Echeverria-Villalobos Marco, Fiorda-Diaz Juan, Uribe Alberto, Bergese Sergio D
Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, United States.
Department of Anesthesiology, Health Sciences Center, School of Medicine, Stony Brook University, New York, NY, United States.
Front Med (Lausanne). 2022 Jul 1;9:909982. doi: 10.3389/fmed.2022.909982. eCollection 2022.
Postoperative nausea and vomiting (PONV) have been widely studied as a multifactorial entity, being of female gender the strongest risk factor. Reported PONV incidence in female surgical populations is extremely variable among randomized clinical trials. In this narrative review, we intend to summarize the incidence, independent predictors, pharmacological and non-pharmacological interventions for PONV reported in recently published clinical trials carried out in female patients undergoing breast and gynecologic surgery, as well as the implications of the anesthetic agents on the incidence of PONV. A literature search of manuscripts describing PONV management in female surgical populations (breast surgery and gynecologic surgery) was carried out in PubMed, MEDLINE, and Embase databases. Postoperative nausea and vomiting incidence were highly variable in patients receiving placebo or no prophylaxis among RCTs whereas consistent results were observed in patients receiving 1 or 2 prophylactic interventions for PONV. Despite efforts made, a considerable number of female patients still experienced significant PONV. It is critical for the anesthesia provider to be aware that the coexistence of independent risk factors such as the level of sex hormones (pre- and postmenopausal), preoperative anxiety or depression, pharmacogenomic pleomorphisms, and ethnicity further enhances the probability of experiencing PONV in female patients. Future RCTs should closely assess the overall risk of PONV in female patients considering patient- and surgery-related factors, and the level of compliance with current guidelines for prevention and management of PONV.
术后恶心呕吐（PONV）作为一种多因素病症已得到广泛研究，其中女性是最强的风险因素。在随机临床试验中，女性手术人群中报告的PONV发生率差异极大。在这篇叙述性综述中，我们旨在总结近期发表的针对接受乳腺和妇科手术的女性患者的临床试验中所报告的PONV的发生率、独立预测因素、药物和非药物干预措施，以及麻醉药物对PONV发生率的影响。我们在PubMed、MEDLINE和Embase数据库中检索了描述女性手术人群（乳腺手术和妇科手术）中PONV管理的手稿。在随机对照试验中，接受安慰剂或未进行预防的患者中，术后恶心呕吐的发生率差异很大，而在接受1种或2种PONV预防干预措施的患者中观察到了一致的结果。尽管已做出努力，但仍有相当数量的女性患者经历了严重的PONV。麻醉提供者必须认识到，诸如性激素水平（绝经前和绝经后）、术前焦虑或抑郁、药物基因组多态性和种族等独立风险因素的共存会进一步增加女性患者发生PONV的可能性。未来的随机对照试验应密切评估女性患者中PONV的总体风险，同时考虑患者和手术相关因素，以及当前PONV预防和管理指南的遵守程度。
