正颌术后恶心和呕吐原因分析及防治策略

doi:10.7518/hxkq.2025.2025072

华西口腔医学杂志 ›› 2025, Vol. 43 ›› Issue (3): 305-313.doi: 10.7518/hxkq.2025.2025072

正颌术后恶心和呕吐原因分析及防治策略

罗楷¹(), 刘乐¹, 赵乐¹, 唐阳露¹, 罗恩²(), 吉阳¹()

^1.口腔疾病防治全国重点实验室国家口腔医学中心国家口腔疾病临床医学研究中心四川大学华西口腔医院麻醉科，成都 610041
^2.口腔疾病防治全国重点实验室国家口腔医学中心国家口腔疾病临床医学研究中心四川大学华西口腔医院正颌及关节外科，成都 610041

收稿日期:2025-02-27 修回日期:2025-04-07 出版日期:2025-06-01 发布日期:2025-06-10
通讯作者: 罗恩,吉阳 E-mail:LuoKai6011@163.com;luoen521125@sina.com;yangji7799@163.com
作者简介:罗楷，主治医师，硕士，E-mail：LuoKai6011@163.com|罗恩，四川大学华西口腔医院教授、一级专家，博士生导师，正颌及关节外科主任。国际牙医师学院Fellow，英国格拉斯哥皇家内外科学院外科Fellow。教育部新世纪优秀人才，四川省海外高层次留学人才。中华口腔医学会口腔颌面外科专业委员会常委，中华口腔医学会创伤正颌专业委员会常委，四川省口腔颌面外科专业委员会副主任委员，四川省正颌与关节专业委员会副主任委员，四川省卫健委学术和技术带头人。主持国家自然科学基金、教育部新世纪优秀人才计划项目、四川省重点研发项目等国家及省部级研究项目10余项。以第一或通讯作者发表论文100多篇，获得教育部科技进步奖一等奖、二等奖，四川省科技进步一等奖，中华口腔医学会科技奖一等奖，国家级教学成果奖二等奖，四川省教学成果特等奖等。获得牙和颌面畸形矫治相关国际/国内发明专利10余项。主编《数字化正颌外科》《口腔颌面外科学》《牙和颌面畸形就医指南》《正颌及关节外科诊疗与操作常规》等专著和教材6部。|吉阳，四川大学华西口腔医院麻醉科主任，主任医师。担任中华口腔医学会镇静镇痛专业委员会常委、中华口腔医学会口腔麻醉专业委员会常委、四川省口腔医学会镇静镇痛专业委员会副主任委员、成都市医师协会麻醉学专业委员会常委、成都高新医学会成渝麻醉与围术期医学专业委员会常委、四川省国际医学交流促进会麻醉学分会常委、四川省口腔医学会口腔急诊专业委员会常委。长期从事口腔颌面外科的临床麻醉工作，具有丰富的临床麻醉管理经验，擅长困难气道的处理、椅旁急救和口腔舒适化治疗。以第一作者或通讯作者发表论文20余篇，SCI论文7篇，参与及主持编写口腔麻醉领域相关学术专著7部。
基金资助:
四川省科技厅重点研发项目(2024YFFK0204);四川大学华西口腔医院探索与研发项目(LCYJ-2023-YF-2)

Causes and prevention strategies of postoperative nausea and vomiting after orthognathic surgery

Luo Kai¹(), Liu Le¹, Zhao Le¹, Tang Yanglu¹, Luo En²(), Ji Yang¹()

^1.State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Anesthesiology, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
^2.State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Dept. of Orthognathic and Temporomandibular Joint Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China

Received:2025-02-27 Revised:2025-04-07 Online:2025-06-01 Published:2025-06-10
Contact: Luo En,Ji Yang E-mail:LuoKai6011@163.com;luoen521125@sina.com;yangji7799@163.com
Supported by:
Key Research and Development Project of Sichuan Provincial Science and Technology Department(2024YFFK0204);Research and Development Program of West China Hospital of Stomatology, Sichuan University(LCYJ-2023-YF-2)

摘要/Abstract

摘要：

术后恶心和呕吐（PONV）是正颌手术后常见的并发症，主要发生在术后24 h内。正颌手术PONV发生率居高不下，目前仍然是患者和外科医生较为棘手的问题。恶心和呕吐不仅影响伤口愈合，增加术后出血风险，呕吐物及血液还可能进一步引发恶心和呕吐，形成恶性循环。频繁的恶心和呕吐是一种痛苦的经历，甚至比术后疼痛更为严重，是术后感染、延迟出院、增加住院费用和影响患者满意度的主要原因之一。本文中笔者结合文献回顾和临床经验，总结并分析正颌手术PONV的原因及预防和治疗策略，以供同行参考。

关键词: 正颌手术, 恶心, 呕吐, 预防, 治疗

Abstract:

Postoperative nausea and vomiting (PONV) are common complications that mainly occur within 24 h after orthognathic surgery. The incidence of nausea and vomiting after orthognathic surgery remains high and is a difficult problem for patients and surgeons. These complications not only affect wound healing and increase the risk of postoperative bleeding. Vomit and blood may also cause nausea and vomiting, which results in a vicious cycle. Frequent nausea and vomiting are a painful experience and more serious than postoperative pain. They are one of the main reasons for postoperative infection, delayed discharge, and increased hospitalization costs and affect patient satisfaction. In this review, the author combined literature review and clinical experience and summarized and analyzed the causes of orthognathic nausea and vomiting and prevention and treatment strategies to improving the related clinical process.

Key words: orthognathic surgery, nausea, vomit, prevention, treatment

中图分类号:

R782.05

罗楷, 刘乐, 赵乐, 唐阳露, 罗恩, 吉阳. 正颌术后恶心和呕吐原因分析及防治策略[J]. 华西口腔医学杂志, 2025, 43(3): 305-313.

Luo Kai, Liu Le, Zhao Le, Tang Yanglu, Luo En, Ji Yang. Causes and prevention strategies of postoperative nausea and vomiting after orthognathic surgery[J]. West China Journal of Stomatology, 2025, 43(3): 305-313.

图/表 2

参考文献 44

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药物	预防给药时间	成人剂量/mg IV	小儿剂量（最大剂量）
昂丹司琼	手术结束前	4~8	0.05~0.15 mg IV（4 mg）
多拉司琼	手术结束前	12.5	0.35 mg/kg IV（12.5 mg）
托烷司琼	手术结束前	5	0.2 mg IV（5 mg）
格拉司琼	手术结束前	3	0.04 mg/kg IV（3 mg）
帕洛诺司琼	诱导前	0.075	-
地塞米松	诱导前	4~5	0.1~0.15 mg/kg IV（5 mg）
甲氧氯普胺	手术结束前	10~20	0.1 mg/kg IV（5 mg）
氟哌利多	手术结束前	0.625~1.25	0.01~0.015 mg/kg IV（1.25 mg）
氟哌啶醇	手术结束前	0.5~2	-

风险分层	预防性治疗	初次治疗	再次治疗
低风险	考虑	地塞米松或5-HT₃受体阻断剂	-
中风险	应该	地塞米松或5-HT₃受体阻断剂	6 h内避免重复用药，应予以不同种类的止吐药物；超过6 h且无其他药物可选时，则应再次予以5-HT₃受体阻断剂或多巴胺D2受体拮抗剂或丁酰苯类止吐药
高风险	必须	地塞米松和5-HT₃受体阻断剂，可加用多巴胺D2受体拮抗剂或丁酰苯类止吐药	同中风险

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正颌术后恶心和呕吐原因分析及防治策略

Causes and prevention strategies of postoperative nausea and vomiting after orthognathic surgery

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