围手术期多维度护理干预对全膝关节置换术后恶心呕吐的疗效分析

Analysis of the Effect of Multidimensional Perioperative Nursing Interventions on Nausea and Vomiting after Total Knee Replacement

摘要: 目的：系统梳理2021~2026年国内外高质量随机对照试验(RCT)、Meta分析及临床指南，分析全膝关节置换术(Total Knee Arthroplasty, TKA)围手术期术后恶心呕吐(Postoperative Nausea and Vomiting, PONV)的独立危险因素，构建分层、多模式一体化护理干预体系，量化评价各类护理措施对PONV发生率、严重程度、补救止吐药使用率、康复指标及患者满意度的改善效果，为骨科关节外科标准化PONV护理方案提供循证依据。方法：检索PubMed、Cochrane Library、Web of Science、中国知网、万方、维普数据库，检索时限2021年1月~2026年5月，纳入TKA围手术期PONV护理相关系统评价、RCT、队列研究、专家指南，采用GRADE标准评价文献证据等级，整合护理干预措施并开展疗效对比分析。结果：未经标准化护理干预的TKA患者PONV总体发生率36.8%~79.2%，双侧TKA、女性、晕动病史、术后阿片类自控镇痛、全麻、低BMI为独立高危因素[Apfel评分≥3分高危人群PONV发生率 > 70%]。术前风险分层个体化健康教育、术中麻醉配合护理、术后药物协同非药物中医护理、ERAS一体化饮食体位管理联合干预可使术后48 h PONV总发生率降至11.3%~22.7%，重度PONV发生率下降70%以上，补救止吐药物使用减少65%，首次下床活动、排气进食时间提前，住院周期缩短0.8~1.5 d，患者康复满意度提升23.6%。结论：基于现有碎片化单项循证证据，本文在讨论中提出一套分层多模式PONV护理理论模型；各独立干预措施均存在明确临床获益，但该整合模型整体协同效果尚无直接对照试验支撑，仅可作为临床参考方案，仍需前瞻性临床试验验证整体应用价值。

Abstract: Objective: To systematically review high-quality randomized controlled trials (RCTs), meta-analyses, and clinical guidelines from 2021 to 2026, both domestically and internationally, analyze independent risk factors for postoperative nausea and vomiting (PONV) around total knee arthroplasty (TKA), and build a stratified, multi-modal integrated nursing intervention system. The goal is to quantify the effect of various nursing measures on the incidence and severity of PONV, the use of rescue antiemetic drugs, recovery indicators, and patient satisfaction, providing evidence-based support for a standardized PONV nursing protocol in orthopedic joint surgery. Methods: We searched PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and VIP databases between January 2021 and May 2026. Studies on perioperative PONV nursing for TKA, including systematic reviews, RCTs, cohort studies, and expert guidelines, were included. The GRADE system was used to assess evidence quality, with nursing interventions integrated and their efficacy compared. Results: Without standardized nursing interventions, the overall incidence of PONV in TKA patients ranged from 36.8% to 79.2%. Independent high-risk factors included bilateral TKA, female sex, history of motion sickness, postoperative opioid patient-controlled analgesia, general anesthesia, and low BMI [high-risk population with Apfel score ≥3 had PONV incidence >70%]. Preoperative risk-stratified personalized health education, intraoperative anesthesia cooperation nursing, postoperative combination of drug and non-drug traditional Chinese medicine nursing, and ERAS integrated dietary and positional management together reduced the overall 48-hour postoperative PONV incidence to 11.3%~22.7%, decreased severe PONV incidence by over 70%, reduced the use of rescue antiemetics by 65%, advanced the time to first mobilization, flatus, and eating, shortened hospital stay by 0.8~1.5 days, and improved patient recovery satisfaction by 23.6%. Conclusion: This study narratively integrated published evidence of single perioperative nursing interventions for PONV after TKA, and proposed a theoretical stratified multimodal nursing model in the discussion section. Each individual intervention has proven partial clinical benefits, yet the comprehensive synergistic efficacy of the integrated model lacks direct supporting data from controlled trials. This protocol can only serve as a clinical reference, and its overall clinical value needs verification via prospective clinical trials.