Golembiewski Julie A, O'Brien Denise
Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, IL 60612, USA.
J Perianesth Nurs. 2002 Dec;17(6):364-76. doi: 10.1053/jpan.2002.36596.
Postoperative nausea and vomiting (PONV), a common complication after anesthesia and surgery, often results in delayed discharge with the patient's unpleasant symptoms continuing at home. To effectively prevent and treat PONV, it is important to understand the factors implicated in PONV, the mechanisms of PONV, the pharmacology of the antiemetic agents, and the nonpharmacologic measures that have been shown to be effective. The cause of PONV is likely to be multifactorial, with important predictors being female gender, history of PONV, and history of motion sickness. The vomiting center can be triggered by activation of dopamine, serotonin (type 3), histamine (type 1), and muscarinic cholingergic receptors in the chemoreceptor trigger zone and the nucleus tractus solitarus, as well as acetylcholine receptors in the vestibular apparatus, vagal afferents from the periphery, and the endocrine environment. Antiemetic agents such as the serotonin antagonists (eg, ondansetron, dolasetron), droperidol, antihistamines (eg, diphenhydramine, dimenhydrinate), and promethazine can prevent and treat PONV effectively. Transdermal scopolamine and dexamethasone have a role in the prevention of PONV, particularly for certain high-risk patients. Nonpharmacologic measures and alternative treatments such as hydration, maintaining blood pressure, acupressure techniques, trancutaneous acupoint stimulation, and isopropyl alcohol must not be overlooked. Finally, an evidence-based algorithm for the prevention and treatment of PONV in adults is presented.
术后恶心呕吐（PONV）是麻醉和手术后的常见并发症，常导致出院延迟，患者在家中仍有不适症状。为有效预防和治疗PONV，了解与PONV相关的因素、PONV的机制、止吐药物的药理学以及已证明有效的非药物措施很重要。PONV的原因可能是多因素的，重要的预测因素包括女性性别、PONV病史和晕动病史。呕吐中枢可由化学感受触发区和孤束核中的多巴胺、5-羟色胺（3型）、组胺（1型）和毒蕈碱胆碱能受体激活，以及前庭装置中的乙酰胆碱受体、外周迷走传入神经和内分泌环境激活。止吐药物如5-羟色胺拮抗剂（如昂丹司琼、多拉司琼）、氟哌利多、抗组胺药（如苯海拉明、茶苯海明）和异丙嗪可有效预防和治疗PONV。透皮东莨菪碱和地塞米松在预防PONV中起作用，特别是对某些高危患者。非药物措施和替代治疗如补液、维持血压、指压技术、经皮穴位刺激和异丙醇也不容忽视。最后，给出了一个基于证据的成人PONV预防和治疗算法。
