Wang Baona, Yan Tao, Sun Li, Zhang Guohua, Zheng Hui
Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China.
Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, 518116, China.
Breast Cancer. 2021 Mar;28(2):506-512. doi: 10.1007/s12282-020-01190-0. Epub 2020 Nov 26.
Postoperative nausea and vomiting (PONV) occur in up to 30 percent of patients after breast cancer surgery despite routine administration of antiemetic prophylaxis. A history of nausea and vomiting during pregnancy (NVP) has been reported as a risk factor of intraoperative nausea and vomiting in caesarean delivery. Nevertheless, whether a history of severe nausea and vomiting during pregnancy (SNVP) is associated with a higher occurrence of PONV remains unclear.
In this study, 121 sequential female patients who were scheduled to undergo breast cancer surgery were assigned to study group (30 cases, with SNVP) or control group (91 cases, with mild NVP (MNVP)). The incidence of PONV and the need for rescue antiemetic were recorded in post-anesthesia care unit (PACU), at 6 h, 12 h, 24 h, and 36 h after operation. Moreover, postoperative pain, level of satisfaction, and the relationship of ER/PR status in breast cancer tissue with SNVP and PONV were also investigated.
Data from 115 patients were analyzed. The incidence of PONV in the SNVP group was significantly higher than that in the MNVP group at 6 h (P < 0.005), 12 h (P < 0.05), and 24 h after the operation (P < 0.05). The incidence of PONV in the MNVP group was approximately 30% lower than in the SNVP group. Besides, more severe PONV, a larger number of demands for rescue antiemetic, fewer patient satisfaction scores, and more dizziness were observed in the SNVP group. Yet, no relationship was found between ER/PR status of breast cancer tissue and SNVP or PONV.
Compared to patients with MNVP, those with a history of SNVP experienced a higher incidence of PONV and severe PONV, presented with a larger number of requirements for postoperative antiemetic and a lower level of satisfaction.
尽管常规给予预防性止吐药，但乳腺癌手术后仍有高达30%的患者发生术后恶心呕吐（PONV）。有报道称，妊娠期间恶心呕吐（NVP）史是剖宫产术中恶心呕吐的一个危险因素。然而，妊娠期间严重恶心呕吐（SNVP）史是否与PONV的较高发生率相关仍不清楚。
在本研究中，将121例计划接受乳腺癌手术的连续女性患者分为研究组（30例，有SNVP）和对照组（91例，有轻度NVP（MNVP））。记录麻醉后恢复室（PACU）、术后6小时、12小时、24小时和36小时时PONV的发生率以及使用急救止吐药的需求。此外，还研究了术后疼痛、满意度以及乳腺癌组织中雌激素受体/孕激素受体（ER/PR）状态与SNVP和PONV的关系。
对115例患者的数据进行了分析。SNVP组术后6小时（P＜0.005）、12小时（P＜0.05）和24小时（P＜0.05）时PONV的发生率显著高于MNVP组。MNVP组PONV的发生率比SNVP组低约30%。此外，SNVP组观察到更严重的PONV、更多的急救止吐药需求、更低的患者满意度评分以及更多的头晕症状。然而，未发现乳腺癌组织的ER/PR状态与SNVP或PONV之间存在关联。
与MNVP患者相比，有SNVP史的患者PONV和严重PONV的发生率更高，术后止吐药需求更多，满意度更低。
