[1]董政怡,蒋维维.儿童术后恶心呕吐的风险评估和预防研究进展[J].临床小儿外科杂志,2026,(05):497-500.[doi:10.3760/cma.j.cn101785-202310008]
　Dong Zhengyi,Jiang Weiwei.Advances in risk assessment and prevention of postoperative nausea and vomiting in children[J].Journal of Clinical Pediatric Surgery,2026,(05):497-500.[doi:10.3760/cma.j.cn101785-202310008]
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儿童术后恶心呕吐的风险评估和预防研究进展

《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R] 卷: 期数: 2026年05 页码: 497-500 栏目: 综述 出版日期: 2026-05-28
Title:
Advances in risk assessment and prevention of postoperative nausea and vomiting in children
作者:
董政怡1;  蒋维维2
1. 南京医科大学儿科学院, 南京 210008;
2. 南京医科大学附属儿童医院新生儿外科, 南京 210008
Author(s):
Dong Zhengyi1;  Jiang Weiwei2
1. College of Pediatrics, Nanjing Medical University, Nanjing 210008, China;
2. Department of Neonatal Surgery, Children’s Hospital of Nanjing Medical University, Nanjing 210008, China
关键词:
术后恶心呕吐; 非药物治疗; 儿童; 麻醉; 术后加速康复
Keywords:
Postoperative Nausea and Vomiting; Non-Drug Treatment; Child; Anesthesia; Enhanced Recovery After Surgery
DOI:
10.3760/cma.j.cn101785-202310008
摘要:
术后恶心呕吐(postoperative nausea and vomiting,PONV)是临床常见的术后并发症,在儿童中的发病率为60%~70%,远高于成人。相较于发病后的治疗,临床上更倾向于发病前的预防。预防儿童术后恶心呕吐的方法包括建立适合儿童的风险评分系统以预测其发生率,选择合适的麻醉方式,制定多模式预防方案以降低基线风险。随着研究的深入,儿童术后恶心呕吐的预防方式持续更新,不断丰富。本文旨在总结儿童术后恶心呕吐的预防方式,以帮助临床及时干预,减少术后恶心呕吐的发生。
Abstract:
Postoperative nausea and vomiting (PONV) is a common clinical complication,with an incidence of approximately 60%-70% in children,which is significantly higher than that in adults.Compared with treatment after onset,clinical practice places greater emphasis on prevention.Preventive strategies for pediatric PONV include establishing pediatric-specific risk scoring systems to predict its occurrence,selecting appropriate anesthesia methods,and implementing multimodal prophylactic strategies to reduce baseline risk.With the advancement of research,preventive approaches for pediatric PONV continue to evolve and expand.This review aims to summarize current strategies for pediatric PONV,in order to facilitate timely clinical intervention and reduce its incidence.

参考文献/References:

[1] Gan TJ, Jin ZS, Ayad S, et al.Fifth consensus guidelines for the management of postoperative nausea and vomiting:executive summary.Anesth Analg:2025.https://pubmed.ncbi.nlm.nih.gov/41237407/.DOI:10.1213/ANE.0000000000007816.
[2] Kovac AL.Postoperative nausea and vomiting in pediatric patients[J].Paediatr Drugs, 2021, 23(1):11-37.DOI:10.1007/s40272-020-00424-0.
[3] Pankiv E, Albornoz AE, Nghiem J, et al.Prophylaxis for pediatric postoperative nausea and vomiting:a scoping review of clinical trials[J].Can J Anaesth, 2023, 70(12):1978-1988.DOI:10.1007/s12630-023-02560-w.
[4] Darvall J, Handscombe M, Maat B, et al.Interpretation of the four risk factors for postoperative nausea and vomiting in the Apfel simplified risk score:an analysis of published studies[J].Can J Anaesth, 2021, 68(7):1057-1063.DOI:10.1007/s12630-021-01974-8.
[5] Eberhart LHJ, Morin AM, Guber D, et al.Applicability of risk scores for postoperative nausea and vomiting in adults to paediatric patients[J].Br J Anaesth, 2004, 93(3):386-392.DOI:10.1093/bja/aeh221.
[6] Eberhart LHJ, Geldner G, Kranke P, et al.The development and validation of a risk score to predict the probability of postoperative vomiting in pediatric patients[J].Anesth Analg, 2004, 99(6):1630-1637.DOI:10.1213/01.ANE.0000135639.57715.6C.
[7] Kranke P, Eberhart LH, Toker H, et al.A prospective evaluation of the POVOC score for the prediction of postoperative vomiting in children[J].Anesth Analg, 2007, 105(6):1592-1597.DOI:10.1213/01.ane.0000287816.44124.03.
[8] Bourdaud N, Devys JM, Bientz J, et al.Development and validation of a risk score to predict the probability of postoperative vomiting in pediatric patients:the VPOP score[J].Paediatr Anaesth, 2014, 24(9):945-952.DOI:10.1111/pan.12428.
[9] Aijima R, Miura D, Takamori A, et al.Impact of general anesthesia on postoperative complications in orthognathic surgery:a retrospective comparison of total intravenous anesthesia versus volatile anesthesia[J].Sci Rep, 2024, 14(1):16075.DOI:10.1038/s41598-024-66926-w.
[10] Nathan N.Propofol:a superior strategy for PONV[J].Anesth An-alg, 2024, 139(1):25.DOI:10.1213/ANE.0000000000007065.
[11] Chung JH, Kim YH, Ko YK, et al.Vomiting after a pediatric adenotonsillectomy:comparison between propofol induced sevoflurane-nitrous oxide maintained anesthesia and TIVA with propofol-remifentanil[J].Korean J Anesthesiol, 2010, 59(3):185-189.DOI:10.4097/kjae.2010.59.3.185.
[12] Apfel CC, Kranke P, Katz MH, et al.Volatile anaesthetics may be the main cause of early but not delayed postoperative vomiting:a randomized controlled trial of factorial design[J].Br J Anaesth, 2002, 88(5):659-668.DOI:10.1093/bja/88.5.659.
[13] Feng Y, Xu JJ, Ma H, et al.Chinese clinical practice guidelines for total intravenous anaesthesia:a systematic review and expert consensus-based recommendations[J].Br J Anaesth, 2026, 136(3):876-896.DOI:10.1016/j.Bja.2025.09.038.
[14] Zhao Y, Qin F, Liu YH, et al.The safety of propofol versus sevoflurane for general anesthesia in children:a meta-analysis of randomized controlled trials[J].Front Surg, 2022, 9:924647.DOI:10.3389/fsurg.2022.924647.
[15] 中国心胸血管麻醉学会日间手术麻醉分会, 中华医学会麻醉分会小儿麻醉学组.儿童加速康复外科麻醉中国专家共识[J].中华医学杂志, 2021, 101(31):2425-2432.DOI:10.3760/cma.j.cn112137-20201108-03034. Chinese Society of Cardiothoracic and Vascular Anesthesia, Daytime Surgery Anesthesia Branch, Chinese Medical Association Anesthesia Branch, Pediatric Anesthesiology Group.Expert consensus on anesthesia for enhanced recovery after surgery in children in China[J].Natl Med J China, 2021, 101(31):2425-2432.DOI:10.3760/cma.j.cn112137-20201108-03034.
[16] Suresh S, Ecoffey C, Bosenberg A, et al.The European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine recommendations on local anesthetics and adjuvants dosage in pediatric regional anesthesia[J].Reg Anesth Pain Med, 2018, 43(2):211-216.DOI:10.1097/AAP.0000000000000702.
[17] Kienbaum P, Schaefer MS, Weibel S, et al.Update on PONV-What is new in prophylaxis and treatment of postoperative nausea and vomiting?:Summary of recent consensus recommendations and Cochrane reviews on prophylaxis and treatment of postoperative nausea and vomiting[J].Anaesthesist, 2022, 71(2):123-128.DOI:10.1007/s00101-021-01045-z.
[18] Huddart R, Altman RB, Klein TE.PharmGKB summary:ondansetron and tropisetron pathways, pharmacokinetics and pharmacodynamics[J].Pharmacogenet Genomics, 2019, 29(4):91-97.DOI:10.1097/FPC.0000000000000369.
[19] Chen HL, Sun LP, Zheng JJ, et al.Palonosetron versus tropisetron with dexamethasone for prevention of postoperative nausea and vomiting in pediatric adenotonsillectomy:a single center, randomized controlled trial[J].Front Med (Lausanne), 2025, 12:1549619.DOI:10.3389/fmed.2025.1549619.
[20] Walker R, Dias S, Phillips RS.Antiemetic medications for preventing chemotherapy-induced nausea and vomiting in children:a systematic review and Bayesian network meta-analysis[J].Support Care Cancer, 2024, 32(11):747.DOI:10.1007/s00520-024-08939-9.
[21] 陈芬.盐酸帕洛诺司琼联合地塞米松对舒芬太尼用于小儿尿道下裂术后静脉镇痛期间恶心呕吐影响的观察[J].海峡药学, 2020, 32(11):132-134.DOI:10.3969/j.issn.1006-3765.2020.11.045. Chen F.Observation of the effect of palonosetron hydrochloride combined with dexamethasone on nausea and vomiting during venous analgesia with sufentanil in children after hypospadias surgery[J].Strait Pharm J, 2020, 32(11):132-134.DOI:10.3969/j.issn.1006-3765.2020.11.045.
[22] Shende D, Bharti N, Kathirvel S, et al.Combination of droperidol and ondansetron reduces PONV after pediatric strabismus surgery more than single drug therapy[J].Acta Anaesthesiol Scand, 2001, 45(6):756-760.DOI:10.1034/j.1399-6576.2001.045006756.x.
[23] Shah S, Godhardt L, Spofford C.Acupuncture and postoperative pain reduction[J].Curr Pain Headache Rep, 2022, 26(6):453-458.DOI:10.1007/s11916-022-01048-4.
[24] Szmit M, Krajewski R, Rudnicki J, et al.Application and efficacy of transcutaneous electrical acupoint stimulation (TEAS) in clinical practice:a systematic review[J].Adv Clin Exp Med, 2023, 32(9):1063-1074.DOI:10.17219/acem/159703.
[25] Li X, Wu T, Li WM, et al.Preventive effect of transcutaneous acupoint electrical stimulation on emergence agitation after general anesthesia in pediatric patients undergoing tonsillectomy:a randomized clinical trial[J].Medicine (Baltimore), 2026, 105(7):e47737.DOI:10.1097/MD.0000000000047737.
[26] Wongyingsinn M, Peanpanich P, Charoensawan S.A randomized controlled trial comparing incidences of postoperative nausea and vomiting after laparoscopic cholecystectomy for preoperative intravenous fluid loading, ondansetron, and control groups in a regional hospital setting in a developing country[J].Medicine (Baltimore), 2022, 101(42):e31155.DOI:10.1097/MD.0000000000031155.
[27] Puri S, Bandyopadhyay A, Ashok V.Supplemental intraoperative crystalloids for pediatric postoperative nausea and vomiting-A systematic review and meta-analysis[J].Paediatr Anaesth, 2023, 33(1):38-45.DOI:10.1111/pan.14566.
[28] Goodarzi M, Matar MM, Shafa M, et al.A prospective randomized blinded study of the effect of intravenous fluid therapy on postoperative nausea and vomiting in children undergoing strabismus surgery[J].Paediatr Anaesth, 2006, 16(1):49-53.DOI:10.1111/j.1460-9592.2005.01693.x.

备注/Memo

收稿日期:2023-10-8。
基金项目:江苏省卫生健康委员会面上项目(M2022037);江苏省卫生健康委员会高层次卫生人才"六个一工程"拔尖人才项目(LGY2020019);高水平医院科技创新支撑计划应用基础研究类(KJCXM2024008)
通讯作者:蒋维维,Email:wwjiang@njmu.edu.cn

更新日期/Last Update: 1900-01-01