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
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 （ 0.8 ug/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 prop ofol ；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。
Antiemetic Effect of Intraoperative Propofol Using Target-Controlled Infusion (TCI) in Patients
Receiving Breast Surgery
Background: The incidence of postoperative nausea and vomiting (PONV) in women undergoing breast su rgery 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, 12 0 women undergoing breast surgery were randomized to one of four groups as receiving no propofol intrao peratively (Group A), propofol administered after anesthetic induction throughout the surgery (Group B), p ropofol administered after anesthetic induction to the midway of the surgery (Group C), and propofol admi nistered from the midway to the end of the surgery (Group D). For the latter three treatment groups, propof ol 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 a mong the four groups. At 0-1 h postoperatively, the incidence of nausea (10.0% vs. 36.7%, p<.05), the num ber of patients reporting severe nausea (0 vs.16.7%, p<.05)and severe vomiting (0 vs.13.3%, p<.05) were l ower in Group B compared to Group A. In addition, at 0-1 h postoperatively, the number of patients reporti ng 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.
