Therneau Isaac W, Martin Erin E, Sprung Juraj, Kellogg Todd A, Schroeder Darrell R, Weingarten Toby N
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
Division of Subspecialty General Surgery, Mayo Clinic, Rochester, MN, USA.
Obes Surg. 2018 Jan;28(1):37-43. doi: 10.1007/s11695-017-2797-0.
Postoperative nausea and vomiting (PONV) is common with bariatric surgery. We examined the PONV rate in bariatric surgical patients who received triple antiemetic prophylaxis (dexamethasone, droperidol, and ondansetron) with and without antiemetic aprepitant.
Medical records of female patients undergoing laparoscopic bariatric surgery from January 1, 2014, to July 28, 2016, were reviewed for PONV episodes during 48 postoperative hours.
In total, 338 patients received triple antiemetic, of whom 172 (51%) also received aprepitant. Rates of PONV in the postanesthesia care unit (PACU) among patients with and without aprepitant therapy were 11 vs 17% (P = .09). Within 1 h after PACU discharge, fewer patients in the aprepitant group had PONV (19 vs 31%; odds ratio [OR] [95% CI], 0.5 [0.30-0.80]; P = .007). During the first 48 postoperative hours, PONV rates were similar between the groups (68 and 66%; P = .73), but fewer emesis episodes occurred in the aprepitant group (6 vs 13%; OR [95% CI], 0.45 [0.21-0.95]; P = .04). Analyses were also performed with a subset of patients matched on propensity for receiving aprepitant. In this subset, OR estimates quantifying aprepitant effect on PONV were similar to those obtained from multivariable regression analyses.
Addition of aprepitant to a multimodal antiemetic prophylactic regimen may be associated with significant reduction of PONV during early recovery and potentially with reduced incidence of vomiting during the first 48 postoperative hours. The high PONV rate in the first 48 postoperative hours is suggestive that introduction of scheduled anti-PONV prophylactic treatment may be desirable.
肥胖症手术患者术后恶心呕吐（PONV）很常见。我们研究了接受三联抗呕吐预防治疗（地塞米松、氟哌利多和昂丹司琼）且联合或不联合使用抗呕吐药物阿瑞匹坦的肥胖症手术患者的PONV发生率。
回顾了2014年1月1日至2016年7月28日期间接受腹腔镜肥胖症手术的女性患者术后48小时内发生PONV的病历。
共有338例患者接受了三联抗呕吐治疗，其中172例（51%）还接受了阿瑞匹坦治疗。接受和未接受阿瑞匹坦治疗的患者在麻醉后护理单元（PACU）中的PONV发生率分别为11%和17%（P = 0.09）。在PACU出院后1小时内，阿瑞匹坦组发生PONV的患者较少（19%对31%；优势比[OR][95%可信区间]，0.5[0.30 - 0.80]；P = 0.007）。在术后的前48小时内，两组的PONV发生率相似（68%和66%；P = 0.73），但阿瑞匹坦组的呕吐发作较少（6%对13%；OR[95%可信区间]，0.45[0.21 - 0.95]；P = 0.04）。还对根据接受阿瑞匹坦的倾向进行匹配的患者子集进行了分析。在该子集中，量化阿瑞匹坦对PONV影响的OR估计值与多变量回归分析得到的结果相似。
在多模式抗呕吐预防方案中添加阿瑞匹坦可能与早期恢复期间PONV的显著降低以及术后48小时内呕吐发生率的降低有关。术后48小时内较高的PONV发生率表明引入计划性抗PONV预防性治疗可能是可取的。
