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, China.
Department of Outcomes Research, Outcomes Research Consortium, Cleveland Clinic, Cleveland, OH, USA.
Breast Cancer. 2024 Sep;31(5):926-934. doi: 10.1007/s12282-024-01606-1. Epub 2024 Jun 19.
A history of severe nausea and vomiting during pregnancy (SNVP) is a risk factor for postoperative nausea and vomiting (PONV). This study aimed to explore potentially effective treatment strategies and potential genetic factors underlying SNVP risk-related PONV.
A total of 140 female patients undergoing breast cancer surgery were assigned to either the study group (70 with SNVP) or the control group (70 with mild to moderate nausea and vomiting during pregnancy (MNVP)). Patients in each group were randomly assigned to two different treatment subgroups and received either ondansetron plus dexamethasone (OD) or OD + TEAS (ODT) (transcutaneous electrical acupoint stimulation, TEAS). Blood samples were collected from patients before induction (D0) and 24 h (D1) after surgery for growth differentiation factor 15 (GDF-15) evaluation. The primary outcome was the incidence of PONV within 36 h. The secondary outcome was the serum GDF-15 level.
The incidence of PONV in the SNVP group was significantly higher than that in the MNVP group within 24 h (P < 0.005). In the SNVP group, ODT-treated patients had less PONV than those in the OD-treated group during the 6-12 h (P = 0.033) and 12-24 h (P = 0.008) intervals, while within 6 h, there were fewer vomiting cases in the ODT-treated group (SNVP-ODT vs. SNVP-OD, 7/33 vs. 19/35, P = 0.005). The preoperative GDF-15 serum levels in patients with SNVP were significantly higher (P = 0.004). Moreover, higher preoperative GDF-15 serum levels correlated with a higher incidence of PONV (P = 0.043).
TEAS showed significant effect on PONV treatment in patients with SNVP. A higher serum GDF-15 level was associated with a history of SNVP, as well as a higher risk of PONV.
妊娠剧吐史是术后恶心呕吐（PONV）的危险因素。本研究旨在探讨潜在有效的治疗策略和与 SNVP 相关 PONV 风险相关的潜在遗传因素。
共有 140 名接受乳腺癌手术的女性患者被分配至研究组（70 例有 SNVP）或对照组（70 例有轻度至中度妊娠恶心和呕吐（MNVP））。每组患者随机分为两个不同的治疗亚组，分别接受昂丹司琼加地塞米松（OD）或 OD+TEAS（ODT）（经皮穴位电刺激，TEAS）治疗。患者在诱导前（D0）和手术后 24 小时（D1）采集血液样本，用于生长分化因子 15（GDF-15）评估。主要结局是 36 小时内 PONV 的发生率。次要结局是血清 GDF-15 水平。
SNVP 组在 24 小时内的 PONV 发生率明显高于 MNVP 组（P<0.005）。在 SNVP 组中，与 OD 治疗组相比，ODT 治疗组在 6-12 小时（P=0.033）和 12-24 小时（P=0.008）时的 PONV 发生率更低，而在 6 小时内，ODT 治疗组的呕吐病例更少（SNVP-ODT 与 SNVP-OD，7/33 与 19/35，P=0.005）。SNVP 患者的术前 GDF-15 血清水平明显更高（P=0.004）。此外，较高的术前 GDF-15 血清水平与 PONV 发生率较高相关（P=0.043）。
TEAS 对 SNVP 患者的 PONV 治疗有显著效果。较高的血清 GDF-15 水平与 SNVP 病史以及 PONV 风险增加相关。
