脊柱外科手术后恶心呕吐的防治策略：从风险评估到多模式管理

Prevention and Management Strategies for Postoperative Nausea and Vomiting in Spinal Surgery: From Risk Assessment to Multimodal Management

摘要: 术后恶心呕吐是脊柱外科手术后最常见、最令患者痛苦的并发症之一。由于其手术时间长、体位特殊、阿片类药物需求量大等特点，脊柱外科患者属于PONV的极高危人群。PONV不仅导致患者严重不适、脱水、电解质紊乱，还可能因剧烈呕吐引起切口张力增高、出血、内固定应力增加，甚至诱发罕见的颈髓或脑干损伤，严重影响手术效果和患者康复进程。因此，系统性的PONV管理已成为脊柱外科加速康复外科(ERAS)路径中的核心环节。本文旨在全面综述脊柱外科PONV的流行病学、病理生理机制、特殊风险因素，并重点阐述从个体化风险评估、到多模式预防、再到分层治疗的完整管理策略。通过整合最新的循证医学证据和临床实践指南，为临床工作者提供一个科学、系统、可操作的PONV防治框架，以最终改善患者预后、提升医疗质量。

Abstract: Postoperative nausea and vomiting (PONV) is one of the most common and distressing complications following spinal surgery. Due to characteristics such as prolonged operative duration, unique surgical positioning, and high demand for opioid analgesics, patients undergoing spinal procedures are at exceptionally high risk for PONV. PONV not only causes significant patient discomfort, dehydration, and electrolyte imbalances but may also lead to increased wound tension, bleeding, and stress on internal fixation devices due to severe vomiting, and in rare cases, may even induce cervical spinal cord or brainstem injury. These complications can severely impact surgical outcomes and delay patient recovery. Consequently, systematic PONV management has become a core component of Enhanced Recovery After Surgery (ERAS) pathways in spinal surgery. This review aims to comprehensively summarize the epidemiology, pathophysiological mechanisms, and specific risk factors of PONV in spinal surgery, with a focus on detailing a complete management strategy encompassing individualized risk assessment, multimodal prevention, and stratified treatment. By integrating the latest evidence-based medical findings and clinical practice guidelines, this paper provides healthcare professionals with a scientific, systematic, and actionable framework for PONV prevention and management, ultimately aiming to improve patient outcomes and enhance the quality of care.