Klinik für Anästhesiologie, Universitätsmedizin der Johannes Gutenberg–Universität Mainz, Germany.
J Neurosurg. 2011 Feb;114(2):491-6. doi: 10.3171/2010.9.JNS10151. Epub 2010 Oct 29.
The purpose of this study was to assess the incidence and risk factors of postoperative nausea and vomiting (PONV) after craniotomy because most available data about PONV in neurosurgical patients are retrospective in nature or derive from small prospective studies.
Postoperative nausea and vomiting was prospectively assessed within 24 hours after surgery in 229 patients requiring supratentorial or infratentorial craniotomy. To rule out the relevance of the neurosurgical procedure itself to the development of PONV, the observed incidence of vomiting was compared with the rate of vomiting predicted with a surgery-independent risk score (Apfel postoperative vomiting score).
The overall incidence of PONV after craniotomy was 47%. Logistic regression identified female sex as a risk factor for postoperative nausea (OR 4.25, 95% CI 2.3-7.8) and vomiting (OR 2.62, 95% CI 1.4-4.9). Both the incidence of nausea (OR 3.76, 95% CI 2.06-6.88) and vomiting (OR 4.48, 95% CI 2.4-8.37) were increased in patients not receiving steroids. Postoperative nausea and vomiting occurred after infratentorial as well as after supratentorial procedures. The observed incidence of vomiting within 24 hours after surgery was higher (49%) than would be predicted with the Apfel surgery-independent risk score (31%; p = 0.0004).
The overall incidence of PONV within 24 hours after craniotomy was approximately 50%. One possible reason is that intracranial surgeries pose an additional and independent risk factor for vomiting, especially in female patients. Patients undergoing craniotomy should be identified as high-risk patients for PONV.
本研究旨在评估颅脑手术后恶心呕吐（PONV）的发生率和危险因素，因为大多数关于神经外科患者 PONV 的可用数据是回顾性的，或者来自于小的前瞻性研究。
在 229 例行幕上或幕下开颅术的患者中，术后 24 小时内前瞻性评估术后恶心呕吐。为了排除神经外科手术本身与 PONV 发展的相关性，观察到的呕吐发生率与手术独立风险评分（Apfel 术后呕吐评分）预测的呕吐率进行了比较。
颅脑手术后 PONV 的总发生率为 47%。Logistic 回归分析确定女性为术后恶心（OR 4.25，95%CI 2.3-7.8）和呕吐（OR 2.62，95%CI 1.4-4.9）的危险因素。未接受类固醇治疗的患者恶心（OR 3.76，95%CI 2.06-6.88）和呕吐（OR 4.48，95%CI 2.4-8.37）的发生率均增加。幕上和幕下手术后均发生恶心呕吐。术后 24 小时内观察到的呕吐发生率（49%）高于 Apfel 手术独立风险评分预测的发生率（31%；p=0.0004）。
颅脑手术后 24 小时内 PONV 的总发生率约为 50%。一个可能的原因是颅内手术是呕吐的一个额外且独立的危险因素，尤其是在女性患者中。接受开颅术的患者应被视为 PONV 的高危患者。
