手术后恶心呕吐的机制及其防治

在过去的几十年里,随着各种手术技术的不断提高和完善,已使外科手术的死亡率大幅降低,这使医生的注意力逐渐转向手术后的并发症和患者的满意程度上,如手术后恶心呕吐。恶心呕吐是术后严重的并发症之一,尽管术后恶心呕吐(Postoperativenausea and vomiting,PONV)是非致命性的并发症,但是PONV可导致严重的后果,并且增加了医疗费用,极大的影响了患者的满意程度。PONV高发率一直困扰着临床医生和患者。所以,探讨其发生及其风险因素是十分必要的。但是,术后恶心呕吐的病理生理学机制还不是十分清楚,本文总结了目前关于术后恶心呕吐发生机制的一些观点以及术后恶心呕吐的风险因素。虽然以往大量的文献报道了如何预防和治疗术后恶心呕吐,但迄今为止,5-HT3受体拮抗剂仍然是临床上使用的最主要的止吐药。目前,一些新药物,如NK-1受体拮抗剂、更加长效的5-HT3受体拮抗剂以及对于PONV高风险的病人实行的多模式管理和新技术的应用,正变得越来越突出。本文综述了现今手术后恶心呕吐的防治方法的最新进展。

The Mechanism and Prevention of PONV

Over the past several decades,as the risk of major mortality due to surgery has decreased,attention has shifted to ad-dressing factors that negatively influence patient morbidity and patient satisfaction,such as postoperative nausea and vomiting.Nausea and vomiting is one of the most common postoperative complaints for patients following general anesthesia.Though generally nonfatal,PONV may lead to serious medical consequences.PONV also has a profound impact on patient satisfaction,and estimated health care costs as a result of delayed discharge.Its occurrence is miserable for the patient and both troubling and perplexing to the provider.So,it is nessary to recognize the mechanism and risk factors of PONV.Unfortunately,its pathophysiology is incompletely understood.This ar-ticle summarizes current thinking and guidelines on the the mechanism and risk factors of PONV.Several developments have aided in the prevention and management of this complication of surgical anesthesia.The 5-hydroxytryptamine type3(5-HT3) receptor antagonists continue to be the mainstay of antiemetic therapy,but newer approaches,such as neurokinin-1 antagonists,a longer-acting serotonin re-ceptor antagonist,multimodal management and novel techniques for managing high-risk patients,are gaining prominence.This article also summarizes the new drugs and techniques.