笑气与术后恶心呕吐的关系.pdf

Anesthesiology 2014；120：1137-45 BACKGROUND  Postoperative nausea and vomiting(PONV )is a common and distressing complication of anesthesia 全麻后恶心呕吐（PONV）延长患者滞留时间和出院时 间，同时导致一系列的并发症如脱水、电解质紊乱、伤 口裂开、误吸等，增加患者痛苦和经济负担，降低手术 质量 BACKGROUND PONV危险因素主要为三方面 一是病人因素，包括女性、非吸烟、有晕动病史、 有PONV史等； 二是麻醉因素，全麻使用的药物如部分吸入麻醉药、阿 片类药物等； 三是手术因素，手术时间>3小时、涉及口颌面部的手术 等 BACKGROUND  A recent meta-analysis showed that, whereas the risk ratio (RR) for PONV was increased by 20% where nitrous oxide was used BACKGROUND  Avoidance of nitrous oxide has been recommended as a strategy to reduce the risk of PONV after general anesthesia  We conducted an updated literature review and metaregression analysis to determine whether duration of expo- sure to nitrous oxide in published randomized trials was related to the incidence of PONV. METHODS a primary search was performed using an electronic database in the form of PubMed with the search terms “nitrous oxide and nausea,” “vomiting,” or “PONV” METHODS The study protocol restricted the search to published Englishlanguage articles in PubMed listed journals reporting trials in adults, which prospectively allocated patients by randomization to groups receiving a nitrous oxide or nitrous oxide–free anesthetic for surgery, where the incidence of PONV within the first 24 postoperative hours was reported in each group, and where the mean or median duration of anesthesia (or duration of surgery if this was not presented) was reported or could be estimated from the data presented PUBMED中检索关 键字，共检索到43 篇相关文章 对于使用静脉而不 是笑气吸入 及PONV发生率为0 的文章予以排除， 剩下27篇文章 27篇文章中，4篇 文章再次分组中 存在丙泊酚与空白 对照组比较，将再 次分组中共143例 排除 最后纳入27篇文章 共29个临床研究 试验对象10317例 CONCLUSIONS  吸入笑气持续的时间越长，发生PONV的可能性越大  当吸入笑气时间大于1小时，笑气的这种影响会更明显 LIMITATIONS  Propofol  High Fio2  Other factors MECHANISMS  an action on central opioid and dopaminergic MECHANISMS  diffusion of nitrous oxide into the middle ear cavity rapid increases in middle ear pressures have been demonstrated in animal models and humans after commencement of nitrous oxide, approaching a peak within 20 to 30 min MECHANISMS  bowel distension Meta-analysis has shown that the degree of bowel distension with nitrous oxide anesthesia is related to duration of anesthesia, with an odds ratio of 2.09 for each additional hour of exposure. Nitrous oxide–related PONV is clinically insignificant up to at least 1h of exposure and should not be seen as an impediment to nitrous oxide use for limited periods of time, such as in minor or ambulatory surgery. THANKS!