Trimas Scott J, Trimas Morgan D
Beaches Facial Plastic and Nasal Surgery Center, Jacksonville Beach, Florida.
Department of Biology, Washington and Lee University, Lexington, Virginia.
JAMA Facial Plast Surg. 2015 Jul-Aug;17(4):251-5. doi: 10.1001/jamafacial.2015.0307.
Patients who experience immediate postoperative nausea and vomiting (PONV) after their facial plastic surgery procedure have a higher incidence of complications and dissatisfaction.
To determine whether a single dose of aprepitant administered preoperatively can decrease the incidence of immediate PONV in patients undergoing facial plastic surgery compared with patients who are administered ondansetron hydrochloride alone and whether patient-related factors pose a greater risk of developing immediate PONV after surgery.
DESIGN, SETTING, AND PARTICIPANTS: In this retrospective study, we reviewed 172 patients undergoing facial plastic surgery with general anesthesia at an accredited office-based surgery practice from January 1, 2012, through December 31, 2013.
All patients received prophylactic treatment to mitigate against immediate PONV. Fifty-six patients received aprepitant in addition to ondansetron as prophylaxis for PONV.
Patients undergoing facial plastic surgery were assessed during the immediate postoperative period for PONV. In addition, patient age, type of procedure, duration of surgery, and sex were reported.
The addition of aprepitant preoperatively effectively reduced the PONV rate from 15.5% to 1.8% (P = . 02). Logistic regression analysis revealed that duration of surgery longer than 90 minutes (odds ratio [OR], 2.936; 95% CI, 0.560-15.385; P = .20), female sex (OR, 1.893; 95% CI, 0.379-9.448; P = .44), and type of procedure increased the likelihood of PONV after facial plastic surgery with an odds ratio of greater than 1 in this sample population. However, the odds ratios were not statistically significantly greater than 1 for the 95% CIs. Of the 19 patients who experienced PONV, 17 were women, and 17 patients had a duration of surgery longer than 90 minutes. Patient age did not appear to affect the rate of PONV (P = .32).
Preoperative aprepitant administered within 1 hour before facial plastic surgery in patients at risk of developing PONV effectively reduce the rate of immediate PONV. Female patients and patients with facial surgery duration of longer than 90 minutes might benefit from the added expense of aprepitant to further reduce the likelihood of PONV.
面部整形手术后立即出现术后恶心呕吐（PONV）的患者并发症发生率和不满率更高。
确定术前单次服用阿瑞匹坦与单独使用盐酸昂丹司琼的患者相比，是否能降低接受面部整形手术患者立即发生PONV的发生率，以及患者相关因素是否会增加术后立即发生PONV的风险。
设计、地点和参与者：在这项回顾性研究中，我们回顾了2012年1月1日至2013年12月31日期间在一家经认可的门诊手术机构接受全身麻醉的172例面部整形手术患者。
所有患者均接受预防性治疗以减轻立即发生的PONV。56例患者除接受昂丹司琼作为PONV预防用药外，还接受了阿瑞匹坦。
在术后即刻对面部整形手术患者进行PONV评估。此外，报告了患者年龄、手术类型、手术持续时间和性别。
术前加用阿瑞匹坦有效地将PONV发生率从15.5%降至1.8%（P = 0.02）。逻辑回归分析显示，手术持续时间超过90分钟（比值比[OR]，2.936；95%可信区间，0.560 - 15.385；P = 0.20）、女性（OR，1.893；95%可信区间，0.379 - 9.448；P = 0.44）和手术类型增加了面部整形手术后发生PONV的可能性，在该样本人群中比值比大于1。然而，对于95%可信区间，比值比在统计学上并不显著大于1。在19例发生PONV的患者中，17例为女性，17例患者手术持续时间超过90分钟。患者年龄似乎不影响PONV发生率（P = 0.32）。
对于有发生PONV风险的患者，在面部整形手术前1小时内给予术前阿瑞匹坦可有效降低立即发生PONV的发生率。女性患者和手术持续时间超过90分钟的面部手术患者可能会从额外使用阿瑞匹坦中获益，以进一步降低发生PONV的可能性。
3级。
