Oddby-Muhrbeck E, Eksborg S, Helander A, Bjellerup P, Lindahl S, Lönnqvist P
Division of Anaesthesia and Intensive Care, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden.
Acta Anaesthesiol Scand. 2005 Oct;49(9):1346-54. doi: 10.1111/j.1399-6576.2005.00836.x.
The pathophysiology behind post-operative nausea and vomiting (PONV) is still not fully understood, especially with respect to gender. According to PONV risk scores, female gender is the strongest predictor for PONV. The risk for PONV after general anaesthesia for breast cancer surgery is 50-80%. The aim of the present explorative study was to identify blood-borne factors that might be associated with the development of PONV in women undergoing breast cancer surgery as a basis for further studies.
Fifty patients were enrolled prospectively in the study. A standardized sevoflurane-based anaesthetic was used. Blood samples for the analysis of vasopressin, gastrin, cholecystokinin, epinephrine, norepinephrine, dopamine, serotonin, platelet count and blood glucose were taken at six pre-determined time points peri-operatively, and PONV was assessed during 24 h.
PONV was found in 27 of 47 patients completing the study. Patients with PONV had a larger variability of the platelet count (P = 0.001), a reduced platelet count on the first post-operative day (P = 0.02) and a less pronounced relationship between the platelet count and whole blood serotonin (P = 0.004) compared with non-PONV patients. A lack of a decrease in epinephrine levels in response to the induction of anaesthesia (P = 0.03) and increased levels of vasopressin (P < 0.001), epinephrine (P = 0.005) and blood glucose (P = 0.004) were observed in the early post-operative period in PONV patients.
Three different platelet-associated factors and an altered epinephrine pattern were found to be associated with the occurrence of PONV after breast cancer surgery.
术后恶心呕吐（PONV）背后的病理生理学仍未完全明了，尤其是在性别方面。根据PONV风险评分，女性是PONV最强的预测因素。乳腺癌手术全身麻醉后发生PONV的风险为50 - 80%。本探索性研究的目的是确定可能与乳腺癌手术女性患者PONV发生相关的血源性因素，作为进一步研究的基础。
前瞻性纳入50例患者进行研究。采用标准化的七氟醚麻醉。在围手术期六个预先确定的时间点采集血样，用于分析血管加压素、胃泌素、胆囊收缩素、肾上腺素、去甲肾上腺素、多巴胺、血清素、血小板计数和血糖，并在24小时内评估PONV情况。
47例完成研究的患者中有27例发生PONV。与未发生PONV的患者相比，发生PONV的患者血小板计数变异性更大（P = 0.001），术后第一天血小板计数降低（P = 0.02），血小板计数与全血血清素之间的关系不那么明显（P = 0.004）。在PONV患者术后早期观察到，麻醉诱导后肾上腺素水平缺乏下降（P = 0.03），血管加压素（P < 0.001）、肾上腺素（P = 0.005）和血糖（P = 0.004）水平升高。
发现三种不同的血小板相关因素和肾上腺素模式改变与乳腺癌手术后PONV的发生有关。
