【罂粟摘要】肠-迷走神经-脑神经通路在术后恶心呕吐中的主导作用：一项观察性队列研究的证据
肠-迷走神经-脑神经通路在术后恶心呕吐中的主导作用：一项观察性队列研究的证据
贵州医科大学 麻醉与心脏电生理课题组
翻译：张中伟 编辑：佟睿 审校：曹莹
术后恶心呕吐（PONV）是临床上最常见的术后并发症，解决此问题需用到针对多种神经递质途径的多模式止吐药物。由于缺乏神经生物学机制，这个“重要的小问题”仍未解决。我们的目的是研究肠-迷走神经-脑反射作为四种典型的催吐神经通路之一是否可能在PONV中起主导作用。
研究纳入2016年12月至2019年1月期间，3223名患者接受了迷走神经切除术（食管切除术和胃切除术）和非迷走神经切断术（肝切除术、肺叶切除术和结直肠手术）。30名患者接受胃切除并选择性切断迷走神经胃支。记录患者术后24小时内恶心和剧烈呕吐的发生情况。
在接受迷走神经切除术的1187名患者中，PONV的发生率为11.9%。在接受非迷走神经干切除术的2036名患者中，PONV的发生率为28.7%。倾向评分匹配显示，接受迷走神经切除术的患者占PONV总发生率的19.9%，远低于非迷走神经切除组的35.1% (P<0.01)。多因素logistic回归分析结果显示，迷走神经切除是PONV显著的相关因素之一(OR=0.302, 95% CI, 0.237-0.386)。接受迷走神经切除术的患者恶心发生率为5.9%~8.6%，非迷走神经切除术患者恶心发生率为12~17%。迷走神经切开术患者呕吐率约为3%，且大多数患者呕吐症状较轻，非迷走神经切开术患者呕吐率约为8~13%。此外，在接受胃切除并选择性迷走神经切除术的患者中，PONV发生率也较低(10%)。
接受迷走神经切除术的患者较少发生PONV，提示肠-迷走神经-脑神经通路在术后恶心呕吐中可能起主导作用。
原始文献来源：
Nana Li, Lu Liu, Menghan Sun, et al. Predominant role of gut-vagus-brain
neuronal pathway in postoperative nausea and vomiting: evidence from an observational cohort study.[J].BMC Anesthesiol (2021) 21:234：1
Predominant role of gut-vagus-brain neuronal pathway in postoperative nausea and vomiting: evidence from an observational cohort study
Abstract
Background: Postoperative nausea and vomiting (PONV) as a clinically most common postoperative complication requires multimodal antiemetic medications targeting at a wide range of neurotransmitter pathways. Lacking of neurobiological mechanism makes this 'big little problem’ still unresolved. We aim to investigate whether gut-vagus-brain reflex generally considered as one of four typical emetic neuronal pathways might be the primary mediator of PONV.
Method:Three thousand two hundred twenty-three patients who underwent vagus nerve trunk resection (esophagectomy and gastrectomy) and non-vagotomy surgery (hepatectomy, pulmonary lobectomy and colorec-
tomy) from December 2016 to January 2019 were enrolled. Thirty cases of gastrectomy with selective resection on the gastric branch of vagus nerve were also recruited. Nausea and intensity of vomiting was recorded within 24 h after the operation.
Results:PONV occurred in 11.9% of 1187 patients who underwent vagus nerve trunk resection and 28.7% of 2036 non-vagotomy patients respectively. Propensity score matching showed that vagotomy surgeries accounted for
19.9% of the whole PONV incidence, much less than that observed in the non-PONV group (35.1%, P < 0.01). Multivariate logistic regression result revealed that vagotomy was one of underlying factor that significantly involved in PONV (OR = 0.302, 95% CI, 0.237-0.386). Nausea was reported in 5.9% ~ 8.6% vagotomy and 12 ~ 17% non-vagotomy patients. Most vomiting were mild, being approximately 3% in vagotomy and 8 ~ 13% in non-vagotomy patients, while sever vomiting was much less experienced. Furthermore, lower PONV occurrence (10%) was also observed in gastrectomy undergoing selective vagotomy.
Conclusion:Patients undergoing surgeries with vagotomy developed less PONV, suggesting that vagus nerve dependent gut-brain signaling might mainly contribute to PONV.