个体化治疗策略对妇科腹腔镜手术术后恶心呕吐的影响：一项双盲、随机、对照试验。

Effect of individualized treatment strategy on postoperative nausea and vomiting in gynaecological laparoscopic surgery: a double-blind, randomized, controlled trial.

机构信息

Department of Anesthesiology, First Affiliated Hospital of Wannan Medical College, No. 2 Zheshan Street, Wuhu, 241000, Anhui, China.

Department of Critical Care Medicine, First Affiliated Hospital of Wannan Medical College, No.2 Zheshan Street, Wuhu, 241000, Anhui, China.

出版信息

BMC Anesthesiol. 2022 Aug 19;22(1):266. doi: 10.1186/s12871-022-01809-z.

DOI:10.1186/s12871-022-01809-z

PMID:35986239

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9389684/

Abstract

BACKGROUND

Postoperative nausea and vomiting (PONV) have always been a concern of clinicians and may increase medical costs for patients. Consensus guidelines recommend using multiple antiemetics with different mechanisms as prophylaxis in patients at high risk of PONV. Individualized risk scores for nausea and vomiting and individualized treatment strategies are feasible. This study evaluated the effect of individualized treatment strategies on postoperative nausea and vomiting after laparoscopic gynaecological operations.

METHODS

This was a double-blind, randomized, controlled trial. A total of 119 adult patients who underwent gynaecological laparoscopic surgery under general anaesthesia were randomly divided into an individualized treatment group or a control group, with the individualized treatment group receiving individualized prevention according to a preoperative risk score of nausea and vomiting and the control group receiving no individualized prevention. Vomiting, retching, nausea, and use of rescue medication were all recorded for 24 h after the operation. The primary outcome variable was complete response, defined as no emesis or the use of rescue medication 24 h postoperatively.

RESULTS

The complete response rate was higher in the individualized treatment group (56.7%) than in the control group (23.7%) (95% CI, 0.01-0.27; P < 0.001). The incidences of emesis (18.3% vs. 44.1%, P = 0.002) were significantly lower in the individualized treatment group than in the control group. There were no differences in any nausea (26.7% vs. 33.9%, P = 0.391) or rescue medication use (6.7% vs. 8.5%, P = 0.743). Adverse events and laboratory and electrocardiogram abnormalities occurred no more frequently in the individualized treatment group than in the control group.

CONCLUSION

In conclusion, this single-centre, double-blind, randomized study suggests that an individualized PONV prophylactic treatment strategy based on the number of PONV risk factors could be a safe and effective regimen to reduce the incidence of PONV in adult patients undergoing laparoscopic gynaecological surgery.

摘要

背景

术后恶心呕吐（PONV）一直是临床医生关注的问题，可能会增加患者的医疗费用。共识指南建议对 PONV 高危患者使用具有不同作用机制的多种止吐药进行预防。恶心和呕吐的个体化风险评分和个体化治疗策略是可行的。本研究评估了个体化治疗策略对腹腔镜妇科手术后恶心呕吐的影响。

方法

这是一项双盲、随机、对照试验。共有 119 名接受全身麻醉下妇科腹腔镜手术的成年患者，随机分为个体化治疗组或对照组，个体化治疗组根据术前恶心呕吐风险评分进行个体化预防，对照组不进行个体化预防。记录术后 24 小时内的呕吐、干呕、恶心和使用解救药物的情况。主要结局变量为完全反应，定义为术后 24 小时内无呕吐或使用解救药物。

结果

个体化治疗组（56.7%）的完全反应率高于对照组（23.7%）（95%CI，0.01-0.27；P<0.001）。个体化治疗组的呕吐发生率（18.3% vs. 44.1%，P=0.002）明显低于对照组。恶心（26.7% vs. 33.9%，P=0.391）或解救药物使用（6.7% vs. 8.5%，P=0.743）无差异。个体化治疗组不良事件及实验室和心电图异常的发生频率与对照组无差异。