induction of anesthesia. The patients were monitored continuously for the first 24 hours after surgery, when patients have nausea, vomiting, 1st treatment with intravenous ondansetron 4 mg in group O or 8 mg of dexamethasone in group D; after the 1st treatment does not help to be treated by other medications in 2™'treatment: 8 mg dexamethasone in group 0 and 4 mg ondansetron in group D. The result: 1st treatment, ondansetron group had a higher success rate than group dexamethasone (71.4% versus 26.7%); 2nd treatment, the success rate is higher in dexamethasone group tiian ondansetron group (54.5% versus 25%); successful rate of twice treatment of ondansetron was 64% and of dexamethasone was 26.3%. Conclusion: ondansetron was better than dexametJiasone in treatment of nausea, vomiting after gynecological laparoscopy.
Keywords: vomiting, nausea following gynecological laparoscopy surgery, ondansetron, dexamethasone
1. DAT V A N o l
Cung vcfi tien bo cua y hoc noi chung, nganh gay me hoi su'c Viet Nam da co nhffng bu'de phat trien vu'dt bac^ tuy nhien viec dieu trj non, buon non sau mo van chu^ du'dc quan tam dung mu'c, dac biet d cac doi tu'dng nguy cd cao nhu* cac phu nff tre sau mo noi soi phu khoa. Non, buon non sau mo khong chi gay kho chju cho ngu'di benh, ma con co the gay trao ngu'dc dich da day vao phoi, chay mau vet mo, mat nu'dc dieri giai va tham chi con gay buc vet mo... Vi vay, dieu trj non, buon non sau mo khong chi lam giam kho chiu cho ngu'di benh ma con han che du'dc cac bien chffng cua gay me va phau thuat, nhanh
VIETNAM MEDICAL JOURNAL NPI - JANUARY - 2017
chdng thiet lap lai can bang nffdc di|n giai, giup ngffcfi benh van dong sdm, rut ngan thdi gian nam vien, giam chi phi dieu trj... Ondsansetron va dexamethason; la cac thuoc cd tac dung trong dieu trj non, buon non da du'dc nghien cffu nhieu tren the gidi, tuy nhien d nffdc ta chu^ cd nhieu nghien cffu ve cac thuoc nay dac biet cho doi tu'dng benh nhan sau mo ngi soi phu khoa.^ Vi vay, chung toi tien hanh de tai nay nham:danh gia hieu qua dieu tri non, buon non sau mo npi soi phu khoa cua ondansetron va dexamethason.
II. fidl TU'CJNG VA PHU'OTMG PHAP NGHIEN CUU 2.1 Soi tu'dng nghien cu'u: Nghien cffu dffdc tien hanh tai Benh vien Phu san Trung ffdng tff thang 1/2011 den thang 8/2011 tren 100 benh nhan nff, khong cd cac benh ly khac kem tlieo trff benh ly phu khoa phai chi dinh mo, tuoi. tff 16 trd len, cd chi djnh mo npi soi phu khoa, gay me npi khi quan. Loai ra kliol nghien cffu cac trffdng hdp cd chong chi dinh sff dyng cua ondansetron va dexamethason, cac tru'dng hdp bj non, buon non tff trffdc mo: cd hpc (tac rupt, hep mon vi...), benh ly he than kinh (u nao, chan thffdng sp nao...), benh npi khoa (tang ure mau...), thuoc (hda chat dieu trj ung thff...)..
2.2 Phu'dng phapjighifin cu'u: Tien cuU, thff nghiem lam sang ngau nhien cd doi chffng.
2.3 Quy trinh nghien ci:i'u: Cac benh nhan duWc kham tien me trffdc mo, giai thfch ro ve nghien cffu. Trffdc !(hi gay me dffdc bdc tham ngau nhien phan thanh hai nhdm: nhdm 0 su"
dung 4mg ondansetron, nhdm D sff dung Smgi dexamethason, tiem tTnh mach trffdc khi khdl^
me. Gay me npi khf quan bang: propofdl!
2mg/kg, fentanyl 2mcg/kg, rocuroniurri^
0,6mg/kg, duy tri me bang isofluran 2%, sau mo giai gian cd bang atropin 0,015mg/kg va Neostigmin 0,05mg/kg, giam dau sau md bang paracetamol 1 g/6 gid, neu VAS>4: chuan do morphin tTnh mach lieu 2mg each nhau lOphut/lan.
• Khi benh nhan bi buon non, non thi dUdc dieu trj lan 1 bang tiem tTnh mach 4mg ondansetron d nhom 0 hoac 8mg dexamethasoni d nhdm D; sau dieu tn lan 1 khong dd se du'dc dieu trj Mn 2 bang loai thuoc khac: 8mg dexamethason d nhdm O va 4mg ondansetron cf nhom D. Cac benh nhan dffdc theo doi lien tuc cac chi so ve huyet dpng, hd hap trong mo va sau mo 24 gid dau, danh gia dau hieu buon non va so lan ndn, cac thuoc chong non va cac thuoc giam dau sff dung sau ma
III. KET QUA
Bang 1. Dac diem dm tu'dng nghien cu'u, phau thuat, gay me hoi sii'c
N h n m n hlhnm HNhdm O
(Ondansetron) (n = 50)
Nhom D (Dexamethason)
Cn = 50)
Tuoi (nam) 35,6 ± 11,8 37; 1 ± 12,4
Chieu cao (cm) 150 ± 5 160 ± 4 >0,05
Can nanq (l(q) 49,6± 6,9 50,8 ± 6,0 >0,05
Chi so BMI 20,7 ± 2,4 20,9 ± 2,1 >0,05
Loai phau thuat U nang buong trijtig Ngi soi cat tu* cung hoan toan Ngi soi can thiep trong vo sinh
Thdi gian mo (phut)
34 (68%) 10 (20%) 6 (12%)
27 (56%) 13 (26%) 10 (20%)
>0,05
>0,05
>0,05 41,2 ± 13,7 43 ± 16,7
Thai gian bdm C02 (phut) 36,7 ± 13,7 38,4 ± 16,7 >0,05
Thdi qian gay me (phut) 56,5 ± 12,9 >0,05
Lu'dng Fentanyl dunq trong mo (mg) 0,24 ± 0,04 0,25 ± 0,05 >0,05 LiTdng Propofoi dijng trong mo (mg)
LlTdnq djch truyen trdng mo (ml) 107 ± 15
774 ± 22,5 111,4 ± 14,2 772,6 ± 26,2
>0,05
>0,05 Bang 2. TV le thanh cong dieu tri non, buon non sau mo cl cac lienli niiSn nliai dieu tri can cAU
Ty ie thanh conq dieu tri lan 1 Ty le that bai dieu tri ian 1 Ty le thanh conq dieu tri lan 2
Ty le that bai dieu tri lan 2
Niiom 0 (Ondansetron)
10 (71,4%) 4 (26,8%) 1 (25%) 3 (75%)
Niiom D (Dexametiiason)
4 (26,7%) 11 (73,3%) 6 (54,5%) 5 (45,5%)
P
<0,05
<0,05
<0,05
<0,05
TAP CHi Y HQC VigT HAM TAP 45Q - THANG 1 • SO 2 - 2017
Bang 3. Ty le thanh cdng dieu tr
Thanii cong That bai
Tong
ndn, buon non sau hai ian dung thudc Ondansetron
n 16 9 25
64 %
36 100
Dexamethason n
5 14 19
26,3 %
73,7 100
/ . BAN LUAND S tffdng nghien cffu trong hai nhdm nghien uli kha tu'dng dong ve cac dac diem: tuoi, chieu ao, can nang, chi sd BMI... do d d se it anh ffdng den ket qua nghien cffu. Chi djnh phau luat npi soi phu khoa d ca hai nhdm chu yeu la dc hoac cat u nang buong trffng, cat tff cung oan toan qua npi soi, npi soi chan doan va can fiiep trong dieu trj vo sinh. Khong cd sff khac liet cd y nghla tiiong ke ve chi djnh phau thuat ua hai nhdm. Mpt sd yeu tS lien qua den ty le ldn, budn ndn sau mo nhff: thdi gian mo, thdi jian bdm C02vao 6 phuc mac, thdi gian gay me, j ' d n g ^ ^ d c hp morphin sff dung trong mo,
^ n ^ p n ! truyen trong mo... khdng cd sff khac liet giffa hai nhdm nghien cffu. Cd che benh sinh ua ndn, budn ndn sau m d npi soi van cd nhieu lieu cdn chu^ dffdc ro, tuy ntiien, mdt sd yeu to am tang t y le ndn, budn ndn la:, gidi, tuoi, sff lungcac thuoc hp morphin trong va sau md, ton Ipng khf C02 trong 6 bung sau mo [1]... Trong ighien cffu cua chung tdi, tat ca cac benh nhan au mo dffdc dieu trj dau bang paracetamol ruyen tTnh mach, khdng cd benh nhan nao phai lung morphin sau mo, do dd t^ le ndn, budn ndn :ung se thap hdn so vdi cac nghien cffu sff dung norphin lieu cao sau m d , cd the do md npl soi )hu khoa ft gay dau sau mo hdn so vcl mo md.
Ty le thanh cdng dieu trj ndn, buon ndn cap :ffu trong nghien cffu cua chung tdi dffdc the lien trong bang 2; cd 14 benh nhan d nhdm )ndansetron ( 2 8 % tong sd benh nhan) va 15 )enh nhan d nhdm dexamethason ( 3 0 % tong sd jenh nhan) ran phai dieu trj ndn, buon ndn cap
;ffu. Ty le thanh cdng cua IBn dieu trj thff nhat a: 71,4% d nhdm ondansetron va 26,7% d ihdm dexamethason, sff khac biet rat cd y nghTa hdng ke vdi p < 0,05. Tdng sd benh nhan that )ai dieu trj ndn, budn ndn sau lan dieu trj ndn hff nhat la 4 benh nhan d nhdm ondansetron 28,6%) va 11 benh nhan d nhdm lexamethason (73,3%), cac benh nhan nay Iffdc tiep tuc dieu tri bang tiem tTnh mach thudc :hdng ndn thff hai (8 mg dexamethason d nhdm jndansetron va 4 mg ondansetron d nhdm
dexamethason), ket qua lan dieu trj thff hai cho thay: ty le thanh cdng cua nhdm ondansetron chi dat 2 5 % so vdi 5 4 , 5 % d nhdm dexamethason.
Ket qua d bang 3 cho thay ty le thanh cdng Chung trong ca hai lan dieu tri cua cac benh nhan dffdc sff dung ondansetron la 6 4 % cao hdn rat nhieu so vdi cac benh nhan dffdc sff dung dexamethason (26,3%). Ket qua cua chung tdi cung phiJ hdp vdi kB: qua cua tac gia Dipasri Bhattacharya khi nghien cffu tren 90 benh nhan nguy cd cao ndn, buon ndn sau mo, t^ le ndn, buon ndn la 2 0 % d nhdm dffdc sff dung 4 mg ondansetron so vdi ty le ndn, budn ndn la 5 0 % d nhdm dung gia dffdc [ 2 ] . Ket qua nay cd the phan nao giai thfcli do cC che tac dung cua ondansetron la tac dung trffc tiep ddi kliang vdi thu the 5HT3 tren day than kinh ngoai vi va he than kinh trung ffdng, cdn dexamethason la chat cd cd che hoat ddng gian tiep thdng qua viec nang rao diem nhay cam, can bang cam giac [3], [ 4 ] . Chfnh vl vay, tac dung dieu trj ndn, buon ndn sau mo cua dexamethason kem lidn so vdi ondansetron.
V . KET LUAN
Ondansetron cd tac dung dieu trj ndn, budn ndn sau m d ndi soi phu khoa tdt hdn so vdi dexamethason.
TAI LIEU T H A M K H A O
1. Barbara J. Pleuvry (2006), "Physyology and phamiacology of nausea arnj vomitb'ng", pp. 250-256.
2. Dipasri. B (2003), "Comparison of ondansetron and granisetron for prevent of nausea and vomiting following day care gynaecologkal laparoscopy", Indian 3. Anaesth 47 (4),pp. 279-282.
3. Gautam B, Shrestha, Lama P, Rai S ( 2 0 0 8 ) ,
"Antiemetic prophylaxis against postoperative nausea and vomiting w/ith ondansetron - dexamethason combination compared to ondansetron or dexamethasone alone fbr patients undergoing laparoscopic cholecystectomy", Kathmandu University Medical Journal, vol 6, No.3, Issue 23, 319-328.
4. Fujii Y. Janaka H. Tokyo H. ( 1 9 9 7 ) , "The effect of dexamethason on antiemeties in female patients undergoing gyneacology surgery", Anesth Analg 85/913 -7.
