Department of Anesthesiology, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China.
Department of Neurosurgery, Peking University People's Hospital, No. 11 Xizhimen South Street, Xicheng District, Beijing 100044, China.
J Clin Neurosci. 2023 Oct;116:27-31. doi: 10.1016/j.jocn.2023.08.010. Epub 2023 Aug 18.
The incidence of postoperative nausea and vomiting (PONV) after microvascular decompression (MVD) surgery is high; however, its underlying mechanisms remain unknown. Serum 5-hydroxytryptamine (5-HT) levels are elevated in patients with PONV. However, the relationship between 5-HT and patients experiencing PONV after MVD surgery is still unknown. Therefore, we hypothesized that 5-HT levels are associated with PONV after MVD surgery.
This prospective study included 85 patients with hemifacial spasm who received MVD surgery. Blood samples were collected preoperatively, postoperatively, and on postoperative day 1, and cerebrospinal fluid samples were collected intraoperatively. 5-HT levels were detected by enzyme-linked immunosorbent assay (ELISA). The incidence and severity of PONV were evaluated at 2, 6, and 24 h after MVD surgery.
In the multivariate regression analysis, PONV within 24 h after MVD surgery was associated with elevated cerebrospinal fluid 5-HT levels [odds ratio (OR) = 1.21, 95% confidence interval (CI): 1.01-1.45, p = 0.044], and reduction of intraocular pressure [OR = 11.54, 95% CI: 1.43-92.84, p = 0.022]. Receiver operating characteristic curve analysis revealed an area under the curve of 0.873 (95% CI: 0.77-0.98, p < 0.001).
Our study found that the cerebrospinal fluid 5-HT levels is an independent risk factor for PONV within 24 h after MVD surgery.
微血管减压术（MVD）后恶心和呕吐（PONV）的发生率较高，但发病机制尚不清楚。PONV 患者的血清 5-羟色胺（5-HT）水平升高。然而，MVD 术后 5-HT 与患者发生 PONV 的关系尚不清楚。因此，我们假设 5-HT 水平与 MVD 术后 PONV 有关。
本前瞻性研究纳入 85 例接受 MVD 手术的面肌痉挛患者。分别于术前、术后和术后第 1 天采集血样，术中采集脑脊液样。采用酶联免疫吸附法（ELISA）检测 5-HT 水平。在 MVD 术后 2、6 和 24 小时评估 PONV 的发生率和严重程度。
多变量回归分析显示，MVD 术后 24 小时内 PONV 与脑脊液 5-HT 水平升高（比值比[OR] = 1.21，95%置信区间[CI]：1.01-1.45，p = 0.044）和眼内压降低（OR = 11.54，95%CI：1.43-92.84，p = 0.022）有关。受试者工作特征曲线分析显示曲线下面积为 0.873（95%CI：0.77-0.98，p<0.001）。
本研究发现，脑脊液 5-HT 水平是 MVD 术后 24 小时内 PONV 的独立危险因素。
