现有止吐措施的效果：一项对高风险患者的前瞻性研究  

作　　者：Paul F. White Jerome F. O'Hara Charles R. Roberson Ronald H. Wender Keith A. Candiotti 崔灿(译) 王庆(校) 

机构地区：[1]Department of Anesthesiology. and Pain Management, University of Texas Southwestern Medical Center. Dallas, TX [2]Department of General Anesthesiology, Cleveland Clinic Foundation, Cleveland, OH [3]Department of Anesthesiology Scott & White Clinic, Temple, TX [4]Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, CA [5]Departments of Anesthesiology, Perioperative Medicine, and Pain Management, University of Miami Miller School of Medicine, Miami, FL [6]不详

出　　处：《麻醉与镇痛》2010年第1期71-78,共8页Anesthesia & Analgesia

摘　　要：背景在这项前瞻性的多中心观察研究中，我们评估了手术后恶心、呕吐（PONV）的发生率和持续时间，评估了对高危患者预防性和补救性使用止吐剂的效果，并且在美国麻醉医师协会（ASA）和美国围麻醉护士学会（ASPAN）指南的基础上确定了基于人口数量的止吐剂作用。方法选择拟行择期腹腔镜手术和大型整形手术且具有两项以上Apfel PONV危险因素的患者作用研究对象（女性，既住有PONV或者晕动病痛电，不吸烟）。记录手术后的72小时内由于PONV所导致的止吐剂的使用、呕吐的发怍次数、恶心的严重程度以硬功能性干预等临床资料。完全有效（CR）定义为无呕吐且未进行补救性药物治疗，完全控制定义为CR且无中、重度恶心。同时分析ASA和ASPAN指南的依从性（相对未遵守者）PONV治疗效果。结果由于使用止吐剂数量不同．大约有18％～40％的患者发生手术后呕吐。补救性药物治疗的发生率（45％）与中、重度恶心的发生率（47％）以及因呕吐症状而进行功能性干预的比例（44％）近拟、预防性使用3种或以上止吐剂的患者相对于预防性使用少于1种止吐剂的患者总体上有更好的预后．尽管遵守了最近编写的PONV治疗指南，CR依旧小于70％（ASA：69％；ASPAN：63％）。在3天的研究时间内，完全控制率比CR率低10％。结论在可能会发展为PONV的患者中，预防性使用3种或以上的止吐剂在72小时内对呕吐有很大的正面影响．虽然遵守编写的PONV治疗指南改善了患者的预后，仍然有30％以上的高危患者发生手术后呕吐和生理功能紊乱。BACKGROUND： In this prospective, multicenter, observational study, we evaluated the incidence and time course of postoperative nausea and vomiting （PONV）, assessed prophylactic and rescue antiemetic use in high-risk patients, and determined population-based effectiveness of antiemetics, including the impact of American Society of Anesthesiologists （ASA） and American Society of Perianesthesia Nurses （ASPAN） guideline compliance. METHODS： Eligible patients undergo- ing elective laparoscopic or major plastic surgery, possessed two or more of the following Apfel PONV risk factors： female gender, historv of PONV or motion sickness, and nonsmoking status. Antiemetic use, emetic episodes, severity of nausea, and functiunal interference due to PONV were documented during the first 72 h after surgery. Complete response （CR） was defined as no emesis or rescue medication use, and complete control was defined as CR and no moderate-severe nausea. The effect of compliancy （versus noncompliance） with ASA and ASPAN guidelines on PONV outcomes was also analyzed. RESULTS： The proportion of patients experiencing postoperative emesis ranged from 18% to 40% depending on the number of antiemetics administered. The rate of rescue medication （45%） was similar to the reported incidences of moderate-to-severe nausea （47%） and functional interference due to emetic symptoms （44%）. The administration of three or more antiemetics produced better patient outcomes overall compared to 〈1 prophylactic antiemetic. CR races were 〈70% despite adherence to current organizational PONV management guidelines （ASA： 69% ; ASPAN： 63% ）. The complete control rates were 10% lower than CR rates over the 3 day study period. CONCLUSIONS： Administration of three or more prophylactic antiemetics had the most positive impact on emetic outcomes over 72 hrs in patients at risk of developing PONV. Although compliance with organizational PONV management guidelines improved patient outcomes, postoperative emetic sym

关 键 词：止吐剂 高风险 手术后呕吐 预防性使用 PONV 术后恶心 治疗指南 生理功能紊乱 

分 类 号：R975.4[医药卫生—药品] R616[医药卫生—药学]