术中低体温与术后恶心呕吐的关系

The Relationship between Intraoperative Hypothermia and Postoperative Nausea and Vomiting

摘要: 本文探讨了术中低体温与术后恶心呕吐(PONV)之间的潜在关联及其临床意义。术中低体温是围术期常见的并发症，发生率高达35.28%，与多种不良结局密切相关，但其对PONV的影响尚未得到充分重视。现有研究表明，术中低体温可能通过影响胃肠血流灌注、激活化学感受器触发区(CTZ)、干扰体温调节中枢等机制，间接或直接增加PONV的发生率。尽管既往研究多聚焦于PONV的药物预防，但对术中低体温的管理不足可能削弱了这些干预措施的效果。本文通过系统回顾流行病学证据、生物学机制及临床干预研究，提出将术中低体温纳入PONV风险评估体系，并强调在加速康复外科(ERAS)路径中整合体温管理与PONV防控的重要性。未来研究应通过大样本多中心随机对照试验进一步验证术中低体温与PONV的因果关系，并探索基于体温调节的个体化PONV预防策略，以优化围术期管理，降低PONV发生率，提升患者术后康复质量。

Abstract: This study explores the potential association between intraoperative hypothermia and postoperative nausea and vomiting (PONV) and its clinical implications. Intraoperative hypothermia is a common perioperative complication, with an incidence as high as 35.28%, and is closely associated with a variety of adverse outcomes; however, its impact on PONV has not been fully recognized. Current evidence suggests that intraoperative hypothermia may increase the incidence of PONV directly or indirectly through mechanisms such as impaired gastrointestinal perfusion, activation of the chemoreceptor trigger zone (CTZ), and disruption of central thermoregulatory pathways. Although previous studies have primarily focused on pharmacological prophylaxis for PONV, insufficient management of intraoperative hypothermia may undermine the effectiveness of these interventions. This review systematically examines epidemiological evidence, underlying biological mechanisms, and clinical intervention studies, proposing the inclusion of intraoperative hypothermia in PONV risk assessment models and highlighting the importance of integrating temperature management with PONV prevention within Enhanced Recovery After Surgery (ERAS) pathways. Future research should employ large-scale, multicenter randomized controlled trials to further validate the causal relationship between intraoperative hypothermia and PONV, and explore individualized, temperature-based PONV prophylactic strategies to optimize perioperative care, reduce PONV incidence, and improve postoperative recovery quality.