Groene Philipp, Eisenlohr Jana, Zeuzem Catharina, Dudok Sara, Karcz Konrad, Hofmann-Kiefer Klaus
Department of Anaesthesiology, University Hospital, Ludwig Maximilian University, Munich, Germany.
Department of General, Visceral and Transplantation Surgery, University Hospital, Ludwig Maximilian University, Munich, Germany.
Wideochir Inne Tech Maloinwazyjne. 2019 Jan;14(1):90-95. doi: 10.5114/wiitm.2018.77629. Epub 2018 Oct 3.
Postoperative nausea and vomiting (PONV) are complications of general anesthesia. Patient-specific factors, type of surgery and a variety of drugs determine the frequency. Clinical experience shows nausea and vomiting to be very frequent in morbidly obese patients undergoing bariatric surgery.
To detect the onset and extent of nausea and vomiting in the group of morbidly obese patients undergoing laparoscopic bariatric surgery.
We conducted a retrospective data bank analysis (since 2004) of all patients with body mass index > 35 kg/m undergoing laparoscopic bariatric surgery in comparison to patients with a body mass index < 35 kg/m undergoing gastric surgery. Propensity score matching was applied to minimize bias effects. The frequency of postoperative nausea was defined as the primary outcome parameter.
One hundred and thirty-eight patients were included. There was a significant difference between the morbidly obese group and the control group concerning the frequency of postoperative nausea (15.9% vs. 55.1%; p < 0.001). In patients receiving volatile anesthetics a significant difference between groups concerning frequency of PONV was not observed. Intravenous anesthetics were suitable to reduce PONV in the control group but not in the morbidly obese group (12.5% vs. 56.8%, p < 0.001). With given prophylaxis PONV events still occurred in 15.6% vs. 48.8% (p = 0.003).
Morbidly obese patients undergoing laparoscopic bariatric surgery are at higher risk of suffering from PONV than non-morbidly obese patients. To reduce the PONV incidence in morbidly obese patients, further research, especially focusing on more efficient use of antiemetic drugs, seems to be necessary.
术后恶心呕吐（PONV）是全身麻醉的并发症。患者个体因素、手术类型和多种药物决定了其发生率。临床经验表明，接受减肥手术的病态肥胖患者中恶心呕吐非常常见。
检测接受腹腔镜减肥手术的病态肥胖患者群体中恶心呕吐的发生情况及程度。
我们对自2004年以来所有体重指数>35kg/m²接受腹腔镜减肥手术的患者与体重指数<35kg/m²接受胃部手术的患者进行了回顾性数据库分析。采用倾向得分匹配以尽量减少偏倚效应。术后恶心的发生率被定义为主要结局参数。
共纳入138例患者。病态肥胖组与对照组在术后恶心发生率方面存在显著差异（15.9%对55.1%；p<0.001）。在接受挥发性麻醉剂的患者中，未观察到两组在PONV发生率方面的显著差异。静脉麻醉剂适用于降低对照组的PONV发生率，但不适用于病态肥胖组（12.5%对56.8%，p<0.001）。给予预防措施后，PONV事件仍分别发生在15.6%和48.8%的患者中（p = 0.003）。
接受腹腔镜减肥手术的病态肥胖患者比非病态肥胖患者发生PONV的风险更高。为降低病态肥胖患者的PONV发生率，似乎有必要进行进一步研究，尤其是专注于更有效地使用止吐药物。
