手术后常见的并发症之一——术后恶心呕吐(postoperative nausea and vomiting, PONV),其机制复杂,对患者的身心和生活带来严重影响,从而影响患者术后康复,降低患者术后满意度。增加医疗费用和延长住院时间,影响患者就医体验,与ERAS和舒适化医疗相悖。PONV一直是手术和麻醉防治的重点和难点。目前,防治PONV的有药物、非药物和多模式联合防治措施,每种措施都有优缺点。本文就术后恶心呕吐的影响因素、机制及防治措施进行综述,以期为术后PONV防治提供参考。Postoperative nausea and vomiting (PONV), one of the common complications after surgery, has a complex mechanism, which seriously affects the body, mind and life of patients, thus affecting the postoperative recovery and reducing the postoperative satisfaction of patients. Increasing medical costs and lengthening hospital stay affect patients’ medical experience, which is contrary to ERAS and comfort medicine. PONV has always been the focus and difficulty of operation and anesthesia. At present, there are drug, non-drug and multi-modal combined prevention and control measures for PONV, each of which has advantages and disadvantages. In this paper, the influencing factors, mechanisms and prevention measures of postoperative nausea and vomiting were reviewed in order to provide reference for prevention and treatment of postoperative PONV.
针刺相关技术防治术后恶心呕吐(postoperative nausea and vomiting,PONV)疗效确切,能够减少不良事件的发生率,可能主要是通过刺激交感神经和副交感神经活动,调节5-HT、β-内啡肽等神经递质水平,调节胃肠运动和神经传导实现的。目前,相关研究选穴以内关及足三里为主,穴位特异性或与腧穴分布、组织构成及神经支配相关,腧穴的侧性是否影响疗效有待探索。不同频率电刺激可产生不同化学递质的释放,究竟何种频率可到达最佳防治效果缺少系统比较研究。现阶段的相关研究多为临床试验,缺乏统一规范标准,亟须规范选穴原则及干预时机,并在此基础上深入探讨其作用机制。此外,需进一步加强电针防治PONV的多中心研究,探讨其作用机制,为针刺相关技术在围术期的应用提供更多理论依据。
术后恶心呕吐(postoperative nausea and vomiting, PONV)是围术期常见的并发症之一,给患者造成了痛苦及经济损失,严重时还会危险生命安全。PONV的发生机制尚不明确,主要与患者易感性、手术和麻醉等危险因素有关,临床上多根据其危险因素进行预防,其预防手段包括药物预防和非药物预防,目前推荐多种药物联合或多模式预防。利多卡因是一种常用的局部麻醉药,静脉注射利多卡因最初主要用于心律失常的治疗,已有研究证明其可有效用于抗炎、镇痛、器官保护和促进胃肠道功能恢复等,大量研究表明其在PONV的预防中具有很大的潜力,可以作为单一用药、联合用药或多模式预防策略的一部分。
