Nagase Satoshi, Imaura Masaharu, Nishimura Mizuki, Takeda Kohei, Takahashi Mari, Taniguchi Hideki, Sato Tomoyuki, Kanno Hiroshi
Department of Pharmacy, Saiseikai Yokohamashi Tobu Hospital, 3-6-1, Shimosueyoshi, Tsurumi-ku, Yokohama-shi, Kanagawa, 230-8765, Japan.
Patient Support Center, Saiseikai Yokohamashi Tobu Hospital, 3-6-1, Shimosueyoshi, Tsurumi-ku, Yokohama-shi, Kanagawa, 230-8765, Japan.
J Pharm Health Care Sci. 2022 Apr 4;8(1):11. doi: 10.1186/s40780-022-00242-1.
Postoperative nausea and vomiting (PONV) delays postoperative recovery, prolongs hospital stays, and hinders patients' return to society, thus making it a major cause of increased healthcare costs. It is also the most troubling postoperative complication in female patients undergoing surgery. However, in Japan, guidelines for the management of PONV have not been established, and the management protocol for PONV is left to each institution and anesthesiologist. Therefore, we developed criteria for intraoperative management of PONV.
In female surgical patients, the usefulness of the criteria was evaluated by comparing the implementation rate of intraoperative management and PONV incidence before and after the establishment of the criteria. An Apfel simplified score (Apfel score) ≥2 was set as an indication for intraoperative management of PONV.
The implementation rate of intraoperative management increased from 91.2 to 96.0% after the introduction of the criteria. In patients with an Apfel score of 2, the intraoperative management implementation rate significantly increased from 81.1 to 94.7% (p = 0.016), while PONV incidence significantly decreased from 44.6 to 34.1% after the introduction of the criteria (p = 0.040).
The criteria for intraoperative management of PONV increased the implementation rate of intraoperative management and decreased PONV incidence, indicating the usefulness of the criteria.
术后恶心呕吐（PONV）会延迟术后恢复、延长住院时间并阻碍患者回归社会，因此成为医疗费用增加的主要原因。它也是接受手术的女性患者最令人困扰的术后并发症。然而，在日本，尚未制定PONV的管理指南，PONV的管理方案由各机构和麻醉医生自行决定。因此，我们制定了PONV术中管理标准。
在女性外科手术患者中，通过比较标准制定前后术中管理的实施率和PONV发生率来评估该标准的有效性。将Apfel简化评分（Apfel评分）≥2设定为PONV术中管理的指征。
引入该标准后，术中管理的实施率从91.2%提高到了96.0%。在Apfel评分为2的患者中，术中管理实施率从81.1%显著提高到了94.7%（p = 0.016），而引入该标准后PONV发生率从44.6%显著降低至34.1%（p = 0.040）。
PONV术中管理标准提高了术中管理的实施率并降低了PONV发生率，表明该标准是有效的。
