Kovac Anthony L
Department of Anesthesiology, University of Kansas Medical Center, Kansas City, KS 66160, USA.
J Clin Anesth. 2006 Jun;18(4):304-18. doi: 10.1016/j.jclinane.2005.06.012.
Postoperative nausea and vomiting (PONV) continues to be a "big little problem" despite recent advances in anesthesia. Because of an increased interest in, and the abundant publications on this topic, guidelines for the management of PONV were published in 2003. Several key but controversial issues regarding PONV prophylaxis were left unaddressed, however. These included whether clinical differences exist between the 5-hydroxytryptamine subtype 3 (5-HT3) receptor antagonists, concern over optimal dosage and timing of administration, optimal 5-HT3 receptor antagonist combination therapy, and whether rescue therapy is effective after prior administration of the same or a different 5-HT3 receptor antagonist. The application of these antiemetics in clinical practice has raised questions regarding the role of the 5-HT3 receptor antagonists in the treatment of postdischarge nausea and vomiting and opioid-induced nausea and vomiting. A brief overview of the incidence, risk factors and current management recommendations for PONV and current controversies with special emphasis on the 5-HT3 receptor antagonists, is discussed.
尽管麻醉技术最近有所进步，但术后恶心呕吐（PONV）仍然是一个“虽小却严重的问题”。由于对该主题的兴趣增加以及相关出版物众多，2003年发布了PONV管理指南。然而，关于PONV预防的几个关键但有争议的问题仍未得到解决。这些问题包括5-羟色胺3型（5-HT3）受体拮抗剂之间是否存在临床差异、对最佳给药剂量和时间的担忧、最佳5-HT3受体拮抗剂联合治疗，以及在先前使用相同或不同的5-HT3受体拮抗剂后救援治疗是否有效。这些止吐药在临床实践中的应用引发了关于5-HT3受体拮抗剂在治疗出院后恶心呕吐和阿片类药物引起的恶心呕吐中的作用的问题。本文将简要概述PONV的发生率、危险因素、当前管理建议以及当前的争议，特别强调5-HT3受体拮抗剂。
