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[术后恶心呕吐防治的更新要点——术后恶心呕吐的预防和治疗有哪些新进展?]

[Update PO(N)V-What is new in the prophylaxis and treatment of postoperative nausea and vomiting?].

作者信息

Knoth S, Weber B, Lotz H, Vojnar B, Eberhart L H J

机构信息

Klinik für Anästhesie und Intensivtherapie, Philipps-Universität Marburg, Baldingerstraße 1, 35033, Marburg, Deutschland.

Klinik für Kinderanästhesie und Intensivmedizin, GNH Klinikum Kassel, Mönchebergstraße 41-43, 34125, Kassel, Deutschland.

出版信息

Anaesthesiologie. 2025 Mar;74(3):171-186. doi: 10.1007/s00101-025-01510-z. Epub 2025 Feb 26.

Abstract

Postoperative nausea and vomiting (PONV) is defined as the joint or individual occurrence of nausea, retching and vomiting within 24-48h after an operation. The peripheral and central nervous systems are involved in the development of PONV. The pathogenesis of PONV is multifactorial. Patient-related, anaesthesia-related and surgery-related risk factors can be present. Some of the risk factors for PONV were combined to form PONV risk scores (e.g., the simplified risk score for predicting postoperative nausea and vomiting from Apfel et al.), with the help of which the risk of PONV can be estimated with a sensitivity and specificity of 65-70%. For certain collectives specialised PONV risk scores should be prioritised. The antiemetic strategy is divided into three areas: modification of the anaesthetic procedure, pharmacological and nonpharmacological interventions. These can be applied individually or combined in the sense of a multimodal PONV prophylaxis.

摘要

术后恶心呕吐(PONV)的定义为术后24至48小时内出现恶心、干呕和呕吐的联合或单独发生情况。外周和中枢神经系统参与了PONV的发生发展。PONV的发病机制是多因素的。可能存在与患者相关、与麻醉相关和与手术相关的危险因素。一些PONV危险因素被组合形成PONV风险评分(例如,Apfel等人提出的预测术后恶心呕吐的简化风险评分),借助该评分可估计PONV风险,其敏感性和特异性为65 - 70%。对于某些特定人群,应优先使用专门的PONV风险评分。止吐策略分为三个方面:麻醉程序的调整、药物和非药物干预。这些可单独应用或在多模式PONV预防的意义上联合应用。

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