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.

Association between operative position and postoperative nausea and vomiting in patients undergoing laparoscopic sleeve gastrectomy

BACKGROUND Bariatric surgery is one of the most effective ways to treat morbid obesity,and postoperative nausea and vomiting(PONV)is one of the common complications after bariatric surgery.At present,the mechanism of the high incidence of PONV after weight-loss surgery has not been clearly explained,and this study aims to investigate the effect of surgical position on PONV in patients undergoing bariatric surgery.AIM To explore the effect of the operative position during bariatric surgery on PONV.METHODS Data from obese patients,who underwent laparoscopic sleeve gastrectomy(LSG)in the authors’hospital between June 2020 and February 2022 were divided into 2 groups and retrospectively analyzed.Multivariable logistic regression analysis and the t-test were used to study the influence of operative position on PONV.RESULTS There were 15 cases of PONV in the supine split-leg group(incidence rate,50%)and 11 in the supine group(incidence rate,36.7%)(P=0.297).The mean operative duration in the supine split-leg group was 168.23±46.24 minutes and 140.60±32.256 minutes in the supine group(P<0.05).Multivariate analysis revealed that operative position was not an independent risk factor for PONV(odds ratio=1.192,95%confidence interval:0.376-3.778,P=0.766).CONCLUSION Operative position during LSG may affect PONV;however,the difference in the incidence of PONV was not statistically significant.Operative position should be carefully considered for obese patients before surgery.

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.

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.

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.

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.

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).

PONV风险因素评估量表在预防妇科腹腔镜术后恶心、呕吐中的应用效果

目的探究术后恶心呕吐(PONV)风险因素评估量表在预防妇科腹腔镜术后恶心、呕吐中的应用价值。方法选取84例妇科腹腔镜手术患者,按照随机单盲法分为对照组(40例)与观察组(44例)。对照组采用常规护理,观察组在对照组基础上应用PONV风险因素评估量表。对比两组术后恶心、呕吐发生情况及临床治疗指标。结果观察组患者轻度和中、重度恶心、呕吐占比均低于对照组,无恶心、呕吐占比95.45%高于对照组的60.00%(P<0.05)。观察组术后首次排气时间、下床活动时间、切口愈合时间和住院时间均明显短于对照组(P<0.05)。结论PONV风险因素评估量表在预防妇科腹腔镜术后恶心、呕吐中的应用价值较高,值得临床推广与应用。

托烷司琼预处理配合丙泊酚全身麻醉对预防PONV的价值

目的观察托烷司琼预处理配合丙泊酚全身麻醉对预防术后恶心呕吐(PONV)的应用价值。方法采用前瞻性研究,纳入融通集团信阳154医院在2021年6月—2022年12月期间收治的接受腹腔镜手术治疗的122例患者,所有患者均实施含丙泊酚的全身麻醉辅助手术,采用随机数字表法对入组患者进行分组,分别列为预处理组(61例)和常规组(61例),常规组术后予以常规止吐,预处理组采用托烷司琼预处理,比较两组患者术后6 h、术后12 h、术后24 h及术后48 h等不同时间点的PONV发生率、呕吐症状改善情况,麻醉苏醒后的疼痛、镇静情况,以及术后48 h内的麻醉相关不良反应发生情况。结果预处理组术后6 h的PONV发生率为3.28%(2/61),术后12 h的PONV发生率为4.92%(3/61),术后24 h的PONV发生率为3.28%(2/61),术后48 h的PONV发生率为0.00%(0/61),均低于常规组[16.39%(10/61)、18.03%(11/61)、16.39%(10/61)、13.11%(8/61)],差异有统计学意义(P<0.05)。预处理组术后6 h的恶心呕吐干呕症状评估量表(INVR)评分为(20.15±5.41)分,术后12 h的INVR评分为(17.66±4.42)分,术后24 h的INVR评分为(13.29±4.17)分,术后48 h的INVR评分为(10.22±3.35)分,均低于常规组[(23.32±5.13)分、(20.12±4.35)分、(16.33±4.24)分、(12.75±3.06)分],差异有统计学意义(P<0.05)。预处理组苏醒后的视觉模拟疼痛量表(VAS)评分为(4.04±1.06)分,Ramsay镇静评分为(3.11±0.25)分,与常规组[(3.87±0.25)分、(3.06±0.35)分]比较差异无统计学意义(P>0.05)。术后48 h内,预处理组的麻醉相关不良反应发生率为9.84%(6/61),与常规组8.20%(5/61)比较差异无统计学意义(P>0.05)。结论托烷司琼预处理辅助含丙泊酚腔镜全身麻醉腹手术可有效降低PONV发生风险并改善患者PONV相关症状,联合应用此药未对麻醉镇静、镇痛效果产生明显影响,且未明显增加术后麻醉相关不良反应发生风险,安全性较高。

Application of PC6 Stimulation in the Prevention and Treatment of Postoperative Nausea and Vomiting in Ambulatory Surgery

Postoperative nausea and vomiting (PONV) is a common complication in ambulatory surgery patients, which affects their quality of life and recovery process. In recent years, acupuncture stimulation as a non-pharmacological therapy has shown significant efficacy in the prevention and treatment of PONV. This review mainly discusses the current research on using PC6 stimulation to prevent PONV in ambulatory surgery patients, elucidates the various effects and mechanisms of PC6 stimulation, analyzes the advantages and disadvantages, safety, and feasibility of different stimulation methods, aiming to improve the postoperative recovery quality of ambulatory surgery patients, reduce medical costs, and promote the application of integrative medicine in the prevention and treatment of PONV.

瑞马唑仑联合瑞芬太尼对老年眼科全麻患者术中循环功能及PONV的影响

目的探讨瑞马唑仑联合瑞芬太尼对老年眼科全麻患者术中循环功能和术后恶心呕吐(PONV)的影响。方法将济南市第二人民医院2021年4月至2022年7月接收的老年全麻手术患者94例进行随机对照试验,随机分为对照组与研究组,每组各47例。对照组男27例,女20例,年龄(67.89±7.58)岁,给予丙泊酚0.6~1.2 mg/kg麻醉诱导及4~10 mg·kg^(-1)•h^(-1) 维持;研究组男25例,女22例,年龄(68.18±7.82)岁,采用瑞马唑仑0.1~0.3 mg/kg麻醉诱导,给予瑞马唑仑0.8~1.2 mg·kg^(-1)•h^(-1) ,瑞芬太尼0.1~0.2μg·kg-1·min-1维持麻醉。比较两组患者麻醉诱导前(T_(0))、麻醉诱导成功(T_(1))、喉罩置入即刻(T_(2))、手术20 min(T3)监测患者的心脏指数(CI)、心输出量(CO)、平均动脉压(MAP)及血氧饱和度(SpO2);比较两组患者术后恶心(PON)、术后呕吐(POV)、PONV发生率及严重程度;对比两组患者麻醉苏醒指标(清醒时间、拔管时间与苏醒期间躁动)。统计学方法采用χ^(2)检验、t检验、Mann-Whitney U检验。结果研究组T_(1)、T_(2)、T3的CI均高于对照组同期[(2.89±0.43)min•m^(-2)比(2.64±0.41)min•m^(-2)、(2.71±0.37)min•m^(-2)比(2.54±0.33)min•m^(-2)、(2.85±0.40)min•m^(-2)比(2.60±0.38)min•m^(-2)];研究组T_(1)、T_(2)、T3的CO均高于对照组同期[(5.26±0.47)L/min比(4.92±0.43)L/min、(4.72±0.41)L/min比(4.46±0.38)L/min、(5.10±0.45)L/min比(4.78±0.40)L/min];研究组T_(2)的MAP高于对照组同期[(75.50±6.73)mmHg比(72.14±6.25)mmHg,t=2.508,P<0.05];研究组T_(2)、T3的SpO2均高于对照组同期,差异均有统计学意义(t=2.699、2.209,均P<0.05);研究组术后48 h内PON、POV及PONV发生率均低于对照组(χ^(2)=4.065、4.821、5.317,均P<0.05);研究组术后6 h的PON及POV严重程度评分均低于对照组同期(Z=2.403、2.354,均P<0.05);研究组术后12 h的PON及POV严重程度评分均低于对照组同期(Z=2.136、2.081,均P<0.05);研究组清醒时间、拔管时间均长于对照组[(20.40±3.98)min比(13.62±2.84)min,(23.25±4.15)min比(15.17±3.32)min,t=8.922、10.423,均P<0.05)]。结论与丙泊酚麻醉诱导与维持比较,瑞马唑仑联合瑞芬太尼应用老年眼科全麻手术患者,术中CI、CO、MAP、SpO2相对平稳,PONV发生率及严重程度更低,不足之处是苏醒时间与拔管时间相对较长。

6种方法预防低危患者术后恶心呕吐(PONV)的成本效果分析(英文)

目的比较6种方法预防相对低危患者在腹腔镜胆囊切除术后发生恶心呕吐的成本和效果。方法180名择期行腹腔镜胆囊切除术并符合入选标准的男性患者，随机分为6组。组1接受异丙酚靶控输注（target—controlledinfusion，11CI）＋5mg托烷司琼；组2接受异丙酚TCI＋10mg地塞米松和1．25mg氟派利多；组3接受异丙酚TCI＋生理盐水；组4接受七氟醚＋5mg托烷司琼；组5接受七氟醚＋10mg地塞米松和1．25mg氟派利多；组6接受七氟醚＋生理盐水。研究终点是术后24h内恶心呕吐发生的次数，采用盲法记录。结果各组患者的一般情况、麻醉时间、手术时间、拔管时间和术后24h的痛觉模拟评分差异均无统计学意义。组2术后恶心呕吐的发生率显著低于组3（P=0．03），组5显著低于组6（P=0．01）。接受托烷司琼和异丙酚或七氟醚发生术后恶心呕吐的相对危险度分别为0．51或0．68；接受地塞米松联合氟哌利多和异丙酚或七氟醚发生术后恶心呕吐的相对危险度分别为0．40或0．39；相对于七氟醚，接受异丙酚麻醉发生术后恶心呕吐的相对危险度是0．80。1～6组每分钟的费用一效果比分别为1．07、0．88、1．14、1．05、0．74和1．06。结论异丙酚、托烷司琼、地塞米松和氟哌利多发生术后恶心呕吐的相对危险度不同。6种干预措施中，七氟醚结合地塞米松和氟哌利多具有最低的每分钟费用一效果比。

舌底涂抹中药辅穴位按摩治疗全麻术后恶心呕吐(PONV)的临床效果观察

目的:探讨舌底涂抹中药辅以穴位按摩法防治全麻术后患者恶心呕吐的疗效,为防治全麻术后恶心呕吐提供有效方法。方法:将2012年3月—2013年3月医院外科收治的120例全麻术后患者随机分为对照组和观察组,每组60例。对照组行常规治疗护理,观察组采用舌底涂抹姜半夏辅以足三里、内关穴按摩法,比较两组患者术后苏醒时、术后12 h、24 h的恶心呕吐评分,及24 h程度分级。结果:观察组术后12 h、24 h恶心呕吐评分低于对照组,24 h呕吐评级优于对照组,差异有统计学意义(P<0.05)。结论:底涂抹中药辅以穴位按摩法治疗全麻术后患者恶心呕吐的疗效确切,操作简便,值得推广。

吸烟患者全身麻醉后PONV发生率的性别差异

目的:探讨吸烟患者全身麻醉后术后恶心呕吐(PONV)发生率的性别差异。方法:选取我院2014年5月-2015年5月腹腔镜手术患者240例临床资料,其中,男性吸烟组(A组)60例,非吸烟组(B组)60例;女性吸烟组(C组)60例,非吸烟组(D组)60例。记录患者术后24h内恶心、呕吐的发生情况,恶心、呕吐的程度以及需要抗恶心、呕吐治疗的患者例数。统计PONV的发生率和PONV程度的评分,分析吸烟对全身麻醉后PONV发生率是否存在性别差异。结果:术后24h内A组未发生PONV患者例数明显多于B组(P<0.05),A组总PONV发生率明显低于B组(P<0.05),A组PONV达Ⅳ级而使用抗恶心、呕吐药物干预病例明显少于B组(P<0.05);C组与D组相比患者未发生PONV例数、总PONV发生率及PONV达Ⅳ级而使用抗恶心、呕吐药物干预病例无统计学差异(P>0.05)。结论:吸烟患者全身麻醉后PONV的发生率存在性别差异,吸烟能明显降低男性患者PONV的发生率,但是吸烟不能降低女性患者PONV的发生率。

术后恶心呕吐(PONV)的机制及其防治研究进展

术后恶心呕吐(PONV)是门诊和日间手术麻醉中日益增长的复杂而重要的问题,也是影响日间手术患者离院的主要因素。了解PONV的机制和影响因素对预防和治疗PONV具有重要意义。本文结合国内外文献,全面系统介绍PONV的可能机制、影响因素、预防和治疗指南。通过详细的术前评估,根据PONV发生机制和影响因素,在围术期采取多模式(药物与非药物)联合干预,有望最大程度地降低PONV发生率,减少患者痛苦,降低相关医疗费用,提高患者满意度。

静脉应用糖皮质激素改善膝关节置换术后PONV和疼痛的meta分析

目的:通过meta分析评价静脉应用糖皮质激素改善膝关节置换术后恶心、呕吐(postoperative nausea and vomiting,PONV)和疼痛的效果。方法:通过检索Pubmed、Cochrane图书馆、EMBA S数据库及万方数据库,搜索静脉应用激素改善膝关节表面置换术后恶心、呕吐和疼痛的随机对照研究,并追查已纳入文献的参考文献。所得数据通过Rev Man 5.1统计软件完成meta分析,比较实验组与对照组术后恶心呕吐和疼痛的改善。结果:共纳入了5篇文献中的461例膝关节置换患者。Meta分析结果显示,术后24 h实验组的效果优于空白组,PONV的OR及95%CI为0.31(0.18~0.46),疼痛VAS(视觉模拟评分)的WMD及95%C1为-13.25(-21.64^-4.76)。结论:静脉应用糖皮质激素能够明显改善膝关节置换PONV和疼痛,并不增加术后感染发生,可以推广使用。

针刺与透皮东莨菪碱联合治疗PONV临床观察35例

目的观察针刺与透皮东莨菪碱联合治疗手术后恶心呕吐(PONV)的疗效。方法将全麻或椎管内麻醉术后6h内出现PONV的患者,随机分为治疗组35例和对照组32例。治疗组采用针刺与透皮东莨菪碱联合治疗,对照组单纯采用透皮东莨菪碱治疗。参照世界卫生组织(WHO)恶心、呕吐反应的分级标准,确定对PONV控制的评价,在术后24h对两组治疗进行PONV控制评价。结果治疗组对于PONV的控制情况明显优于对照组,二者差异具有统计学意义(P<0.05)。结论针刺与透皮东莨菪碱联合治疗PONV效果好于单纯采用透皮东莨菪碱治疗。

昂丹司琼单用与地塞米松联用预防PONV效果的Meta分析

目的评价昂丹司琼联用地塞米松预防腹腔镜胆囊切除术后恶心呕吐(PONV)的效果。方法通过检索Pubmed、CNKI和万方数据库,搜集昂丹司琼联用地塞米松预防腹腔镜胆囊切除术后恶心呕吐的随机对照试验研究(RCT),以评价联用药的效果。结果共纳入9篇文献,共625例腹腔镜胆囊术患者。结果显示,试验组效果优于对照组。PONV及呕吐OR及95%CI分别为0.32(0.20,0.52)和0.25(0.13,0.50)。结论昂丹司琼联用地塞米松能有效预防腹腔镜胆囊切除术后恶心呕吐的发生。