Fujii Yoshitaka
Department of Anesthesiology, University of Tsukuba Institute of Clinical Medicine, 2-1-1 Anakubo, Tsukuba City, Ibaraki 305-0876, Japan.
Curr Pharm Des. 2005;11(24):3173-83. doi: 10.2174/1381612054864911.
Postoperative nausea and vomiting (PONV) are distressing and frequent adverse events of anesthesia and surgery, with a relatively high incidence after laparoscopic cholecystectomy. Numerous antiemetics have been studied for the prevention and treatment of PONV in patients scheduled for laparoscopic cholecystectomy. Traditional antiemetics, including anticholinergics (e.g., scopolamine), antihistamines (e.g., dimenhydrinate), phenothiazines (e.g., promethazine), butyrophenones (e.g., droperidol), and benzamide (e.g., metoclopramide), are used for the control of PONV. The available nontraditional antiemetics for the prophylaxis against PONV are dexamethasone and propofol. Serotonin receptor antagonists (ondansetron, granisetron, tropisetron, dolasetron, and ramosetron), compared with traditional antiemetics, are highly efficacious for PONV. The prophylactic ondansetron, granisetron, tropisetron, and dolasetron in antiemetic efficacy are comparable. Ramosetron is effective for the long-term prevention of PONV. None of the available antiemetics is entirely effective, perhaps because most of them act through the blockade on one type of receptor. There is a possibility that combined antiemetics with different sites of activity would be more effective than one drug alone for the prophylaxis against PONV. Combination antiemetic therapy is often effective for the prevention of PONV following laparoscopic cholecystectomy. The efficacy of a combination of serotonin receptor antagonists (ondansetron and granisetron) and droperidol is superior to monotherapy with a serotonin receptor antagonist or droperidol. Similarly, adding dexamethasone to ondansetron or granisetron improves antiemetic efficacy in PONV. Knowledge regarding antiemetics is necessary to completely prevent and treatment of PONV in patients scheduled for laparoscopic cholecystectomy.
术后恶心呕吐（PONV）是麻醉和手术中令人痛苦且常见的不良事件，在腹腔镜胆囊切除术后发生率相对较高。针对计划接受腹腔镜胆囊切除术的患者，人们研究了众多用于预防和治疗PONV的止吐药。传统止吐药，包括抗胆碱能药（如东莨菪碱）、抗组胺药（如茶苯海明）、吩噻嗪类（如异丙嗪）、丁酰苯类（如氟哌利多）和苯甲酰胺类（如甲氧氯普胺），用于控制PONV。可用于预防PONV的非传统止吐药有地塞米松和丙泊酚。与传统止吐药相比，5-羟色胺受体拮抗剂（昂丹司琼、格拉司琼、托烷司琼、多拉司琼和雷莫司琼）对PONV的疗效很高。预防性使用时，昂丹司琼、格拉司琼、托烷司琼和多拉司琼的止吐疗效相当。雷莫司琼对PONV的长期预防有效。现有的止吐药都不是完全有效的，可能是因为它们大多通过阻断一种类型的受体起作用。不同作用位点的止吐药联合使用可能比单一药物预防PONV更有效。联合止吐疗法通常对预防腹腔镜胆囊切除术后的PONV有效。5-羟色胺受体拮抗剂（昂丹司琼和格拉司琼）与氟哌利多联合使用的疗效优于5-羟色胺受体拮抗剂或氟哌利多单药治疗。同样，在昂丹司琼或格拉司琼中加入地塞米松可提高对PONV的止吐疗效。了解止吐药知识对于全面预防和治疗计划接受腹腔镜胆囊切除术患者的PONV很有必要。
