青少年特发性脊柱侧弯术后恶心呕吐的循证医学防治策略及疗效分析
Evidence-Based Prevention and Treatment Strategies for Postoperative Nausea and Vomiting in Adolescent Idiopathic Scoliosis Surgery: An Efficacy Analysis

目的：探究循证医学指导下的多模式干预方案相较于常规止吐方案，在防治青少年特发性脊柱侧弯(AIS)术后恶心呕吐(PONV)方面的效果差异，为临床提供更有效的防治策略。方法：选取2021年1月至2024年6月于新疆医科大学第六附属医院脊柱外科，行后路脊柱融合术及全身麻醉的180例AIS患儿。按PONV防治方案分为对照组(n = 90，常规止吐，含术后按需用昂丹司琼、定时评估、特定体位及禁食禁水)与观察组(n = 90，多模式循证干预，包括术前风险评估、预防性联合给药、优化麻醉、术后合理用药、早期活动、温姜茶及心理干预)。结果：在主要疗效指标上，观察组术后24小时PONV累计发生率(27.8%)低于对照组(44.4%)，恶心程度(VAS评分 ≥ 40 mm阳性率：20.0% vs. 33.3%)、呕吐事件次数(2.1 ± 1.2次vs. 3.2 ± 1.5次)、干呕发作次数(1.6 ± 1.0次vs. 2.5 ± 1.3次)及止吐药物补救治疗需求率(20.0% vs. 33.3%)均显著低于对照组，差异有统计学意义(P < 0.05)。次要疗效指标方面，观察组的 PONV-IMI量表评分(12.1 ± 2.8)更低，首次下床活动时间(2.8 ± 0.9天)、术后住院天数(7.0 ± 1.5天)更短，治疗满意度评分(3.8 ± 0.6)更高，且头痛、眩晕、便秘等并发症发生率也相对较低，与对照组相比差异有统计学意义(P < 0.05)。结论：多模式循证干预在降低AIS术后PONV发生率、减少相关症状、缩短住院时间、提升治疗满意度及降低并发症发生率等方面，较常规土方具有显著优势。循证医学在AIS术后PONV防治中，能为临床医生提供更科学有效的策略，规范临床实践。但本研究存在样本来源单一的局限性，未来需扩大样本量、开展多中心研究，以进一步优化防治策略，改善患者预后，提升医疗服务水平。
Objective: To investigate the effectiveness of a multimodal intervention protocol guided by evidence-based medicine compared to conventional antiemetic protocols in preventing and treating postoperative nausea and vomiting (PONV) in adolescents with adolescent idiopathic scoliosis (AIS). The aim is to provide more effective clinical strategies for prevention and treatment. Methods: A total of 180 AIS patients who underwent posterior spinal fusion surgery under general anesthesia at the Sixth Affiliated Hospital of Xinjiang Medical University from January 2021 to June 2024 were selected. Participants were divided into two groups based on their PONV prevention and treatment protocols: the control group (n = 90, conventional antiemetics including ondansetron as needed postoperatively, regular assessment, specific positioning, and fasting) and the observation group (n = 90, multimodal evidence-based interventions including preoperative risk assessment, prophylactic combined medication administration, optimized anesthesia, rational postoperative drug use, early mobilization, warm ginger tea, and psychological intervention). Results: In primary efficacy outcomes, the cumulative incidence rate of PONV within 24 hours postoperatively was lower in the observation group (27.8%) compared to the control group (44.4%). Additionally, nausea severity (positive VAS score ≥40 mm: 20.0% vs. 33.3%), frequency of vomiting episodes (2.1 ± 1.2 vs. 3.2 ± 1.5), frequency of retching episodes (1.6 ± 1.0 vs. 2.5 ± 1.3), and rescue