阿片类药物相关PONV的应对路径：从受体 机制到无阿片麻醉实践

Pathways to Cope with Opioid-Associated PONV: From Receptor Mechanisms to Opioid-Free Anesthesia Practice

摘要: 术后恶心呕吐作为手术后使用阿片类药物后的常见并发症，严重影响患者围术期舒适度，会导致切口裂开或脑血管意外等一系列不良后果，应及时采取干预措施。其病理生理机制包括肠–脑轴信号传导及多受体协同作用，为基于受体靶点作用的药物研发提供了研究思路。基于加速康复外科理念，无阿片化麻醉通过多模式镇痛策略减少阿片类药物依赖，成为降低术后恶心呕吐的核心方案。本文就阿片类药物相关术后恶心呕吐的概述、发生机制、危险因素、多模式干预策略、新兴疗法、目前仍存在的挑战以及未来展望逐一进行阐述，麻醉管理者需结合个体化精准镇痛与高质量临床证据来平衡疗效与安全性。

Abstract: Postoperative nausea and vomiting, as a common complication after the use of opioids after surgery, seriously affects the perioperative comfort of patients, and will lead to a series of adverse consequences such as incision dehiscence or cerebrovascular accident, and timely intervention should be taken. Its pathophysiological mechanisms include gut-brain axis signaling and multi-receptor synergy, which provide research ideas for drug development based on receptor target effects. Based on the concept of accelerated recovery surgery, opioid-free anesthesia has become the core program to reduce postoperative nausea and vomiting by reducing opioid dependence through multimodal analgesic strategies. This article reviews the overview, pathogenesis, risk factors, multimodal intervention strategies, emerging therapies, remaining challenges, and future prospects of opioid-associated PONV, and anesthesia managers need to combine individualized precision analgesia with high-quality clinical evidence to balance efficacy and safety.