Objective To compare the effectiveness of P6 stimulation and sham stimulation/ drug intervention on prevention of postoperative nausea and vomiting (PONV). Methods We searched PubMed (1990 to 2010), OVID (1990 to 2010), EBSCO (1990 to 2010), The Cochrane Library (1996 to 2010), PNAI (1990 to 2010), Hight Wirepres (1990 to 2010), and Chinese Digital Hospital Library (www.chkd.cnki.net) (1999 to 2010) to identify randomized controlled trials (RCTs) about P6 stimulation and sham stimulation/drug intervention on prevention of PONV. The methodological quality of the included studies was assessed and the data was extracted according to the Cochrane Reviewer’s Handbook 4.2.2. Meta-analyses were performed using RevMan 4.2 software. Results A total of 21 studies were included. The results of meta-analyses indicated that: (1) Compared with sham stimulation, P6 stimulation could be effective in preventing postoperative nausea (beginning to termination) (Plt;0.000 01), postoperative early nausea (lt;after surgery 6 h) (P=0.000 6) and postoperative late nausea (gt;after surgery 6 h) (P=0.001). (2) Compared with sham stimulation, P6 stimulation could be effective in preventing postoperative vomiting (beginning to termination) (Plt;0.0.000 1) and postoperative early vomiting (P=0.002), but as to postoperative late vomiting (gt;after surgery 6 h), P6 stimulation had no effective preventive effect (P=0.08). (3) Compared with the drug intervention, P6 stimulation had little effect on preventing postoperative nausea (P=0.29) and vomiting (P=0.15). Conclusion Compared with sham stimulation, P6 stimulation can be effective in preventing postoperative early nausea and vomiting as well as postoperative late nausea, but not effective in preventing postoperative late vomiting. In comparison with drugs, a large number of clinical trials are needed to prove P6 stimulation can replace drugs to prevent postoperative nausea and vomiting.
【摘要】 目的 观察曲马多超前镇痛对经腹子宫切除术患者术后疼痛和恶心呕吐的影响。 方法 2008年11月-2009年5月，40例全身麻醉下行经腹子宫切除术的患者，分为超前镇痛组和对照组（n=20）。超前镇痛组和对照组于麻醉诱导前30 min分别静脉注射曲马多（3 mg/kg）和生理盐水。术后12、24 h，观察Bolus次数和芬太尼的用量，患者疼痛评分及术后恶心呕吐的发生率。 结果 术后12、24 h，曲马多超前镇痛组Bolus次数和芬太尼的用量均小于对照组（Plt;0.05），术后恶心呕吐的发生率差异无统计学意义（Pgt;0.05）。 结论 经腹子宫切除术手术前给予曲马多超前镇痛能够减少术后镇痛药的需要量，且不增加术后恶心呕吐的发生率。【Abstract】 Objective To observe the effects of tramadonl preemptive analgesia on postoperative pain and postoperative nausea and vomiting (PONV) in patients with hysterectomy. Methods Form November 2008 to May 2009, fourty patients who had undergone hysterectomy were divided into preemptive analgesia (PA) group and control group, 20 patients in each. The PA and control group were intravenously injected with tramadol (3 mg/kg) and normal saline respectively. Twelve and 24 hours after hysterectomy, the Bolus times, consumption of fentanil, pain score and incidence of PONV were observed. Results Twelve and 24 hours after hysterectomy, the Bolus times and consumption of fentanil were both lower than those in control group(Plt;0.05), the difference of PONV incidences between two groups was not statistically significant (Pgt;0.05). Conclusion Intravenously injected with tramadol before hysterectomy can recduce the dosage of analgesic, and don′t increase the incidence of PONV.
ObjectiveTo systematically review the effect of dexamethasone in preventing post-operative nausea and vomiting (PONV) associated with epidural opioids for post-cesarean section analgesia. MethodsWe searched PubMed, EMbase, CNKI, WanFang Data and CBM databases from inception to Dec. 31th 2015, to collect randomized controlled trials (RCTs) comparing dexamethasone with placebo/blank for the prevention of PONV associated with epidural opioids for postcesarean section analgesia. Two reviewer independently screened literature, extracted data, and assess the risk of bias of included studies. Then, meta-analysis was conducted by using RevMan 5.3 software. ResultsA total of 11 RCTs from 10 papers involving 1 011 patients were included. The results of meta-analysis showed that, compared with the placebo/ blank group, the dexamethasone group had lower incidence rates of post-operative nausea (RR=0.50, 95% CI 0.39 to 0.65, P < 0.000 01), postoperative vomiting (RR=0.39, 95% CI 0.29 to 0.52, P < 0.000 01), PONV (RR=0.37, 95% CI 0.30 to 0.46, P < 0.000 01), and rescue antiemetic (RR=0.34, 95% CI 0.19 to 0.62, P=0.000 5). ConclusionsCurrent evidence indicates that dexamethasone is effective for preventing PONV after epidural opioids for post-cesarean section analgesia. Due to the limited quantity and quality of the included studies, the above conclusion needs to be further verified by more high quality studies.
目的:探讨恶心呕吐的病因,为临床诊断提供依据,避免漏误诊发生。方法:消化内科住院患者128例出现恶心和（或）呕吐症状,对其病因统计分析。结果:恶心呕吐常见病为反流性食管炎、巨幼贫、胆系结石、颅内占位和功能性消化不良。其它尚有十二指肠溃疡、粪石梗阻、肝功损害、肠系膜动脉缺血、急性阑尾炎、腹部术后和流行性出血热(EHF)等。乙型肝炎与十二指肠溃疡有关,急性支气管炎、白细胞减少症和溃疡性结肠炎可有恶心呕吐表现。结论:恶心呕吐常见,病因有时难以确定,尤其是慢性起病者。病因的诊断应详询病史、仔细诊查、结合诊断学有关知识及有关检查,不应圉于消化系疾病。
Objective To systematically evaluate the efficacy and safety of palonosetron hydrochloride injection for the prevention of chemotherapy-induced nausea and vomiting (CINV) associated with moderately or highly emetogenic chemotherapy. Methods Searched PubMed, Embase, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Biological Medical Database, Wanfang Database and VIP Chinese Science and Technology Journal Database to find domestic and abroad published literatures of palonosetron used to control CINV associated with moderately or highly emetogenic chemotherapy. Two reviewers independently selected literatures, extracted data and assessed quality of the included studies by the Cochrane handbook 5.1. Meta-analysis was performed using RevMan 5.3 software. Results Twenty trials involving 4 919 patients were included. The results of meta-analysis showed statistically significant differences between palonosetron and first-generation 5-hydroxytryptamine3 receptor antagonists (5-HT3RAS) in prevention of acute〔RR=1.09, 95%CI (1.40, 1.14),P=0.000 4〕, delayed 〔RR=1.26, 95%CI (1.15, 1.37),P＜0.000 01〕, and overall phase of CINV 〔RR=1.19, 95%CI (1.10, 1.30),P＜0.000 1〕. Subgroup analyses indicated that there were no statistical significances between palonosetron and granisetron (P=0.09) or ondansetron (P=0.08) in prevention of acute CINV, as well as between palonosetron and first-generation 5-HT3RAS in prophylaxis of moderately CINV (P=0.18), while there was statistical significance in favor of palonosetron in prophylaxis of delayed and overall phase of CINV. Compared with first-generation 5-HT3RAS, there were different in prophylaxis of highly chemotherapy-induced acute〔RR=1.10, 95%CI (1.02, 1.18),P=0.01〕, delayed〔RR=1.20, 95%CI (1.06, 1.36),P=0.005〕, and overall phase〔RR=1.18, 95%CI (1.04,1.33),P=0.008〕of CINV. In terms of safety, such as headache, constipation, diarrhea and dizziness, there were no statistical differences between two groups. Conclusions Palonosetron hydrochloride injection showed efficacy in prophylaxis of moderately or highly CINV, and didn't increase adverse events. Palonosetron hydrochloride injection is more better than first-generation 5-HT3RAS, especially in prevention of highly CINV, and can significantly improve the control rate of acute, delayed, and overall phase of CINV.
ObjectiveTo compare the postoperative nausea and vomiting (PONV) after laparoscopic sleeve gastrectomy (LSG) and single-anastomosis sleeve ileal bypass (SASI), and to explore the risk factors for PONV. MethodA total of 220 patients at the Affiliated Hospital of Xuzhou Medical University from June 2022 to December 2022 were prospectively collected, and were randomly divided into the LSG group and the SASI group; the general condition of the patients was recorded. PONV was assessed on the POD0, POD1, POD2, POD30, POD60, POD90, using the Rhodes index score.ResultsThe total Rhodes index score in the LSG group was higher than that in the SASI group [(25.56±13.54) vs. (16.06±11.28), P＜0.05]. The results of multiple linear regression analysis showed that female (P=0.014), LSG (P＜0.001), young age (P=0.050), and low BMI (P=0.019) were risk factors for PONV. ConclusionsCompared with LSG, the Rhodes index score after SASI is low. For young women with low BMI, special attention should be paid to the prevention and treatment of PONV after LSG.
Enhanced recovery after surgery (ERAS) is a protocol designed to improve perioperative outcomes by multidisciplinary team with evidence-based interventions. The implementation of ERAS concept has been proved to reduce postoperative complications and hospital stay. The anesthesia management under the concept of ERAS is the basis of safe and smooth ambulatory surgical protocol. This article summarizes the latest clinical evidence at home and abroad, and reviews the preoperative optimization, anesthesia mode selection, ventilation strategies, fluid management, temperature support, pain management, postoperative nausea and vomiting prevention, postoperative nutritional support, and postoperative sleep improvement in the management of anesthesia under ERAS concept, in order to provide a reference for anesthesia management in ambulatory surgery.
目的:观察醋酸甲地孕酮(MA)在预防化疗引起的消化道反应中的作用。方法:收集2007年6月～2008年6月病理学和细胞学证实的消化道恶性肿瘤60例,采用自身前后交叉对照研究,随机分为AB和BA两组。AB组第一周期止吐方案用格拉司琼+胃复安＋MA,第二周期止吐方案用格拉司琼+胃复安;BA组第一周期止吐方案用格拉司琼+胃复安,第二周期止吐方案MA＋格拉司琼+胃复安。结果:化疗同时配合使用MA恶心、呕吐发生率下降(Plt;0.05);恶心、呕吐程度改善(P.001),并且可以预防化疗引起的急性期和延迟期恶心、呕吐反应(Plt;0.05)。结论:化疗同时配合使用MA可以改善化疗患者的恶心呕吐反应