小儿术后恶心与呕吐的预防

术后恶心与呕吐 ( PONV)是小儿门诊手术术后的重要问题。北美中心通过对 1 5 0 0 0名患儿的研究发现 ,PONV是病人出现非计划住院的最常见原因。遗憾的是 ,每天进行的许多普通门诊手术都伴有高发生率的PONV(如 PONV的发生率在增生性扁桃体切除术为 70 %、外耳整形术为 6 0 %、斜视矫正术达 80 % )。识别出儿童 PONV的危险 ,对于处理这个困难问题是重要的。通过采取一系列的措施可以尽可能地降低 PONV的发生率。一般对策包括 :避免术前过度禁食、保持良好的围术期水平衡、不能过早经口进食和恢复期避免快速的起床活动。就麻醉技术而…     

老年髋关节置换术后恶心和呕吐发生影响因素及ERAS围术期干预效果

目的探讨老年髋关节置换术后恶心和呕吐发生影响因素及快速康复外科(ERAS)围术期干预效果。方法选取2018年5月—2020年7月收治的未接受ERAS围术期干预的老年髋关节置换术172例作为未干预组,根据术后24 h有无发生恶心和呕吐将未干预组分为恶心和呕吐组(43例)及非恶心和呕吐组(129例)两个亚组;另选取同期收治的接受ERAS围术期干预的老年髋关节置换术89例作为干预组。采用单因素和多因素Logistic回归分析对老年髋关节置换术后恶心和呕吐发生影响因素进行分析,观察ERAS围术期干预预防老年髋关节置换术后恶心和呕吐效果。结果女性、焦虑自评量表(SAS)评分50分、术前静脉补液量500 ml、静吸复合全身麻醉和术中使用地佐辛是老年髋关节置换术后恶心和呕吐发生的高危因素,吸烟史和术中使用地塞米松是老年髋关节置换术后恶心和呕吐发生的保护因素(P0.05或P0.01)。干预组术后恶心和呕吐总发生率低于未干预组(P0.01)。结论老年髋关节置换术后恶心和呕吐发生与性别、吸烟史、SAS评分、术前静脉补液量、静吸复合全身麻醉、术中使用地佐辛和术中使用地塞米松密切相关,ERAS围术期干预可降低老年髋关节置换术后恶心和呕吐发生率。     

术后恶心呕吐病因、机制和治疗进展

术后恶心呕吐(postoperative nausea and vomiting,PONV)是手术常见的并发症之一,可对患者术后康复和生活质量造成不利影响。既往研究表明,PONV的发生与呕吐中枢密切相关,且受患者自身情况、使用药物、麻醉手术等因素影响。识别高危因素,术前预防性用药,优化给药方式等措施可降低其发生风险。如何减少PONV的发生,成为临床医师们关注的焦点。本文将通过回顾PONV的文献资料,分析影响PONV发生发展的因素和机制,同时探讨治疗进展。     

腹腔镜胆囊切除术术后恶心呕吐的危险因素分析

目的探讨腹腔镜胆囊切除术术后恶心呕吐(PONV)的相关危险因素。方法回顾性病例对照研究,选择2019年2～6月上海健康医学院附属嘉定区中心医院收治的行腹腔镜胆囊切除术的患者75例,术后根据是否发生恶心呕吐分为两组,恶心呕吐组(PONV组)以及无恶心呕吐组(无PONV组)。记录患者的一般资料及PONV可能危险因素,分别采用单因素和多因素Logistics回归分析研究腹腔镜胆囊切除手术PONV的相关危险因素。结果 PONV组25例、无PONV组50例,PONV发生率为33. 3%。单因素Logistics回归分析显示:PONV组和无PONV组相比,吸烟史、胃炎或消化道溃疡史的差异具有统计学意义(P 0. 05)。多因素logistics回归分析显示:无吸烟史、胃炎、消化道溃疡史、吸入麻醉维持方式是腹腔镜胆囊切除术PONV的危险因素。结论无吸烟史、胃炎或消化道溃疡史、吸入麻醉维持方式是腹腔镜胆囊切除术PONV的危险因素,对于此类患者应加强预防措施,减少PONV的发生。     

昂丹司琼用于预防腹腔镜术后恶心呕吐的临床观察

目的探讨昂丹司琼预防腹腔镜术后恶心呕吐(PONV)的临床疗效。方法将2009年1～12月行腹腔镜手术的患者110例,分成对照组和观察组;对照组50例,观察组60例,两组在常规治疗及用药的基础上,观察组于术前和术后静注昂丹司琼4 mg,并于术后第1、2天观察统计两组出现恶心呕吐的患者人数,分析结果,比较两组PONV发生率。结果对照组恶心呕吐发生率为34.0%,观察组为8.3%,观察组PONV发生率明显低于对照组,且差异有显著性(P<0.01)。结论昂丹司琼用于预防PONV疗效显著,不良反应少,值得临床推广应用。     

微血管减压术后病人恶心呕吐的现状调查及影响因素研究

[目的]了解微血管减压术(MVD)术后病人恶心呕吐的发生情况,探讨其发生的影响因素,以期为MVD术后病人恶心呕吐的研究及临床护理干预提供一定的理论依据。[方法]选取2019年2月—2019年4月南京市某三级甲等医院神经外科100例行MVD术后病人为研究对象。应用病人的一般资料、麻醉及手术相关资料调查表和世界卫生组织(WHO)推荐的恶心呕吐的标准分级等进行调查分析,并采用单因素和Logistic回归分析法分析。[结果]100例病人中有63例发生术后恶心呕吐(PONV),发生率为63%,Logistic回归分析结果显示,性别、PONV史或晕动症史为MVD术后病人PONV的独立影响因素。[结论]MVD术后病人发生PONV的概率较高;在日常护理工作中针对有PONV史或晕动症史的女性病人,需重点观察其PONV的发生情况,为预防病人发生PONV,可以提早采取干预措施。     

昂丹司琼、胃复安联合应用对剖宫产术后恶心、呕吐的预防作用

剖宫产术后，产妇恶心、呕吐（PONV）的发生率比较高。术后镇痛在剖宫产术后应用也越来越广泛，术后镇痛使用的麻醉性镇痛药是引起恶心、呕吐（PONV）的一种重要因素。昂丹司琼是有高度选择性的5-羟色胺（5-HT）受体拮抗药，临床已广泛适用于癌症的放、化疗以及治疗PONV。胃复安可以作用于延髓催吐化受区中多巴胺受体，具有强大的中枢性镇吐作用，同时松弛幽门括约肌，促进胃排空。也经常用于术后恶心、呕吐（PONV）的治疗。本观察就两种不同药理作用的药物单独和联合用药对剖腹产术后恶心、呕吐的预防作用做一对比分析。     

基于证据的术后恶心呕吐管理方案在麻醉科持续质量改进中的应用

目的制订基于证据的术后恶心呕吐(PONV)管理方案, 为规范麻醉科PONV管理、降低患者PONV的发生率及严重程度提供参考。方法 2021年1—11月, 基于证据临床转化模式图, 通过证据检索、质量评价、证据总结、障碍因素分析等方法制订麻醉科PONV管理方案, 并在临床开展2轮实践变革, 评价医护人员的质量审查指标执行情况和患者术后恶心、术后呕吐、PONV的发生率及术后恶心、术后呕吐的严重程度。结果基线、第1次审查、第2次审查, 医护人员各质量审查指标的执行率逐渐提高, 差异有统计学意义(P<0.05)。第2次审查后, 患者术后恶心、术后呕吐、PONV的发生率及术后恶心、术后呕吐的严重程度较第1次审查降低, 差异有统计学意义(P<0.05)。结论基于证据的PONV管理方案可规范麻醉科医护人员的PONV管理行为, 降低患者术后恶心、术后呕吐、PONV的发生率及术后恶心、术后呕吐的严重程度, 提高PONV管理质量。     

托烷司琼联合地塞米松预防全麻腹部手术术后恶心呕吐临床观察

目的:观察托烷司琼联合地塞米松对全麻腹部手术术后恶心呕吐(PONV)的防治效果。方法:采用随机抽样法将患者分为三组,每组20例,托烷司琼联合地塞米松组、托烷司琼组及生理盐水对照组。结果:托烷司琼联合地塞米松组及托烷司琼组术后0～6h、6～24h内PONV的发生率降低,PONV的程度减轻,差别均有统计学意义。结论:托烷司琼合用小剂量地塞米松预防PONV有协同作用,可降低PONV的发生率及严重程度。     

枢丹、地塞米松、胃复安联合预防小儿斜视术后恶心呕吐的临床观察

小儿斜视矫正术后恶心呕吐(Postoperative nausea and vomiting，PONV)的发生率高达40％～80％，枢丹、地塞米松等作为抗癌预防恶心呕吐的药物亦已广泛应用于临床。我们观察比较了枢丹联合地塞米松胃复安和单用枢丹预防小儿斜视术后PONV的临床疗效，现报告如下。     

Identification of Risk Factors for Postoperative Nausea and Vomiting in the Perianesthesia Adult Patient

Postoperative nausea and vomiting (PONV) is a common and potentially debilitating complication of surgery. The preoperative assessment of PONV using established risk assessment tools enables the identification of patients at risk and potentially decreases the incidence of PONV in adult surgical patients. The identification of risk factors associated with PONV and the factors that are independent predictors of PONV preoperatively can facilitate the effective prophylactic treatment and management of PONV in adult surgical patients.     

Nausea and vomiting in the ambulatory surgical setting

Postoperative nausea and vomiting (PONV) is a significant problem in the ambulatory surgical setting. PONV results in delayed discharge, increased cost, and decreased patient satisfaction. Treating patients at risk for PONV preemptively before surgery can minimize these negative outcomes. Nurses play a key role in preventing PONV by first identifying patients at risk. Administering medication and fluids, providing comfort measures, and assessing the patient throughout the postoperative course are crucial nursing functions in the treatment of PONV. However, successful patient outcomes require a multidisciplinary approach. There have been great advances in the treatment of this common postoperative complication with improved anesthesia techniques and newer antiemetic drugs. Future research is needed to determine optimal combinations and timing of medications. Effective prevention and treatment of PONV improve patient outcomes and provide a more pleasant postoperative experience for the patient.     

Pharmacological Prophylaxis and Management of Adult Postoperative/Postdischarge Nausea and Vomiting

Postoperative nausea and vomiting (PONV) is a relatively common complication that can adversely affect the quality of a patient's postoperative recovery. Factors to consider when determining a patient's risk for developing PONV include female gender, history of PONV, history of motion sickness, nonsmoking status, postoperative use of opioids, use of inhaled anesthetic agents, and use of nitrous oxide. Receptors that, when activated, can cause PONV include dopamine type-2, serotonin type-3, histamine type-1, muscarinic cholinergic type-1, and neurokinin type-1. Patients with a moderate-to-high risk of developing PONV will benefit from the administration of a prophylactic antiemetic agent that blocks one or more of these receptors. Effective agents for prophylaxis include transdermal scopolamine, prochlorperazine, promethazine, droperidol, ondansetron, dolasetron, granisetron, dexamethasone, and aprepitant. In the highest-risk patients, combining two or more prophylactic antiemetics with different mechanisms of action has been shown to be more effective than a single agent. In addition, the patient's risk could be reduced by considering the use of regional anesthesia, maintaining general anesthesia with propofol rather than with inhaled anesthetic agents, ensuring good intravenous hydration, and providing effective pain management using a multimodal approach (eg, minimizing the use of opioids). If PONV does occur in the immediate postoperative period, it is best treated with an antiemetic agent from a different pharmacologic class than the agent that was administered for prophylaxis. Once a patient is discharged, alternative formulations of antiemetics such as ondansetron oral or dissolving tablets or promethazine tablets or suppositories can be used.     

积极评估与干预:胃肠加速康复外科指南中的营养问题

加速康复外科(enhanced recovery after surgery, ERAS)在胃肠外科领域开展已有20余年, 尤其在结直肠外科中应用较为广泛。胃肠外科领域已有多部ERAS指南发表, 近年来国内外对胃肠外科ERAS指南又作了多次修订与更新, 有助于进一步规范围手术期胃肠外科管理。临床营养是ERAS中必不可少的重要组成部分, 包括术前营养评估、口服营养补充预康复、术后早期肠内营养等内容, 在指南更新中得到越来越多的关注与重视, 本文就国内外最新更新的ERAS指南中的临床营养部分进行重点解读。     

Prevention and Management of Postoperative Nausea and Vomiting in Adults

In early 2007, patients at our small community hospital's outpatient surgery center experienced postoperative nausea and postoperative nausea and vomiting (PONV) at a rate of 27% to 35%. Many record reviews and a written survey of nurses in the postanesthesia care unit and same day surgery center revealed that little or no risk assessment and no consistent prophylaxis or treatment were in use by nurses, physicians, or anesthesia care providers.After a review of the literature and discussions with anesthesia care providers, we developed and put into practice a risk assessment tool and perioperative care path. A formal evaluation to assess the effectiveness of the plan was performed one year after implementation. We found that the rates of PONV had decreased to 16%. AORN J 90 (September 2009) 391-413. © AORN, Inc, 2009.     

Therapeutic Modalities for the Prophylactic Management of Postoperative Nausea and Vomiting

The occurrence of postoperative nausea and vomiting (PONV) remains one of the most common complications after general anesthesia. The causes of PONV are multimodal, involving several physiologic pathways that stimulate the vomiting center, including the chemoreceptor trigger zone, the gastrointestinal tract, the vestibular system, the cerebral cortex, and the midbrain. Significant research has been published focusing on the use of different pharmacologic agents and varying anesthetic techniques to prevent and manage PONV. The addition of therapeutic modalities to the arsenal of prophylactic management techniques may decrease patient incidence of PONV by directing treatment to various pathways that stimulate the vomiting center. The purpose of this article is to review briefly the literature and discuss three therapeutic modalities for preventing PONV: perioperative oxygen administration, perioperative intravenous fluid administration, and differing fasting protocols.     

Evidence-Based Interventions for Post Discharge Nausea and Vomiting: A Review of the Literature

Postoperative nausea and vomiting (PONV) and postdischarge nausea and vomiting (PDNV) continue to be a problem for one third of all patients who require surgery and anesthesia. Very few studies have been reported that specifically target PDNV in the outpatient surgery population for interventions after discharge home. Twenty studies were identified that specifically addressed the effect of an intervention for the purpose of preventing PDNV or rescuing the patient who develops PDNV. This article presents an integrative review of the research literature to determine the best evidence for prevention of PDNV in adults or for the rescue of patients who suffer from PDNV.     

加速康复外科理念对妇科腹腔镜手术麻醉相关并发症的防治

目的 探讨通过加速康复外科理念进行麻醉的实施与管理对妇科腹腔镜手术患者麻醉相关并发症发生率的防治作用。 方法 选取2015年10月~2016年10月首次接受择期腹腔镜妇科手术的患者156例随机分为对照组与加速康复外科组,对照组采用常规麻醉处理,观察组实施加速康复外科策略优化麻醉管理及围术期处理,记录观察患者术毕体温、术后气管导管拔除时间、麻醉复苏室停留时间、拔管后30 minVAS评分、术后恶心呕吐、苏醒延迟、烦躁及术后寒战发生率。 结果 加速康复外科策略能够降低术后恶心呕吐、术后寒战的发生率,并缩短气管导管拔除时间和VAS评分（P<0.05）;两组麻醉复苏室停留时间、术后烦躁及苏醒延迟发生率之间差异无统计学意义（P>0.05）。 结论 加速康复外科策略能够降低围术期麻醉相关并发症发生率,促进妇科腹腔镜手术患者术后早期恢复。       

The Effects of Stimulation of Acupressure Point P6 on Postoperative Nausea and Vomiting: A Review of Literature

Nonpharmacologic techniques including TAES; P6 acupoint injections; acustimulation with ReliefBand, SeaBand, or Acuband; plain acupressure; and acupressure with electrical stimulation have all shown antiemetic effectiveness for prevention of PONV. These modalities are desirable with regard to ease of administration, rapid onset of action, cost effectiveness, and incidence of side effects. All of these are ideal complements for the patient at high risk or as alternatives for the patient at low to moderate risk for PONV. Because all antiemetic pharmacologic therapies produce side effects, there is a distinct advantage of using nonpharmacologic antiemetic techniques, such as stimulation of acupressure points, instead of pharmacologic therapies. According to the reviewed literature, acupressure applied to P6 was as effective as pharmacologic antiemetic medications for the prevention and treatment of PONV in adults. The most effective method was bilateral stimulation before the induction of anesthesia. Research involving acupressure stimulation of the P6 acupoint in pediatric patients was too inconsistent to establish generalizations regarding effectiveness for management and prevention of PONV.Based on the information from this review, the authors would suggest that perianesthesia nurses and nurse anesthetists include one or more of the methods of stimulating acupoint P6 as a complement to antiemetics in patients with more than a 70% risk of PONV or as an alternative to antiemetics in patients who have less than a 70% risk for PONV. Because the cost of acupressure bands and instruction in their use is so economical, both hospital and outpatient settings using anesthesia might be willing to support their use for a trial period.     

Postoperative nausea and vomiting: understanding the enigma.

Postoperative nausea and vomiting (PONV) remains one of the most common complications related to surgery and anesthesia. Referred to as the "big little problem," PONV complications range from minor patient discomfort to gastric aspiration or death. There are multiple contributing factors that stimulate the vomiting reflex in PONV; yet, no single component is typically the causative factor. It usually is a variety of factors that trigger this response. Because the causes of PONV are multifactorial, no single antiemetic medication has been 100% effective for its prevention. A thorough understanding of these factors and the pharmacology related to PONV is essential for the effective management of this common postoperative complication.