Okafor Dionne, Kaye Alan David, Kaye Rachel J, Urman Richard D
Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Department of Anesthesiology, Louisiana State University Health Science Center, New Orleans, LA 70112, USA.
J Anaesthesiol Clin Pharmacol. 2017 Oct-Dec;33(4):441-445. doi: 10.4103/0970-9185.222511.
Postoperative nausea and vomiting (PONV) can be very debilitating for surgical patients, and effective management reduces potential morbidity, aiding in patient satisfaction, and minimizing the need for unintended hospital stays. Risk factors include female sex, nonsmoker, and having a previous history of motion sickness or PONV. Anesthetic risk factors include receiving opioids, not receiving a total intravenous anesthetic (TIVA), exposure to nitrous oxide, and extended length of anesthetic. Many treatments, including serotonin antagonists, dopamine antagonists, corticosteroids, inhaled isopropyl alcohol, and anticholinergics, as well as techniques such as TIVA, have been utilized over recent decades in an attempt to reduce PONV incidence. However, it remains a problem for a significant number of surgical patients. Aprepitant is a neurokinin-1 (substance P) antagonist, which exerts its effects via a final common pathway of the emetic centers after crossing the blood brain barrier. Aprepitant is commonly used in the cancer population to help prevent cancer chemotherapy-induced nausea and vomiting and has shown great promise in both acute and delayed phase PONV. Published data has shown improved efficacy when compared with ondansetron administered prior to surgery. The use of aprepitant in combination with other antiemetics potentially may help decrease unplanned hospital admissions and potentially, reduce costs associated with PONV.
术后恶心呕吐（PONV）对外科手术患者而言可能极为虚弱，有效的管理可降低潜在的发病率，提高患者满意度，并尽量减少意外住院的需求。风险因素包括女性、不吸烟者以及既往有晕动病或PONV病史。麻醉风险因素包括使用阿片类药物、未接受全静脉麻醉（TIVA）、接触氧化亚氮以及麻醉时间延长。近几十年来，人们采用了多种治疗方法，包括5-羟色胺拮抗剂、多巴胺拮抗剂、皮质类固醇、吸入异丙醇和抗胆碱能药物，以及TIVA等技术，试图降低PONV的发生率。然而，对于大量外科手术患者来说，这仍然是一个问题。阿瑞匹坦是一种神经激肽-1（P物质）拮抗剂，它在穿过血脑屏障后，通过呕吐中枢的最终共同途径发挥作用。阿瑞匹坦常用于癌症患者，以帮助预防癌症化疗引起的恶心和呕吐，并且在急性和延迟期PONV方面都显示出了巨大的前景。已发表的数据表明，与术前使用昂丹司琼相比，其疗效有所提高。将阿瑞匹坦与其他止吐药联合使用可能有助于减少计划外的住院，并有可能降低与PONV相关的费用。
