文献综述

儿童日间手术术后恶心呕吐防治策略及研究进展

  • 甘欣艳 ,
  • 李想 ,
  • 邱倩怡 ,
  • 陈芳
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  • 1.南方科技大学深圳市儿童医院麻醉科 (广东深圳 518038)
    2.深圳大学深圳市儿童医院麻醉科 (广东深圳 518038)
陈芳 电子信箱:18938690929@163.com

收稿日期: 2025-12-15

  录用日期: 2026-01-22

  网络出版日期: 2026-03-06

Progress in prevention and management strategies of postoperative nausea and vomiting in pediatric day surgery

  • GAN Xinyan ,
  • LI Xiang ,
  • QIU Qianyi ,
  • CHEN Fang
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  • 1. Department of Anesthesiology, Shenzhen Children’s Hospital, Southern University of Science and Technology, Shenzhen 518038, Guangdong, China
    2. Department of Anesthesiology, Shenzhen Children’s Hospital, Shenzhen University, Shenzhen 518038, Guangdong, China

Received date: 2025-12-15

  Accepted date: 2026-01-22

  Online published: 2026-03-06

摘要

术后恶心呕吐(PONV)是儿童日间手术后最常见的并发症之一,发生率高达70%~80%,严重影响患儿舒适度、恢复进程及日间手术效率。随着日间手术模式在儿科的广泛应用,PONV防治已成为围手术期管理的关键环节。然而,儿童生理结构特殊、手术类型多样,且目前防治策略尚缺乏统一标准,亟须系统整合现有证据以指导临床实践。本综述旨在总结儿童日间手术PONV的危险因素、评估工具、药物与非药物预防措施的最新进展,并探讨多模式联合防治策略在优化PONV管理中的价值,以期为临床提供科学、规范的防治参考,提升患儿手术体验与康复质量。

本文引用格式

甘欣艳 , 李想 , 邱倩怡 , 陈芳 . 儿童日间手术术后恶心呕吐防治策略及研究进展[J]. 临床儿科杂志, 2026 , 44(3) : 270 -276 . DOI: 10.12372/jcp.2026.25e1575

Abstract

Postoperative nausea and vomiting (PONV) is one of the most common complications following pediatric day surgery, with an incidence ranging from 70% to 80%. It significantly impacts patient comfort, recovery progress, and the efficiency of day surgery. With the widespread implementation of the day surgery model in pediatrics, the prevention and management of PONV have become a crucial component of perioperative care. However, factors such as the unique physiological characteristics of children, the diversity of surgical procedures, and the current lack of standardized prevention and management strategies necessitate the systematic integration of existing evidence to guide clinical practice. This review aims to summarize the latest advancements in risk factors, assessment tools, pharmacological and non-pharmacological preventive measures for PONV in pediatric day surgery. It also explores the value of multimodal combined prevention strategies in optimizing PONV management. The goal is to provide scientific and standardized references for clinical practice, thereby improving the surgical experience and recovery quality for pediatric patients.

参考文献

[1] Kovac AL. Postoperative nausea and vomiting in pediatric patients[J]. Paediatr Drugs, 2021, 23(1): 11-37.
[2] Gan TJ, Belani KG, Bergese S, et al. Fourth consensus guidelines for the management of postoperative nausea and vomiting[J]. Anesth Analg, 2020, 131(2): 411-448.
[3] 马洪升, 程南生, 朱涛, 等. 华西医院日间手术快速康复(ERAS)规范[J]. 中国胸心血管外科临床杂志, 2016, 23(2): 104-106.
  Ma HS, Cheng NS, Zhu T, et al. Standard of enhanced recovery after surgery for day surgery in West China Hospital[J]. Zhongguo Xiongxinxueguan Waike Linchuang Zazhi, 2016, 23(2): 104-106.
[4] Kim MS, Lee JR, Choi EM, et al. Association of 5-HT3B receptor gene polymorphisms with the efficacy of ondansetron for postoperative nausea and vomiting[J]. Yonsei Med J, 2015, 56(5): 1415-1420.
[5] Sayed JA, F Riad MA, M Ali MO. Comparison of dexamethasone or intravenous fluids or combination of both on postoperative nausea, vomiting and pain in pediatric strabismus surgery[J]. J Clin Anesth, 2016, 34: 136-142.
[6] Messerer B, Stijic M, Sandner-Kiesling A, et al. Is PONV still a problem in pediatric surgery: a prospective study of what children tell us[J]. Front Pediatr, 2023, 11: 1241304.
[7] Sümer I, Uysal H, Ye?ilta? S, et al. The effect of intraoperative body temperature on postoperative nausea and vomiting in pediatric patients[J]. J Perianesth Nurs, 2021, 36(6): 706-710.
[8] 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[J]. Paediatr Anaesth, 2017, 27(8): 810-815.
[9] Mou Y, Zhao W, Pan W, et al. A comparison of ondansetron in preventing postoperative nausea and vomiting for patients with or without preoperative anxiety with painless egg retrieval: a prospective, randomized, controlled trial[J]. Gland Surg, 2024, 13(8): 1522-1534.
[10] Pomicino L, Maccacari E, Buchini S. Levels of anxiety in parents in the 24 hr before and after their child's surgery: a descriptive study[J]. J Clin Nurs, 2018, 27(1-2): 278-287.
[11] Eberhart LH, Morin AM, Guber D, et al. Applicability of risk scores for postoperative nausea and vomiting in adults to paediatric patients[J]. Br J Anaesth, 2004, 93(3): 386-392.
[12] Hou M, Wu L, Wei Z, et al. Elevated serum pepsinogen level predicts postoperative nausea and vomiting and pain in females with obesity following laparoscopic sleeve gastrectomy[J]. Int J Obes (Lond), 2025, 49(4): 665-672.
[13] Fan D, Yin Q, Li D, et al. Development and validation of a machine learning-based predictive model for postoperative nausea and vomiting in patients undergoing day-case laparoscopic cholecystectomy: a single-centre retrospective study[J]. BMJ Open, 2025, 15(10): e093884.
[14] Huddart R, Altman RB, Klein TE. PharmGKB summary: Ondansetron and tropisetron pathways, pharmacokinetics and pharmacodynamics[J]. Pharmacogenet Genomics, 2019, 29(4): 91-97.
[15] Chen H, Sun L, Zheng J, et al. Palonosetron versus tropisetron with dexamethasone for prevention of postoperative nausea and vomiting in pediatric adeno-tonsillectomy: a single center, randomized controlled trial[J]. Front Med (Lausanne), 2025, 12: 1549619.
[16] Singh PM, Borle A, Gouda D, et al. Efficacy of palonosetron in postoperative nausea and vomiting (PONV)-a meta-analysis[J]. J Clin Anesth, 2016, 34: 459-482.
[17] Steward DL, Grisel J, Meinzen-Derr J. Steroids for improving recovery following tonsillectomy in children[J]. Cochrane Database Syst Rev, 2011, 2011(8): CD003997.
[18] Murakami C, Kakuta N, Satomi S, et al. Neurokinin-1 receptor antagonists for postoperative nausea and vomiting: a systematic review and meta-analysis[J]. Braz J Anesthesiol, 2020, 70(5): 508-519.
[19] Sun J, Cao X, Lu T, et al. Penehyclidine mitigates postoperative nausea and vomiting and intraoperative oculocardiac reflex in patients undergoing strabismus surgery: a prospective, randomized, double-blind comparison[J]. BMC Anesthesiol, 2021, 21(1): 49.
[20] Chiang FW, Chang JL, Hsu SC, et al. Dexmedetomidine use in pediatric strabismus surgery: A systematic review and meta-analysis[J]. PLoS One, 2020, 15(10): e0240553.
[21] 范小丽, 贺伟忠, 苏凡. 眼科日间手术患儿术前2h口服清饮对术后恶心呕吐的影响[J]. 护理学杂志, 2017, 32(2): 38-40.
  Fan XL, He WZ, Su F. Impact of oral intake of clear liquids two hours before ophthalmic day surgery on postoperative nausea and vomiting in children[J]. Hulixue Zazhi, 2017, 32(2): 38-40.
[22] 金芝芝, 王闰平, 王雅静, 等. 虚拟现实技术在儿童医疗辅导中的应用进展[J]. 中国护理管理, 2024, 24(12): 1863-1867.
  Jin ZZ, Wang RP, Wang YP, et al. Application progress on virtual reality in child life[J]. Zhongguo Huli Guanli, 2024, 24(12): 1863-1867.
[23] Xiao H, Ying H, Wang Y, et al. Application of the information-motivation-behavioral skill model in the perioperative period of pediatric day-case surgery[J]. J Surg Res, 2025, 313: 112-119.
[24] Nathan N. Propofol: a superior strategy for PONV[J]. Anesth Analg, 2024, 139(1): 25.
[25] Frelich M, Sklienka P, Romanová T, et al. The effect of BIS-guided anaesthesia on the incidence of postoperative nausea and vomiting in children: a prospective randomized double-blind study[J]. BMC Anesthesiol, 2024, 24(1): 228.
[26] Puri S, Bandyopadhyay A, Ashok V. Supplemental intraoperative crystalloids for pediatric postoperative nausea and vomiting-A systematic review and meta-analysis[J]. Paediatr Anaesth, 2023, 33(1): 38-45.
[27] Benhamou D. Postoperative nausea and vomiting: is the big little problem becoming a smaller little problem?[J]. Br J Anaesth, 2023, 131(1): 22-25.
[28] Mieszczański P, Jurczak M, Cylke R, et al. Evidence-based perioperative prevention of postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic bariatric surgery: a scoping review[J]. J Clin Med, 2025, 14(19): 6901.
[29] Yang XY, Xiao J, Chen YH, et al. Dexamethasone alone vs in combination with transcutaneous electrical acupoint stimulation or tropisetron for prevention of postoperative nausea and vomiting in gynaecological patients undergoing laparoscopic surgery[J]. Br J Anaesth, 2015, 115(6): 883-889.
[30] Griffin K L, Svetanoff W J, Diefenbach K, et al. Implementation of an ERAS protocol for pediatric metabolic and bariatric surgery: a single institutional perspective and lessons learned[J]. J Pediatr Surg, 2024, 6: 100131.
[31] Moser JJ, Walker AM, Spencer AO. Point-of-care paediatric gastric sonography: can antral cut-off values be used to diagnose an empty stomach?[J]. Br J Anaesth, 2017, 119(5): 943-947.
[32] Chatterjee S, Arora RC, Crisafi C, et al. State of the art: proceedings of the American association for thoracic surgery enhanced recovery after cardiac surgery summit[J]. JTCVS Open, 2023, 14: 205-213.
[33] Kim S, Song Y. Effects of early oral hydration on postextubation thirst, nausea, and vomiting in cardiac surgery patients: a randomized controlled trial[J]. J Perianesth Nurs, 2025, S1089-9472(25)00168-6.
[34] Kang MR, Seo HJ, Lee JS, et al. The effects of early oral intake in the postanesthesia care unit on nausea and vomiting: a meta-analysis of randomized controlled trials[J]. J Perianesth Nurs, 2025, 40(5): 1366-1374.
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