基于ERAS理念的脊柱术后PONV多模式防治方案研究进展

Research Progress on Multimodal Prevention and Treatment of Postoperative Nausea and Vomiting after Spinal Surgery Based on ERAS Concept

摘要: 术后恶心呕吐(Postoperative Nausea and Vomiting, PONV)是脊柱手术后发生率较高的围术期并发症，受手术创伤、麻醉方案、患者个体差异等多重因素影响，其总体发生率可达30%~80%，在女性、有PONV病史、非吸烟及术后使用阿片类药物等高危人群中发生率更超70%。PONV不仅会引发患者主观不适，还可能诱发水电解质紊乱、伤口血肿或裂开、吸入性肺炎、颅内压升高等严重不良事件，延长患者术后卧床时间与住院周期，降低康复效率，同时增加额外诊疗费用，加重医疗资源负担，与加速康复外科(Enhanced Recovery after Surgery, ERAS)“减少应激、优化路径、快速康复”的核心理念存在显著冲突。ERAS作为一种以循证医学为基础的围术期管理模式，强调多学科协作与全流程干预，通过术前优化、术中调控、术后康复的闭环管理，最大程度减轻手术对机体的生理干扰。本文基于ERAS理念核心，系统梳理近年国内外相关研究进展，深入剖析脊柱术后PONV的发生机制与关键危险因素，阐述临床常用的风险分层评估工具与应用要点，重点总结围术期药物与非药物结合的多模式防治策略，同时探讨当前临床实践中存在的问题与未来研究方向，旨在为脊柱术后PONV的规范化、个体化管理提供循证依据，进一步推动ERAS理念在脊柱外科领域的深度融合与落地实施，助力提升脊柱手术患者的围术期安全与康复质量。

Abstract: Postoperative Nausea and Vomiting (PONV) is a common perioperative complication with a high incidence after spinal surgery, ranging from 30% to 80%. Its occurrence is influenced by multiple factors, including surgical trauma, anesthesia regimens, and individual patient differences. In high‑risk groups, such as female patients, those with a history of PONV, non‑smokers, and individuals requiring postoperative opioid use, the incidence can exceed 70%. PONV not only causes subjective discomfort but may also lead to serious adverse events, such as fluid and electrolyte imbalances, wound hematoma or dehiscence, aspiration pneumonia, and increased intracranial pressure. These complications can prolong bed rest and hospital stays, delay recovery efficiency, increase additional medical costs, and intensify the burden on healthcare resources. This clearly conflicts with the core principles of Enhanced Recovery after Surgery (ERAS), which emphasize “reducing stress, optimizing pathways, and promoting rapid recovery”. As an evidence‑based perioperative management model, ERAS focuses on multidisciplinary collaboration and comprehensive intervention throughout the entire perioperative process. Through preoperative optimization, intraoperative regulation, and postoperative rehabilitation in a closed‑loop management system, it aims to minimize the physiological impact of surgery. Based on the core principles of ERAS, this article systematically reviews recent domestic and international research advances, analyzes in depth the mechanisms and key risk factors for PONV after spinal surgery, outlines commonly used clinical risk‑stratification assessment tools and their application, and highlights multimodal prevention strategies that combine pharmacological and non‑pharmacological interventions. It also discusses current challenges in clinical practice and future research directions. The aim is to provide evidence‑based guidance for the standardized and individualized management of PONV after spinal surgery, further promote the indepth integration and implementation of the ERAS concept in the field of spinal surgery, and help improve the perioperative safety and rehabilitation quality of patients undergoing spinal surgery.