Effect of anesthesia induction with butorphanol on postoperative nausea and vomiting:A randomized controlled trial

BACKGROUND Postoperative nausea and vomiting(PONV)are common complications that affect the recovery and well-being of elderly patients undergoing gastrointestinal laparoscopic surgery.AIM To investigate the effect of butorphanol on PONV in this patient population.METHODS A total of 110 elderly patients(≥65 years old)who underwent gastrointestinal laparoscopic surgery were randomly assigned to receive butorphanol(40μg/kg)or sufentanil(0.3μg/kg)during anesthesia induction in a 1:1 ratio.The measured outcomes included the incidence of PONV at 48 h after surgery,intraoperative dose of propofol and remifentanil,Bruggrmann Comfort Scale score in the postanesthesia care unit(PACU),number of compressions for postoperative patientcontrolled intravenous analgesia(PCIA),and time to first flatulence after surgery.RESULTS The results revealed a noteworthy reduction in the occurrence of PONV at 24 h after surgery in the butorphanol group,when compared to the sufentanil group(T1:23.64%vs 5.45%,T2:43.64%vs 20.00%,P<0.05).However,no significant variations were observed between the two groups,in terms of the clinical characteristics,such as the PONV or motion sickness history,intraoperative and postoperative 48-h total infusion volume and hemodynamic parameters,intraoperative dose of propofol and remifentanil,number of postoperative PCIA compressions,time until the first occurrence of postoperative flatulence,and incidence of PONV at 48 h post-surgery(all,P>0.05).Furthermore,patients in the butorphanol group were more comfortable,when compared to patients in the sufentanil group in the PACU.CONCLUSION The present study revealed that butorphanol can be an efficacious substitute for sufentanil during anesthesia induction to diminish PONV within 24 h following gastrointestinal laparoscopic surgery in the elderly,simultaneously improving patient comfort in the PACU.

The selection rules of acupoints and meridians of traditional acupuncture for postoperative nausea and vomiting:a data mining-based literature study

Background:Postoperative nausea and vomiting(PONV)refers to a problem commonly occurring after surgery.Acupuncture is considered a critical complementary alternative therapy for PONV.The acupoints selection critically determines the efficacy of acupuncture,whereas the selection rules remain unclear.The objective of the present study was to delve into the principles of acupoints selection for PONV using data mining technology.Methods:The clinical trials assessing the acupuncture effect for PONV were searched with the use of computer in PubMed,China National Knowledge Infrastructure,and Chinese Biomedical Database;the time span was confined as 2009–2019.The database of acupuncture prescriptions for PONV was built using Excel 2016;the description and association were analyzed by IBM SPSS modeler 18.Result:Eighty-three relevant literatures were screened out.The number of specific acupoints took up 72.5%of all acupoints;specific acupoints exhibited the frequency taking up 91.30%of the total frequency.As revealed from the result,Neiguan(PC 6),Zusanli(ST 36),Hegu(LI 4),and Zhongwan(CV 12)were most frequently applied,suggesting the tightest associations.Most acupoints were taken from the stomach meridian and pericardium meridian.The common acupoints were concentrated in the lower limbs,chest,as well as abdomen.Conclusion:Data mining acts as a feasible method to identify acupoints selection and compatibility characteristics.As suggested from our study,the acupoints selection for PONV prioritizes specific acupoints and related meridians.The selection and combination of acupoints comply with the theory of traditional Chinese medicine.

Prevention of Postoperative Nausea and Vomiting in Elective Hysterectomy: A Prospective, Randomized, Placebo Controlled Outcomes Trial of Aprepitant NK-1-Receptor Antagonist

Objectives: Current prophylactic interventions fail to completely eliminate postoperative nausea and vomiting (PONV) for a substantial number of patients. A new antiemetic (aprepitant) has been effective in preventing chemotherapy induced nausea and vomiting (CINV). We hypothesized that adding aprepitant to our current prophylactic regimen of dexamethasone and ondansetron would reduce the incidence of PONV in our elective hysterectomy population. Methods: 256 patients undergoing elective hysterectomy were enrolled in this prospective, randomized, double blinded, placebo controlled trial. Subjects received either oral aprepitant 40 mg or oral placebo 30 minutes prior to induction of standardized anesthesia. The primary outcome was vomiting within the first 24 hours after surgery. Postoperative nausea, vomiting, and use of rescue antiemetics were documented over a 24 h period. Additionally, adverse events, hospitalization days, and readmissions for PONV were compared. Results: There was a trend towards reduction of postoperative nausea and vomiting in the aprepitant group. Nausea and vomiting were noted for 24% and 17% of women in the aprepitant group versus 38% and 29% of women in the Placebo group, respectively. Supplemental antiemetic medication was used by 42% of women in the aprepitant group versus 60% of women in the Placebo group. No adverse events were substantially more common in the aprepitant group than the Placebo group. Conclusions: Preemptive use of aprepitant prior to elective hysterectomy may reduce the incidence of PONV and diminish the need for rescue antiemetics postoperatively. Further studies with larger power are needed to confirm the trends observed in this study.

Acupuncture in preventing postoperative nausea and vomiting:a systematic review and Bayesian network meta-analysis

However,the best choice of acupuncture therapy for postoperative nausea and vomiting remains controversy.Methods:Several databases were searched from inception to April 2020.Randomized controlled trials met the criterion were included.Risk of bias was implemented with Cochrane risk-of-bias tool.Addis,R,OpenBUGS and STATA were used to conduct meta-analysis.The evidence was assessed by GRADE profiler 3.6.Results:Fifty studies involving 5980 patients were included.The risk of bias of most included studies were acceptable.The results of network meta-analyses indicated,compared with placebo,electroacupuncture was the best choice for postoperative nausea(odds ratio=0.09,95%confidence interval:0.02-0.51)and acupoint plaster for postoperative vomiting(odds ratio=0.07,95%confidence interval:0.01-0.42),acupoint catgut embedding+5HTRA for postoperative nausea and vomiting(odds ratio=0.05,95%confidence interval:0.01-0.15),and transcutaneous electrical nerve stimulation+5-hydroxytryptamine receptor antagonists for postoperative rescue antiemetics(odds ratio=0.14,95%confidence interval:0.08-0.46).Conclusion:It was suggested transcutaneous electrical nerve stimulation+5-hydroxytryptamine receptor antagonists was the best choice.The results provided guidance for the prevention of postoperative nausea and vomiting.

Comparative study on effects of dexmedetomidine and dexamethasone on the incidence of postoperative nausea and vomiting in patients undergoing laparoscopic surgery

Objective:To compare the safety and efficacy of dexmedetomidine and dexamethasone for the prevention of postoperative nausea and vomiting(PONV)in patients scheduled for laparoscopic surgery.Methods:A total of 86 female patients were prospectively administered dexmedetomidine 1μg/kg i.v.(the group A,n=43),and dexamethasone 8 mg i.v.(the group B,n=43).The two groups were compared in treatment response,hemodynamic changes,and Numerical Analog Scale(NAS).Besides,the relation of PONV with patient baseline characteristics in the perioperative period was determined as well.Results:Patients in group A had lower PONV scores(t=3.1,P<0.002),less needs for rescue anti-emetics(χ2=0.47,P<0.001),and decreased intraoperative heart rate(t=9.72,P<0.001)and mean arterial pressure(t=7.58,P<0.001)compared to that of group B.Group A reported lower NAS than group B(t=2.66,P<0.001).In addition,we found no relationship between PONV score and rescue anti-emetic requirement,age,or body mass index(P=0.96,P=0.60,P=0.28,respectively).Conclusion:Dexmedetomidine could be used as an effective antiemetic in laparoscopic surgeries,with better efficacy than dexamethasone.Dexmedetomidine not only can reduce PONV but also is effective in postoperative analgesia.

Postoperative Nausea &Vomiting in Malawi

Background: Postoperative nausea and vomiting are common complications of anaesthesia and surgery. Known risk factors include motion sickness, migraine, gender and types of surgery. Other possible risk factors for postoperative nausea and vomiting are ethnicity and genetics surgery. Objective: The main objective of the study was to describe factors associated with postoperative nausea and vomiting among adult Malawians. Methods: This was a prospective observational study. 138 adult patients were recruited into the study. Data were collected using a predesigned questionnaire. Patients were followed up to 18 hours postoperatively and any episodes of postoperative nausea and vomiting were noted. Results: A total of 138 patients were enrolled in the study. 78 were female (56.5%) and 60 were males (43.5%). The ages ranged from 18 to 87 years. The mean age was 36.9 years. The overall incidence of postoperative nausea and vomiting was 29.6%. It was higher among women than men. Patients with motion sickness had the highest incidence of postoperative nausea and vomiting (78.6%) followed by those with migraine (73.3%). Patients whose intraoperative systolic blood pressure fell <80 mmHg had an incidence of 71.4% and those who received postoperative opioids had an incidence of 37.7%. Conclusions: Patients with a history of migraine, motion sickness, whose intraoperative blood pressures fall below a systolic of 80 mmHg and who receive postoperative opioids are at an increased risk for postoperative nausea and vomiting.

Preoperative Concern about Nausea and Vomiting and Postoperative Use of Antiemetics among Patients Undergoing Breast Cancer-Related Surgery

Background: Postoperative nausea and vomiting (PONV) can lead to complications and increased healthcare costs. We investigated whether patient preoperative concern about PONV is associated with postoperative antiemetic use, independently of Apfel score. Methods: Patients eligible for study were English- or Spanish-speaking women with breast cancer undergoing mastectomy, lumpectomy or reconstructive surgery as outpatients during July 2014-July 2017, when the pre-anesthesia clinic routinely screened for preoperative concern via tablet computer-based survey. Excluded were patients who did not rate their concern or lacked Apfel score. Risk factors for concern were evaluated in a multinomial model adjusted for multiple hypotheses. Using generalized linear regression, preoperative concern was tested for association with number of antiemetics administered in the postanesthesia care unit. Results:?Of preoperative surveys, 7.1% (58/812) were excluded for missing data, leaving n = 754 surveys contributed by n = 706 subjects (age 26 - 80 years). Patient preoperative concern ranged from none (32.8%), mild (30.2%), moderate (22.9%), severe (7.8%), to very severe (6.2%). Adjusted for age, concern was increased by history of motion sickness (Odds Ratio 1.51, 95% Confidence Interval 1.11 - 2.06) and history of PONV (9.02, 6.30 - 12.90) and decreased by prior surgery without PONV (0.35, 0.23 - 0.53) and Spanish as primary language (0.42, 0.25 - 0.68). Number of postoperative antiemetics, usually 1 (41.2%) or 2 (33.4%) drugs, was unassociated with preoperative concern before or after adjustment for Apfel score. Conclusions: Among women undergoing breast cancer-related surgery, preoperative concern about PONV varies by prior history of PONV and motion sickness and by ethnicity. However, preoperative concern is not associated with postoperative antiemetic medications.

The Addition of Midazolam Reduces the Incidence of Early Postoperative Nausea and Vomiting in Short Time Gynecological Procedures

Background: If untreated, one third of patients who undergo surgery develop postoperative nausea and/or vomiting (PONV). The prevention of postoperative nausea and vomiting can improve satisfaction among vulnerable patients. We hypothesized that preoperative anxiety may increase the incidence of PONV. The objective was to assess whether administration of a benzodiazepine prior to surgery would reduce the incidence of PONV. Methods: 130 women (ASA I and II) scheduled to undergo dilatation and curettage comprised the study group. The women were allocated randomly to two study groups according to the type of anesthesia administered (with and without midazolam). Results: Sixty-eight women received midazolam and 62 did not. Patients treated with midazolam were feeling more comfortable (“friendliness”, p = 0.005 and “elation”, p = 0.01) and had less postoperative fatigue (p = 0.04) than non-midazolam-treated group. Patients treated with midazolam had significantly fewer emetic episodes during the first 4 hours after surgery than those without midazolam (0.1 ± 0.2 vs 0.3 ± 0.6, respectively, p = 0.003). Conclusions: Midazolam reduces the incidence of PONV and improves patient’s comfort. We suggest that midazolam has to be routinely included in the anesthesia protocol for short-term gynecological procedures (dilatation and curettage).

Intraoperative systemic vascular resistance is associated with postoperative nausea and vomiting after laparoscopic hysterectomy

BACKGROUND The incidence of postoperative nausea and vomiting(PONV)in patients undergoing laparoscopic hysterectomy is very high compared with other surgeries,even when many prophylactic measures have been taken.However,the pathogenesis of PONV is multifactorial.Female sex,a history of motion sickness or PONV,nonsmokers,and perioperative opioid use are the most closely related factors.Among the multiple risk factors,suboptimal gastrointestinal(GI)perfusion may be attributed to some cases of PONV,and increased systemic vascular resistance(SVR)may lead to GI ischemia.The hypothesis of this research was that SVR is related to PONV.AIM To investigate the relationship between SVR and PONV in patients undergoing laparoscopic hysterectomy.METHODS A total of 228 patients who underwent elective laparoscopic hysterectomy were included in this prospective observational study.SVR was monitored using a noninvasive hemodynamic monitoring system.Four indices of SVR,the baseline,mean,area under the curve(AUC),and weighted AUC,were used for analysis.The incidence and severity of nausea and vomiting were evaluated while patients were awake and throughout the intervals from 0 to 2 h,2 to 6 h,and 6 to 24 h starting upon arrival at the post-anesthesia care unit.The associations between various SVR indices and PONV were investigated by logistic regression.P<0.05 was considered statistically significant.RESULTS The incidence of PONV in the study was 56.14%(128/228),and PONV tended to appear within 6 h after surgery.Five variables were significant in univariate analyses,however,only SVR mean[odds ratio(OR)=1.015,95%CI:1.005-1.109,P=0.047]and duration of surgery(OR=1.316,95%CI:1.003-2.030,P=0.012)were associated with PONV after logistic regression analysis.Furthermore,patients with high SVR mean were more likely to suffer from PONV after laparoscopic hysterectomy.On average,patients who developed PONV needed more time to tolerate diet and demonstrated poorer sleep quality on the first night after surgery.CONCLUSION In this study,PONV was a common complication after laparoscopic hysterectomy.SVR was associated with PONV,and high SVR mean was associated with a significantly increased risk of PONV.

Palonosetron versus Ondansetron as Prophylaxis against Postoperative Nausea and Vomiting (PONV) after Laparoscopic Sleeve Gastrectomy: A Randomized Controlled Trial

Introduction: Postoperative nausea and vomiting (PONV) are prevalent symptoms after laparoscopic surgeries with an incidence rate of (54% - 79%) in bariatric procedures. Despite its popularity, limited studies assessed the effect of antiemetics for PONV prophylaxis after laparoscopic sleeve gastrectomy (LSG). The aim of this trail is to compare the effectiveness of a single pre-induction intravenous dose of Palonosetron versus Ondansetron for prophylaxis of PONV, 24 hours after LSG. Subjects and Methods: This prospective randomized controlled double-blind parallel-group study was conducted from May till December 2019. Recruited patients were consented and randomized using a closed envelop method into two groups with fifty patients each. The total number of nausea and vomiting attacks in the 24 hours postoperatively was considered as a primary end point. The secondary end points were the frequency of nausea, retching and vomiting attacks in the 24 hours post-surgery. The severity of nausea was evaluated using a 10 cm visual analogue scale (VAS). Results: This RCT included 100 patients divided into 2 groups of 50 patients each. Patients received either 75 mcg Palonosetron (Group I) or Ondansetron 4 mg (group II). Group I had statistically significant fewer episodes of nausea, retching and vomiting in the first 4 hours (P = 0.022) and from 4 to 12 hours (P = 0.024) but not after 12 hours post LSG. Total episodes of nausea, retching and vomiting in 24 hours postoperative were significantly less in group I (P = 0.021). Conclusion: A single dose of intravenous 75 mcg Palonosetron is superior to Ondansetron 4 mg in preventing PONV for patients after LSG.

Optimizing surgical outcomes for elderly gallstone patients with a high body mass index using enhanced recovery after surgery protocol

BACKGROUND Rehabilitation of elderly patients with a high body mass index(BMI)after cholecystectomy carries risks and requires the adoption of effective perioperative management strategies.The enhanced recovery after surgery(ERAS)protocol is a comprehensive treatment approach that facilitates early patient recovery and reduces postoperative complications.AIM To compare the effectiveness of traditional perioperative management methods with the ERAS protocol in elderly patients with gallbladder stones and a high BMI.METHODS This retrospective cohort study examined data from 198 elderly patients with a high BMI who underwent cholecystectomy at the Shanghai Fourth People's Hospital from August 2019 to August 2022.Among them,99 patients were managed using the traditional perioperative care approach(non-ERAS protocol),while the remaining 99 patients were managed using the ERAS protocol.Relevant indicator data were collected for patients preoperatively,intraoperatively,and postoperatively,and surgical outcomes were compared between the two groups.RESULTS The comparison results between the two groups of patients in terms of age,sex,BMI,underlying diseases,surgical type,and preoperative hospital stay showed no statistically significant differences.However,the ERAS group had a significantly shorter preoperative fasting time than the non-ERAS group(4.0±0.9 h vs 7.6±0.9 h).Regarding intraoperative indicators,there were no significant differences between the two groups of patients.However,in terms of postoperative recovery,the ERAS protocol group exhibited significant advantages over the non-ERAS group,including a shorter hospital stay,lower postoperative pain scores and postoperative hunger scores,and higher satisfaction levels.The readmission rate was lower in the ERAS protocol group than in the non-ERAS group(3.0%vs 8.1%),although the difference was not significant.Furthermore,there were significant differences between the two groups in terms of postoperative nausea and vomiting severity,postoperative abdominal distention at 24 h,and daily life ability scores.CONCLUSION The findings of this study demonstrate that the ERAS protocol confers significant advantages in postoperative outcomes following cholecystectomy,including reduced readmission rates,decreased postoperative nausea and vomiting,alleviated abdominal distension,and enhanced functional capacity.While the protocol may not exhibit significant improvement in early postoperative symptoms,it does exhibit advantages in long-term postoperative symptoms and recovery.These findings underscore the importance of implementing the ERAS protocol in the postoperative management of cholecystectomy patients,as it contributes to improving patients'recovery and quality of life while reducing health care resource utilization.

温针配合穴位贴敷及药物干预乳腺癌化疗相关性恶心呕吐的临床研究

目的观察温针配合穴位贴敷及药物干预乳腺癌化疗相关性恶心呕吐(chemotherapy induced nausea and vomiting,CINV)的临床疗效。方法将110例乳腺癌术后辅助化疗患者随机分为观察组和对照组,每组55例。对照组于化疗前30 min接受静脉滴注注射用盐酸托烷司琼治疗,观察组在对照组基础上于化疗前1 d接受温针配合穴位贴敷治疗。观察两组化疗前后不同时间点恶心、呕吐反应症状评分及血清5-羟色胺(5-hydroxytryptamine,5-HT)水平的变化情况,并比较两组CINV发生率。结果观察组CINV发生率为34.5%,明显低于对照组的56.4%,差异具有统计学意义(P<0.05)。两组化疗后第3 d恶心、呕吐反应症状评分均较同组化疗前显著上升,化疗后第5、7 d恶心、呕吐反应症状评分均较同组化疗第3 d显著下降,差异均具有统计学意义(P<0.05)。观察组化疗后第3、5、7 d恶心、呕吐反应症状评分均明显低于对照组,差异均具有统计学意义(P<0.05)。两组化疗后第7 d血清5-HT水平均较同组化疗前显著上升(P<0.05)。观察组化疗后第7 d血清5-HT水平明显低于对照组,差异具有统计学意义(P<0.05)。结论温针配合穴位贴敷及药物干预能降低乳腺癌CINV的发生率,有助于缓解恶心、呕吐症状,其机制可能与降低5-HT水平有关。

日间手术麻醉规范化管理策略

日间手术具有床位周转快、患者满意度高、医疗费用少、院内感染率低等优势,是目前国内外大力探索和发展的一种手术模式。安全是日间手术开展的底线,舒适是日间手术的核心追求,二者的保障均离不开对高质量的围术期麻醉管理。因此,在快速周转的日间手术模式下,本文就如何实施规范化的麻醉管理策略,分别从日间手术麻醉临床路径的制定、硬件设施以及人员的配备,麻醉术前评估与术前准备,麻醉方式的选择,围术期疼痛管理,术后恶心呕吐(postoperative nausea and vomiting,PONV)管理,麻醉后监测治疗,术后随访几方面加以阐述。

小剂量艾司氯胺酮对正颌手术患者术后恶心、呕吐发生情况及严重程度的影响

目的 探讨小剂量艾司氯胺酮对正颌手术患者术后恶心、呕吐发生情况及严重程度的影响。方法 选取2023年1—7月首都医科大学附属北京口腔医院收治的75例择期进行正颌手术的患者为研究对象,在组间基线特征可比的原则上,采用随机数字表法分成对照组[切皮前静脉输注0.25 mg/(kg·h)生理盐水,38例]和观察组[切皮前静脉输注0.25 mg/(kg·h)艾司氯胺酮,37例]。比较分析两组患者术后48 h的恶心、呕吐发生率以及严重程度。比较分析两组患者的围手术期麻醉药物用量以及术后24 h的躁动、疼痛情况。结果 观察组患者术后48 h的恶心、呕吐发生率低于对照组,差异有统计学意义(P<0.05)。观察组患者术后48 h的中重度恶心、呕吐发生率低于对照组,差异有统计学意义(P<0.05)。两组患者围手术期的瑞芬太尼用量、丙泊酚用量以及术后24 h的躁动发生率比较差异均无统计学意义(P>0.05);观察组患者术后24 h的视觉模拟评分法评分低于对照组,差异有统计学意义(P<0.05)。结论 小剂量艾司氯胺酮可降低正颌手术患者术后的恶心、呕吐发生率,减轻术后恶心、呕吐的严重程度,且可显著缓解患者的术后疼痛,值得临床应用。

经皮穴位电刺激手环行内关穴刺激对全麻甲状腺切除术后恶心呕吐的影响

目的 探讨围术期采用经皮穴位电刺激手环行内关穴刺激对全麻甲状腺切除术后恶心呕吐的影响。方法 选择择期在全麻下行甲状腺切除术的女性患者72例,年龄18~50岁,ASAⅠ或Ⅱ级。采用可变区组随机化将患者1∶1随机分配入两组:电刺激组和对照组,每组36例。两组患者均在麻醉诱导前佩戴国产经皮穴位电刺激手环,电极对准内关穴。电刺激组开机刺激内关穴,调整强度使患者感觉手部关联区域有麻刺感且可耐受,固定手环后关机;手术结束时立即打开手环,给予麻醉诱导前确定的刺激强度,持续佩戴24 h。对照组同样佩戴24 h,但始终不通电。记录术后24 h内术后恶心呕吐(PONV)例数及止吐药物的使用情况。结果 与对照组比较,电刺激组术后24 h内PONV发生率、术后呕吐发生率明显降低(P<0.05),且差异主要出现在术后1~6 h(P<0.05)。两组不同时间段止吐药物补救率差异无统计学意义。结论 采用穿戴式手环行经皮内关穴电刺激可以有效降低甲状腺切除术后24 h内PONV发生率。

手术患者接受患者自控静脉镇痛期间发生术后恶心呕吐的危险因素分析

目的分析手术患者接受患者自控静脉镇痛(patient controlled intravenous analgesia,PCIA)期间发生术后恶心呕吐(postoperative nausea and vomiting,PONV)的危险因素。方法本研究为回顾性队列研究,纳入2023年7月1日—10月31日在北京协和医院接受外科手术且术后接受PCIA的患者。通过电子病历系统获取患者的一般资料、既往史、手术信息、术中用药信息、术后镇痛随访信息。根据接受PCIA期间PONV的发生情况,将患者分为PCIA⁃PONV组和非PCIA⁃PONV组;根据是否发生术后呕吐(postoperative vomiting,POV),将其分为PCIA⁃POV组和非PCIA⁃POV组。采用多因素Logistic回归分析法筛选PCIA⁃PONV和PCIA⁃POV的危险因素。结果共纳入1373例患者,其中PCIA⁃PONV组676例,PCIA⁃PONV的发生率为49.2%;PCIA⁃POV组285例,PCIA⁃POV的发生率为20.8%。多因素Logistic回归分析显示,女性(OR=2.134,95%CI:1.590~2.865,P<0.001)、腹部手术(OR=1.655,95%CI:1.253~2.186,P<0.001)是手术患者接受PCIA期间出现PONV的危险因素,而年龄增长(OR=0.990,95%CI:0.982~0.998,P=0.019)、体质量指数增加(OR=0.961,95%CI:0.932~0.991,P=0.012)则是其保护因素;女性(OR=2.646,95%CI:1.754~3.992,P<0.001)、全麻史(OR=1.372,95%CI:1.042~1.806,P=0.024)、术中使用大剂量阿片类药物(OR=1.607,95%CI:1.206~2.142,P=0.001)是手术患者接受PCIA期间出现POV的危险因素,而术中未使用肌松拮抗剂(OR=0.393,95%CI:0.237~0.651,P<0.001)则是其保护因素。结论本研究初步揭示了手术患者接受PCIA期间发生PONV的危险因素,完善的术前评估及合理的围术期管理策略对于预防PCIA⁃PONV具有重要意义。

胸腔镜肺部手术后恶心呕吐严重程度与术后恢复质量及活动能力的相关性

目的评估胸腔镜肺部手术患者术后恶心呕吐(PONV)严重程度与术后恢复质量及早期活动能力的相关性。方法选择择期胸腔镜肺部手术患者125例,男80例,女45例,年龄18~64岁,BMI 18~35 kg/m^(2),ASAⅠ—Ⅲ级。采用PONV影响量表评估术后第1天PONV的严重程度,根据严重程度将患者分为三组:无PONV组(n=87)、轻度PONV组(n=38)和中重度PONV组(n=7)。采用15项恢复质量(QoR-15)量表评估术后第1天的恢复质量,6分钟步行试验(6-MWT)评估术后第2天的活动能力。采用多重线性回归模型分析PONV严重程度与术后恢复质量及活动能力的相关性。结果校正后的多重线性回归模型结果显示,与无PONV患者比较,轻度和中重度PONV患者术后第1天QoR-15量表评分分别降低4.5分(95%CI-8.9~-0.04分,P=0.048)和15.8分(95%CI-24.8~-6.8分,P=0.001);轻度(MD=-27.4 m,95%CI-70.1~15.4 m,P=0.207)和中重度PONV(MD=-57.0 m,95%CI-145.7~31.6 m,P=0.204)与术后第2天6-MWT距离缩短无明显相关性。结论在肺部手术患者中,PONV严重程度的增加与更差的恢复质量存在相关性。积极地预防和治疗PONV可能有助于患者的早期康复。

微血管减压术患者发生术后恶心呕吐的影响因素分析

目的 探讨微血管减压术(microvascular decompression, MVD)患者发生术后恶心呕吐(postoperative nausea and vomiting, PONV)的影响因素。方法 选取2022年1月4日至2023年3月25日首都医科大学宣武医院行MVD的患者385例。根据术后24 h内是否发生PONV分为PONV组(203例)和非PONV组(182例)。采用多因素logistic回归分析MVD患者发生PONV的影响因素。结果 385例患者中男164例,女221例,年龄24~80岁,平均(56.3±11.0)岁;其中面肌痉挛148例,三叉神经痛237例。术后24 h内发生PONV 203例,发生率为52.73%。多因素logistic回归分析结果显示,无吸烟史(OR=0.290,95%CI:0.161~0.521,P=0.000)、血管与神经粘连(OR=2.381,95%CI:1.115~5.084,P=0.040)、责任血管数量越多(OR=2.426,95%CI:1.132~5.198,P=0.023)、垫片数量越多(OR=1.665,95%CI:1.187~2.335,P=0.003)、麻醉时间越长(OR=1.006,95%CI:1.001~1.012,P=0.031)、未预防使用止吐剂(OR=0.535,95%CI:0.300~0.953,P=0.034)、使用七氟烷(OR=33.315,95%CI:14.102~78.707,P=0.000)、术后镇痛泵舒芬太尼使用量越多(OR=1.029,95%CI:1.010~1.049,P=0.003)的患者术后更容易发生PONV。结论 MVD患者PONV发病率较高,手术操作、患者本身因素、术中麻醉及术后镇痛等因素均可导致PONV的发生。在MVD手术时长一定的情况下,对于术中血管与神经粘连、责任血管数量多的患者预防性使用止吐剂、减少术中吸入类麻醉药物使用、术后采用多模式镇痛以减少阿片类药物的使用量,能够有针对性的预防PONV的发生。

围术期氧疗的研究进展

目的氧疗是围术期麻醉管理的重要组成部分。氧疗是把双刃剑,氧浓度过高可产生肺不张、氧化应激,给机体造成损伤,过低又会导致低氧血症,影响氧合。因此,围术期氧疗如何选择合适的吸氧浓度一直是麻醉管理的热点问题。本文将围绕围术期氧疗对机体的影响、不同类型患者吸入氧浓度的选择作一综述,以期为围术期精准氧疗提供理论参考。