目的:术后恶心呕吐(PONV)是一种常见的无吸引力的腹腔镜袖状胃切除术(LSG)后遗症。这项研究的目的是确定患病率,PONV的危险因素,以及LSG后PONV的管理。
方法:这项多中心回顾性研究包括2022年1月至2023年4月期间患有LSG的病态肥胖患者。LSG的年龄范围是16到65岁,根据国际指南,资格要求包括病态肥胖。
结果:74.6%的患者在术后6小时接受LSG治疗后发生PONV。多变量分析表明,女性性别,吸烟者,术前GERD,胃切除术,发现疼痛的严重程度是PONV发展的独立风险变量,在保存窦的同时,无阿片类药物镇痛,发现术中联合镇痛是对抗PONV发展的独立保护性变量。联合静脉内昂丹司琼和甲氧氯普胺可改善发生PONV的92.6%患者。42例持续性PONV患者静脉注射昂丹司琼和甲氧氯普胺后给予地塞米松和抗组胺药。术后疼痛管理无阿片类药物镇痛管理PONV。幽门螺杆菌地位在LSG后PONV的发展中没有感化。
结论:女性性别,吸烟,术前是否存在GERD,胃切除术,发现疼痛的严重程度是PONV发展的独立风险变量,在保存窦的同时,无阿片类药物镇痛,术中联合镇痛是预防PONV发生的独立保护因素。静脉注射昂丹司琼和甲氧氯普胺可改善PONV。给予地塞米松和抗组胺药物治疗持续性PONV。
Postoperative nausea and vomiting (PONV) is a frequent unappealing laparoscopic sleeve gastrectomy (LSG) sequel. The study\'s purpose was to determine the prevalence, risk factors of PONV, and management of PONV after LSG.
This multicenter retrospective study included patients with morbid obesity who had LSG between January 2022 and April 2023. The age range for LSG was 16 to 65 years, and the eligibility requirements included morbid obesity according to international guidelines.
PONV was experienced by 74.6% of patients who underwent LSG at 6 h postoperative. Multivariate analysis revealed that female gender, smokers, preoperative GERD, gastropexy, and severity of pain were found to be independent risk variables of the development of PONV, while antral preservation, opioid-free analgesia, and intraoperative combined analgesia were found to be independent protective variables against the development of PONV. Combined intravenous ondansetron and metoclopramide improved 92.6% of patients who developed PONV. Dexamethasone and antihistamines drugs are given for 42 cases with persistent PONV after using intravenous ondansetron and metoclopramide. Pain management postoperatively by opioid-free analgesia managed PONV. Helicobacter pylori status has no role in the development of PONV after LSG.
Female gender, smoking, presence of preoperative GERD, gastropexy, and severity of pain were found to be independent risk variables of the development of PONV, while antral preservation, opioid-free analgesia, and intraoperative combined analgesia were observed to be independent protective factors against the occurrence of PONV. Combined intravenous ondansetron and metoclopramide improved PONV. Dexamethasone and antihistamines drugs are given for persistent PONV.