Wang Dongpi,Huang Wenfang,Zhao Jialian,et al.Efficacies of prophylactic ondansetron for postoperative nausea and vomiting in children undergoing ambulatory surgeries[J].Journal of Clinical Pediatric Surgery,2019,18(09):757-762.[doi:10.3969/j.issn.1671-6353.2019.09.010]
昂丹司琼对日间手术患儿术后恶心呕吐的预防作用研究
- Title:
- Efficacies of prophylactic ondansetron for postoperative nausea and vomiting in children undergoing ambulatory surgeries
- Keywords:
- Child; Anesthesia; Postoperative Nausea and Vomiting; Ambulatory Surgery; Enhanced Recovery After Surgery
- 分类号:
- R726;R614
- 摘要:
- 目的 探讨5-HT3受体拮抗剂昂丹司琼在日间手术使用过程的安全性及其对术后24 h内恶心、呕吐的预防效果。方法 统计浙江大学医学院附属儿童医院2017年4月至2017年12月间2 002例接受日间手术患儿术后24 h内恶心、呕吐和其他并发症的发生情况，根据是否预防性给予昂丹司琼分为昂丹司琼组（OND组）和对照组，评估昂丹司琼预防术后恶心呕吐（postoperative nausea and vomiting，PONV）的安全性和有效性，并对导致术后呕吐（postoperative vomiting，POV）的危险因素进行分析。结果 OND组PONV和POV发生率明显低于对照组（PONV：5.4%vs.8.8%，P<0.05；POV：3.2%vs.6.8%，P<0.005）。就麻醉方式而言，昂丹司琼在基础麻醉复合局部浸润麻醉中对PONV/POV的预防作用比复合骶管神经阻滞的效果更好（PONV：OR=0.24，95% CI：0.113~0.508；POV：OR=0.207，95% CI：0.084~0.509）。就手术方式而言，昂丹司琼对POV的预防作用在鞘膜积液手术中最为理想（OR=0.067，95% CI：0.007~0.618，P=0.002）。采用基础麻醉复合骶管神经阻滞（RR=1.712，95% CI：1.097~2.672，P=0.017）、接受腹股沟斜疝手术（RR=1.946，95% CI：1.262~3.000，P=0.002）和男性（RR=1.829，95% CI：1.081~3.095，P=0.023）是导致术后POV的危险因素。结论 昂丹司琼可有效降低日间手术患儿PONV和POV的发生率，加速患儿术后康复进程，增加就医舒适度。推荐在日间手术（尤其是下腹部腹股沟斜疝和鞘膜积液手术）患儿中使用昂丹司琼以预防PONV/POV。
- Abstract:
- Objective To evaluate the safety and efficacy of prophylactic ondansetron,a 5-HT3 receptor antagonist,on postoperative nausea and vomiting(PONV)within 24h in children undergoing ambulatory surgeries.Methods A total of 2 002 children undergoing ambulatory surgeries were enrolled.The ondansetron group received prophylactic ondansetron while the control group did not.The anesthetic methods and surgical procedures were reviewed and the postoperative occurrences of nausea-vomiting within 24 hours assessed.Results There were no complications associated with ondansetron.The incidence of PONV and postoperative vomiting(POV)was significantly less in the ondansetron group than that in the control group(PONV 5.4% vs.8.8% in control,P<0.05; POV 3.2% vs.6.8% in control,P<0.05).In children with basal plus local infiltration anesthesia,the preventive efficacy of ondansetron seemed be superior to combined use of caudal block(OR=0.24(0.113-0.508)in PONV; OR=0.207(0.084-0.509)in POV).The best prophylactic efficacy was observed in ligation of traffic tube for hydrocele with caudal block[OR=0.067(0.007-0.618),P=0.002].Basal anesthesia plus caudal block[RR=1.712(1.097-2.672),P=0.017],high ligation of hernial sac[RR=1.946(1.262-3.000),P=0.002]and male[RR=1.829(1.081-3.095),P=0.023]were risk factors while prophylactic dosing of ondansetron served as a protective factor for POV.Conclusion Prophylactic ondansetron is both safe and effective for reducing the incidence of PONV and POV in children undergoing short-time ambulatory surgeries without related complications.The preventive efficacy of ondansetron improves medical comforts.It is recommended for preventing PONV/POV in children undergoing ambulatory surgeries,especially for those with inguinal hernia and hydrocele.
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备注/Memo
收稿日期:2019-01-13。
基金项目:国家自然科学基金（编号：81601358）；浙江省教育厅科研项目（编号：Y201328483）
通讯作者:黄寿奖,Email:CQ638@zju.edu.cn