Enhanced recovery after surgery (ERAS) is a protocol designed to improve perioperative outcomes by multidisciplinary team with evidence-based interventions. The implementation of ERAS concept has been proved to reduce postoperative complications and hospital stay. The anesthesia management under the concept of ERAS is the basis of safe and smooth ambulatory surgical protocol. This article summarizes the latest clinical evidence at home and abroad, and reviews the preoperative optimization, anesthesia mode selection, ventilation strategies, fluid management, temperature support, pain management, postoperative nausea and vomiting prevention, postoperative nutritional support, and postoperative sleep improvement in the management of anesthesia under ERAS concept, in order to provide a reference for anesthesia management in ambulatory surgery.
目的:探讨恶心呕吐的病因,为临床诊断提供依据,避免漏误诊发生。方法:消化内科住院患者128例出现恶心和（或）呕吐症状,对其病因统计分析。结果:恶心呕吐常见病为反流性食管炎、巨幼贫、胆系结石、颅内占位和功能性消化不良。其它尚有十二指肠溃疡、粪石梗阻、肝功损害、肠系膜动脉缺血、急性阑尾炎、腹部术后和流行性出血热(EHF)等。乙型肝炎与十二指肠溃疡有关,急性支气管炎、白细胞减少症和溃疡性结肠炎可有恶心呕吐表现。结论:恶心呕吐常见,病因有时难以确定,尤其是慢性起病者。病因的诊断应详询病史、仔细诊查、结合诊断学有关知识及有关检查,不应圉于消化系疾病。
目的 探讨腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）中不同CO2气腹压力对患者肝功能、动脉血气及对颈、肩痛的影响。方法 选择行择期LC术患者120例，采用随机数字表法，按住院先后顺序对应入组，随机均分为气腹压力10mmHg （1 mm Hg=0.133kPa）组、12mmHg组及14mmHg组3组；对比分析3组患者手术后肝功能、血气指标以及术后当天、第1和第2天恶心、呕吐及颈肩部疼痛的发生率。结果 3组患者术前各参数组间比较差异均无统计学意义（P＞0.05）。术后肝功能及血气分析指标的改变3组间的差异有统计学意义（P＜0.05），气腹压力越大，其术后AST、ALT及TBIL水平升高越明显，而pH及PO2的下降越明显，PCO2的升高也越明显；术后患者颈、肩痛及恶心呕吐发生率3组间比较差异也有统计学意义（P＜0.05），气腹压力越大，术后颈、肩痛及恶心呕吐发生率越高。结论 CO2气腹压力对术后肝功能及动脉血气指标的改变以及术后颈、肩痛和恶心呕吐发生率有明显影响。
Objective To explore the nursing effect of using Neiguan acupoint massage combined with chewing gum in patients undergoing day-case laparoscopic cholecystectomy. Methods A prospective study was conducted on patients who underwent day-case laparoscopic cholecystectomy in West China Hospital of Sichuan University between March 2023 and March 2024. The patients were randomly divided into the control group and the intervention group according to a random number table. The control group received routine care, while the intervention group received chewing gum and Neiguan acupoint massage intervention at the P6 acupoint in addition to routine care. The incidence of postoperative nausea and vomiting (PONV), pain scores, gastrointestinal function recovery time, medication use, and hospitalization related indicators were compared between the two groups of patients after surgery. Results A total of 298 patients were included. Among them, there were 163 cases in the control group and 135 cases in the intervention group. The incidence of PONV at 0.5 and 2 hours after surgery and the pain scores at 6, 12, and 24 hours after surgery in the intervention group were lower than those in the control group (P<0.05). The first bowel sounds recovery time, anal exhaust time, and eating time in the intervention group were shorter than those in the control group (P<0.05). Twenty-four hours after surgery, the usage rate of analgesic drugs (6.67% vs. 14.11%) and the usage rate of rescue antiemetic drugs (2.96% vs. 8.59%) in the intervention group were lower than those in the control group (P<0.05). There was no statistically significant difference in the delayed discharge rate or total cost between the two groups (P>0.05). The nursing satisfaction of the intervention group was higher than that of the control group (99.26% vs. 93.25%, P<0.05). Conclusions After the combination of Neiguan acupoint massage and chewing gum intervention in patients undergoingin day-case laparoscopic cholecystectomy, the PONV incidence and pain are significantly reduced, gastrointestinal functions recover faster, drug use rate is low, patient nursing satisfaction is high. This method can be promoted and applied.
ObjectiveTo systematically review the effect of dexamethasone in preventing post-operative nausea and vomiting (PONV) associated with epidural opioids for post-cesarean section analgesia. MethodsWe searched PubMed, EMbase, CNKI, WanFang Data and CBM databases from inception to Dec. 31th 2015, to collect randomized controlled trials (RCTs) comparing dexamethasone with placebo/blank for the prevention of PONV associated with epidural opioids for postcesarean section analgesia. Two reviewer independently screened literature, extracted data, and assess the risk of bias of included studies. Then, meta-analysis was conducted by using RevMan 5.3 software. ResultsA total of 11 RCTs from 10 papers involving 1 011 patients were included. The results of meta-analysis showed that, compared with the placebo/ blank group, the dexamethasone group had lower incidence rates of post-operative nausea (RR=0.50, 95% CI 0.39 to 0.65, P < 0.000 01), postoperative vomiting (RR=0.39, 95% CI 0.29 to 0.52, P < 0.000 01), PONV (RR=0.37, 95% CI 0.30 to 0.46, P < 0.000 01), and rescue antiemetic (RR=0.34, 95% CI 0.19 to 0.62, P=0.000 5). ConclusionsCurrent evidence indicates that dexamethasone is effective for preventing PONV after epidural opioids for post-cesarean section analgesia. Due to the limited quantity and quality of the included studies, the above conclusion needs to be further verified by more high quality studies.
ObjectiveTo compare the postoperative nausea and vomiting (PONV) after laparoscopic sleeve gastrectomy (LSG) and single-anastomosis sleeve ileal bypass (SASI), and to explore the risk factors for PONV. MethodA total of 220 patients at the Affiliated Hospital of Xuzhou Medical University from June 2022 to December 2022 were prospectively collected, and were randomly divided into the LSG group and the SASI group; the general condition of the patients was recorded. PONV was assessed on the POD0, POD1, POD2, POD30, POD60, POD90, using the Rhodes index score.ResultsThe total Rhodes index score in the LSG group was higher than that in the SASI group [(25.56±13.54) vs. (16.06±11.28), P＜0.05]. The results of multiple linear regression analysis showed that female (P=0.014), LSG (P＜0.001), young age (P=0.050), and low BMI (P=0.019) were risk factors for PONV. ConclusionsCompared with LSG, the Rhodes index score after SASI is low. For young women with low BMI, special attention should be paid to the prevention and treatment of PONV after LSG.
Objective To explore whether bundled care for anesthesia management can reduce the risk of postoperative nausea and vomiting (PONV). Methods The data of laparoscopic cholecystectomy patients admitted to the Day Surgery Center of West China Hospital, Sichuan University between July and November 2021 were retrospectively collected. Patients were divided into a bundled care group and a control group based on whether anesthesia management was implemented according to the bundled care. The demographic characteristics, intraoperative anesthesia management methods, postoperative conditions, and incidence of PONV between the two groups of patients were analyzed and compared. Results A total of 314 patients were included. Among them, there were 124 cases in the bundled care group and 190 cases in the control group; PONV occurred in 52 cases, the incidence of PONV was 16.6% (52/314). Except for surgical time and postoperative incision infiltration (P>0.05), there were statistically significant differences in age, gender, body mass index, anesthesia time, airway establishment, and postoperative analgesic use between the two groups of patients (P<0.05). There was no statistically significant difference in the occurrence of PONV between the bundled care group and the control group (17 vs. 35 cases; χ2=1.205, P>0.05). The results of logistic regression analysis showed that PONV was correlated with gender [odds ratio=0.107, 95% confidence interval (0.030, 0.375), P<0.001], and using bundled care [odds ratio=0.388, 95% confidence interval (0.169, 0.894), P=0.026]. Conclusions Women are at high risk of PONV among patients undergoing day laparoscopic cholecystectomy. The risk of PONV is lower when using bundled care.
目的 探讨针刺治疗在防治术后恶心呕吐（PONV）中的作用与疗效。 方法 通过对2012年6月收治的1例全身麻醉下行小脑血肿清除术后出现持续性恶心呕吐症状，后辅以针刺治疗好转的病例报道，就针刺治疗对PONV的穴位选择，刺激方式，介入时间等相关研究进行复习和总结。 结果 患者恶心呕吐症状在选取中脘、足三里（双）、内关（双）穴针刺治疗3次后（30 min/次）明显减少，自诉恶心程度较前缓解，连续针灸6次后呕吐现象得到有效控制。 结论 目前有关针刺治疗PONV的研究越来越多，但尚无统一的治疗标准。