术后恶心呕吐发生率与预防性用药的意义

The incidence of PONV and the significance of prophylactic use of antiemetics

目的通过大样本调查分析术后恶心呕吐(PONV)发生的因素并观察预防性应用不同5-羟色胺3(5-HT3)受体拮抗药的效果。方法1046例手术患者随机分为三组,于术前分别给予昂丹司琼、托烷司琼或生理盐水。术后24h回访患者PONV发生率和情况。结果显著影响PONV发生率的因素有性别、麻醉方式、手术时间、术后阿片类药物镇痛及既往PONV或晕动病史。三组PONV发生率依次为昂丹司琼组26.3%、托烷司琼组21.4%、空白对照组28.3%,其中托烷司琼组PONV发生率较低(P<0.05)。女性或接受全麻的患者应用昂丹司琼或托烷司琼均可有效的降低其PONV发生率(P<0.05)。结论女性或全麻患者预防应用5-HT3受体拮抗药可降低PONV发生率。

Objective To analysis the possible causes of PONV and evaluate the significance to use ondansetron or tropisetron prophylactically. Methods One thousand and forty-six patients divided into three groups,and ondansetron（group A）,tropisetron （group B） or normal saline （group C） was given randomly after anesthesia was induced. The incidence and severity of PONV were recorded 24 hours later. Results The obvious factors associated with PONV included gender,type of anesthesia, duration of surgery, to use opioids postoperatively and history of motion sickness. The incidences of PONV in group A,B and C were 26.3%, 21.4% and 28.3%, respectively. Given tropisetron before operation could reduce the risk of PONV significantly（P〈0.05）. Either ondansetron and tropisetron were effective in reducing the severity of PONV in women or those accepted general anesthesia（P〈0.05）. Conclusion Prophylactic use of 5-HT3 receptor antagonists is effective in reducing PONV in women or the patients underwent general anesthesia.