体動に関連する術後悪心・嘔吐と制吐薬の予防効果の実態調査：成人女性を対象とした後ろ向き観察研究

Postoperative Nausea and Vomiting Related to Patient Movement and the Preventive Effects of Antiemetics：A Retrospective Observational Study of Adult Women

要旨

　体位変換や離床に伴う体動は術後悪心・嘔吐（postoperative nausea and vomiting：PONV）の術後要因であるが，近年の周術期管理における体動に関連する（体動関連）PONVの実態調査はない。われわれは，体動関連PONVの現状と制吐薬の効果を，上肢・鎖骨手術を受けた成人女性793名を対象に後ろ向きに調査した。術後24時間の体動関連PONVは91名（11％）に発生し，全PONV症例の69％を占めた。ヒドロキシジンは制吐薬非投与に比べて体動関連PONVの発生率を低下させ（各5％および12％，P＝0.046），交絡調整後も発生率低下と関連した〔オッズ比0.36［95％信頼区間（confidence interval：CI）：0.16-0.81］，P＝0.014〕。ドロペリドールはその発生率に影響しなかった。体動は依然PONVの重要な術後要因であり，ヒドロキシジンは体動関連PONVの防止に有用であることが示唆された。

　Background：Although it has long been known that postoperative nausea and vomiting（PONV）can be triggered by patient movements such as changes in position and ambulation, the actual situation of PONV that is related to patient movement（movement-related PONV）remains unknown, and no specific preventive measures have been proposed. We retrospectively investigated the current status of movement-related PONV and the preventive effects of antiemetics.

　Methods：We reviewed the data of 793 adult women who underwent upper extremity or clavicle surgery at our hospital from July 2018 to April 2022. The primary outcome was the incidence of movement-related PONV within 24 h postoperatively. The preventive effects of droperidol and hydroxyzine were also evaluated.

　Results：Of the total series of patients, 11％（n＝91）experienced movement-related PONV, and their movement-related PONV accounted for 69％ of all of the PONV cases in the series（n＝132）. The incidence of movement-related PONV in patients who received hydroxyzine（5％）was significantly lower than those in the untreated patients（12％；p＝0.046）and those who received droperidol（14％；p＝0.012）. A multivariate logistic regression analysis showed that hydroxyzine was independently associated with a lower incidence of movement-related PONV（adjusted odds ratio, 0.36；95％ confidence interval, 0.16-0.81, P＝0.014）.

　Conclusion：These results suggest that（ⅰ）postoperative patient movement remains a factor influencing PONV and（ⅱ）hydroxyzine is effective for preventing movement-related PONV.