Сравнительная противорвотная эффективность метоклопрамида, ондансетрона и пиридоксина для профилактики тошноты и рвоты у пациенток, перенесших кесарево сечение в условиях спинномозговой анестезии

Введение. Одним из осложнений после кесарева сечения является тошнота и рвота, особенно при проведении спинномозговой анестезии. Основные причины развития тошноты и рвоты сложны и могут быть связаны с хирургическим вмешательством, снижением артериального давления, возбуждением блуждающего нерва и введением окситоцина.

Цель – сравнение и оценка эффективности внутривенного введения ондансетрона, пиридоксина и метоклопрамида для профилактики рвоты у пациенток, перенесших кесарево сечение в условиях спинномозговой анестезии. Материалы и методы. В данное исследование включены 100 беременных женщин на позднем сроке беременности без выраженной сопутствующей патологии, соответствующих I и II классу по шкале ASA. Пациентки случайным образом разделены на группы, принимающие три препарата, и контрольную группу. В каждой группе было по 25 пациенток: группа ондансетрона (4 мг внутривенно), группа метоклопрамида (10 мг внутривенно), группа пиридоксина (100 мг внутривенно) и группа плацебо или контрольная группа (физиологический раствор – 2 мл внутривенно). В ходе исследования фиксировали тошноту и рвоту, которые возникали во время операции и после нее, а также любые дополнительные побочные эффекты. Для статистического анализа данных была использована программа SPSS 20.0.

Результаты. Частота интра- и послеоперационной тошноты и рвоты была выше в группе плацебо (40% и 32%) по сравнению с группой ондансетрона (4% и 8%), метоклопрамида (8% и 16%) и пиридоксина (20% и 24%). Признаки расстройства ЖКТ были более выражены в группе пиридоксина по сравнению с группами метоклопрамида и ондансетрона. Частота тошноты и рвоты после операции была высокой в группе плацебо и статистически значимой по сравнению с группой ондансетрона (р = 0,0232), статистически значимой разницы с группами метоклопрамида и ондансетрона не было.

Заключение. Согласно результатам исследования, ондансетрон и метоклопрамид были более эффективны в снижении тошноты и рвоты, чем пиридоксин и плацебо. Ондансетрон показал наибольшую эффективность для профилактики как интра-, так и послеоперационной тошноты и рвоты.

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