背景:腹腔镜袖状胃切除术(LSG)与术后恶心和呕吐(PONV)相关。我们旨在比较阿瑞匹坦对LSG术后PONV发生率的影响。
方法:在这种双盲中,随机对照试验,病例组接受标准的PONV治疗方案(地塞米松10mg,昂丹司琼4毫克,和甲氧氯普胺10毫克)加术前1小时预防性口服阿瑞吡坦80毫克。对照组接受标准护理加安慰剂。在术后0、6、12和24h使用Rhodes指数进行比较分析。
结果:共有400名患者(阿瑞吡坦组201名,安慰剂组199名)接受了LSG。这些群体是同质的。阿瑞吡坦组较少经历PONV:早期,69(34.3%)与103(51.7%),p≤0.001;6小时,67(33.3%)与131(65.8%),p≤0.001;12小时,41(20.4%)与115(57.8%),p≤0.001;和24小时,22(10.9%)与67(33.7%),p≤0.001。阿瑞吡坦组中呕吐的患者较少:早期,3(1.5%)与5(2.5%),p=0.020;6h,6(3%)vs.18(9%),p=0.020;12h,2(1%)与17(8.5%),p=0.006;和24小时,1(0.5%)与6(3%),p=0.040。阿瑞吡坦组中的患者需要较少的额外PONV药物:早期,61(30.3%)与86(43.2),p=0.008;6h,7(3.5%)与34(17%),p=0.001;12小时,6(3%)vs.31(15.6%),p≤0.001;和24小时,5(2.5%)与11(5.5%),p≤0.001。
结论:预防性阿瑞吡坦可改善LSG患者术后0小时(早期)至24小时的PONV。
BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is associated with postoperative nausea and vomiting (
PONV). We aimed to compare the effects of aprepitant on the incidence of
PONV after LSG.
METHODS: In this double-blind, randomized controlled trial, the case group received the standard care regimen for
PONV (dexamethasone 10 mg, ondansetron 4 mg, and metoclopramide 10 mg) plus prophylactic oral aprepitant 80 mg 1 h preoperatively. The control group received standard care plus a placebo. Comparative analyses using the Rhodes index were performed at 0, 6, 12, and 24 h postoperatively.
RESULTS: A total of 400 patients (201 in the aprepitant group and 199 in the placebo group) underwent LSG. The groups were homogeneous. The aprepitant group experienced less
PONV: early, 69 (34.3%) vs. 103 (51.7%), p ≤ 0.001; 6 h, 67 (33.3%) vs. 131 (65.8%), p ≤ 0.001; 12 h, 41 (20.4%) vs. 115 (57.8%), p ≤ 0.001; and 24 h, 22 (10.9%) vs. 67 (33.7%), p ≤ 0.001. Fewer patients in the aprepitant group vomited: early, 3 (1.5%) vs. 5 (2.5%), p = 0.020; 6 h, 6 (3%) vs. 18 (9%), p = 0.020; 12 h, 2 (1%) vs. 17 (8.5%), p = 0.006; and 24 h, 1 (0.5%) vs. 6 (3%), p = 0.040. Patients in the aprepitant group required less additional
PONV medication: early, 61 (30.3%) vs. 86 (43.2), p = 0.008; 6 h, 7 (3.5%) vs. 34 (17%), p = 0.001; 12 h, 6 (3%) vs. 31 (15.6%), p ≤ 0.001; and 24 h, 5 (2.5%) vs. 11 (5.5%), p ≤ 0.001.
CONCLUSIONS: Prophylactic aprepitant improved PONV between 0 h (early) and 24 h postoperatively in patients undergoing LSG.