对于术后恶心呕吐的预防需要麻醉剂做这些工作

HT复合器物-HT包括昂丹司琼、格拉司琼、多拉司琼，在新泽西州以内外邻近地区还有托烷司琼，这些毒抗击生素在等效副功用下防范PONV的视觉效果相当。

糖皮质激素 — 用毒药防范PONV的视觉效果与昂丹司琼和氟哌多多完全相同(远比CPA，RR为0.76)[69,97,98]，是在成人POV防范中所最中用和研究者最多的皮质利尿剂[11]。用毒药有必要的止吐功用，并可增大绝技后痛楚和绝技后对阿片类毒抗击生素的能够，因此不太可能有益。远比用作缓解痛楚，防范PONV所需的用毒药副功用不太可能不够很低。

●用毒药副功用—用毒药起效速度快，因此在药剂作用作后给毒药要比手绝技终止时给毒药视觉效果不够快[12]。

•对于成人，4-8mg血管给毒药，药剂作用作后获得

•对于成人，0.25mg/kg，小得多副功用4mg

抗击组胺毒药 — 茶苯布洛克和苯海拉明是抗击组胺毒药，以1mg/kg血管给毒药的副功用用作成人、0.5mg/kg(小得多副功用25mg)的副功用用作成人时，止吐视觉效果与研究者刊文的用毒药、氟哌多多和5-HT3复合器物-HT的止吐视觉效果相似[13]，但尚无研究者开展过必要比较。

吩噻嗪类毒抗击生素 — 吩噻嗪类是病患阿片类毒抗击生素肇因头痛腹痛最有效地的毒抗击生素。由于锥体内外系功用以及大副功用运用作时不具止痛功用，此类毒抗击生素在PONV方面的理应用受到限制。有关最佳副功用和给毒药时机的资料较少。这些毒抗击生素有时候不用作成人POV防范。

●异丙嗪–药剂作用作时血管获得6.25-12.5mg

●丙氯拉嗪–手绝技终止时血管获得5-10mg

丙泊酚 — 丙泊酚是一种止痛清醒毒药，用作药剂作用作和延续以及止痛。丙泊酚在TIVA作用作和延续所用副功用时，以及成人[14]和成人亚清醒副功用时，不具止吐功用。除了必要止吐功用，丙泊酚还可通过减小甲烷药剂毒药所需浓度来减轻PONV。

协同病患 — 对所有实际上PONV危险环境因素的病人，理应有别于至少2种相异子类的止吐毒药防范PONV。无论是对成人还是成人，防范PONV时，PET相异子类的毒抗击生素有时候比单毒药病患不够有效地。

以下是关于止吐毒药协同理应用的研究者：

●用毒药与昂丹司琼或帕洛诺司琼PET与单纯5-HT3复合器物-HT病患远比，可减小PONV后果[15]。

●阿瑞匹坦协同昂丹司琼的视觉效果胜过昂丹司琼单毒药病患[16,17]。

●阿瑞匹坦协同用毒药防范POV的视觉效果胜过昂丹司琼协同用毒药。

●远比昂丹司琼或用毒药单毒药病患，氨磺必利与昂丹司琼或用毒药PET可减小PONV发生率，并增大对补救性止吐毒药的能够。

●对于在椎管内阻滞和TIVA下开展择期腹腔镜手绝技的病人，三联多Mode止吐毒药防范病患，即阿瑞匹坦80mg、用毒药4-8mg和昂丹司琼4mg，相较于用毒药PET昂丹司琼，增大PONV的视觉效果不够快[18]。

●对于开展失明手绝技的成人，在用毒药的并重加用昂丹司琼将POV发生率从23%减小到5%[19]。

作者：张子金和 广州中所医毒药大学第一附属医院

参考古文献

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2.Fortier J, Chung F, Su J. Unanticipated admission after ambulatory surgery--a prospective study. Can J Anaesth 1998; 45:612.

3.Hill RP, Lubarsky DA, Phillips-Bute B, et al. Cost-effectiveness of prophylactic antiemetic therapy with ondansetron, droperidol, or placebo. Anesthesiology 2000; 92:958.

4.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. Paediatr Anaesth 2006; 16:49.

5.Ashok V, Bala I, Bharti N, et al. Effects of intraoperative liberal fluid therapy on postoperative nausea and vomiting in children-A randomized controlled trial. Paediatr Anaesth 2017; 27:810.

6.Sanford EL, Zurakowski D, Litvinova A, et al. The association between high-volume intraoperative fluid administration and outcomes among pediatric patients undergoing large bowel resection. Paediatr Anaesth 2019; 29:315.

7.Zorrilla-Vaca A, Marmolejo-Posso D, Stone A, et al. Perioperative Dextrose Infusion and Postoperative Nausea and Vomiting: A Meta-analysis of Randomized Trials. Anesth Analg 2019; 129:943.

8.Yokoyama C, Mihara T, Kashiwagi S, et al. Effects of intravenous dextrose on preventing postoperative nausea and vomiting: A systematic review and meta-analysis with trial sequential analysis. PLoS One 2020; 15:e0231958.

9.Apfel CC, Korttila K, Abdalla M, et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med 2004; 350:2441.

10.Elbakry AE, Sultan WE, Ibrahim E. A comparison between inhalational (Desflurane) and total intravenous anaesthesia (Propofol and dexmedetomidine) in improving postoperative recovery for morbidly obese patients undergoing laparoscopic sleeve gastrectomy: A double-blinded randomised controlled trial. J Clin Anesth 2018; 45:6.

11.Wang JJ, Ho ST, Lee SC, et al. The use of dexamethasone for preventing postoperative nausea and vomiting in females undergoing thyroidectomy: a dose-ranging study. Anesth Analg 2000; 91:1404.

12.Weren M, Demeere JL. Methylprednisolone vs. dexamethasone in the prevention of postoperative nausea and vomiting: a prospective, randomised, double-blind, placebo-controlled trial. Acta Anaesthesiol Belg 2008; 59:1.

13.Kranke P, Morin AM, Roewer N, Eberhart LH. Dimenhydrinate for prophylaxis of postoperative nausea and vomiting: a meta-analysis of randomized controlled trials. Acta Anaesthesiol Scand 2002; 46:238.

14.Gan TJ, Glass PS, Howell ST, et al. Determination of plasma concentrations of propofol associated with 50% reduction in postoperative nausea. Anesthesiology 1997; 87:779.

15.Som A, Bhattacharjee S, Maitra S, et al. Combination of 5-HT3 Antagonist and Dexamethasone Is Superior to 5-HT3 Antagonist Alone for PONV Prophylaxis After Laparoscopic Surgeries: A Meta-analysis. Anesth Analg 2016; 123:1418.

16.Vallejo MC, Phelps AL, Ibinson JW, et al. Aprepitant plus ondansetron compared with ondansetron alone in reducing postoperative nausea and vomiting in ambulatory patients undergoing plastic surgery. Plast Reconstr Surg 2012; 129:519.

17.Sinha AC, Singh PM, Williams NW, et al. Aprepitant's prophylactic efficacy in decreasing postoperative nausea and vomiting in morbidly obese patients undergoing bariatric surgery. Obes Surg 2014; 24:225.

18.de Morais LC, Sousa AM, Flora GF, et al. Aprepitant as a fourth antiemetic prophylactic strategy in high-risk patients: a double-blind, randomized trial. Acta Anaesthesiol Scand 2018; 62:483.

19.Splinter WM. Prevention of vomiting after strabismus surgery in children: dexamethasone alone versus dexamethasone plus low-dose ondansetron. Paediatr Anaesth 2001; 11:591.

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