未行對癥處理的全麻患者約1/3發(fā)生術后惡心嘔吐（PONV），可導致脫水,、出血,、誤吸等并發(fā)癥，雖然已有各種藥物用于預防PONV,，但是并不完全有效且有不良反應,，因此各種非藥物治療手段應運而生。咀嚼口香糖作為減少胃腸術后麻痹性腸梗阻的治療手段之一,，其作用原理類似“假飼”,，通過咀嚼活動，興奮迷走神經,，刺激胃腸活動,。咀嚼口香糖易于實施、幾乎可忽略成本且不需要特殊條件儲存,。另外,，咀嚼口香糖被人們所熟知，可自行控制實施,。咀嚼口香糖與其他需要專業(yè)技術和專業(yè)設備的非藥物治療相比,，較易被麻醉師和護士接受。既往研究表明,，咀嚼口香糖還可縮短術后肛門排氣排便時間,。但是，至今尚無證據(jù)表明其對PONV是否有效,。

　　2017年1月,，英國牛津大學出版社旗下《英國麻醉學雜志》正式發(fā)表澳大利亞墨爾本皇家醫(yī)院、墨爾本大學,、莫納什大學的初步隨機對照研究報告,，發(fā)現(xiàn)咀嚼口香糖作為一種新型治療手段，抑制女性腹腔鏡和乳腺外科手術PONV的效果并不亞于昂丹司瓊,。

　　該研究入組94例行腹腔鏡（48例）或乳腺手術（46例）后在麻醉后監(jiān)護室（PACU）發(fā)生PONV的女性患者,，隨機分配接受靜脈注射昂丹司瓊4mg（46例）或咀嚼口香糖（48例）。主要觀察結局指標為PONV完全緩解，非劣效性定義為兩個方案分析的組間差異＜15%,。次要觀察結局指標為PACU停留持續(xù)時間,、抗嘔吐補救使用、抗嘔吐治療耐受性,。

　　結果發(fā)現(xiàn),，13例（28%）昂丹司瓊組患者和15例（31%）口香糖組患者發(fā)生PONV（P=0.75），有3例口香糖組患者發(fā)生PONV時無法咀嚼口香糖,，PONV完全緩解率分別為39%（5/13）和75%（9/12）,，組間風險相差37%（90%置信區(qū)間：6.3～67%，P=0.07）,，組間次要結局無顯著差異,。入組情況令人滿意，麻醉師和護士可以接受該方案并完成數(shù)據(jù)收集,。

　　當然,，該研究僅記錄惡心嘔吐是否發(fā)生，并不能判斷兩組患者嚴重程度是否相似,。而且有部分口香糖組患者無法咀嚼,，故該療法并不能普遍用于術后患者。該療法是否適用于更大,、更長時間的手術有待進一步研究,。

　　因此，在該初步研究中,，對于治療女性患者腹腔鏡或乳腺手術全身麻醉后PONV,，咀嚼口香糖并不遜色于昂丹司瓊。該研究結果表明,，有必要開展更大樣本的多中心隨機對照研究，證實該新型療法的可行性,。

Br J Anaesth. 2017 Jan;118(1):83-89.

Chewing gum for the treatment of postoperative nausea and vomiting: a pilot randomized controlled trial.

Darvall JN, Handscombe M, Leslie K.

Royal Melbourne Hospital, Melbourne, Victoria, Australia; University of Melbourne, Melbourne, Victoria, Australia; Monash University, Melbourne, Victoria, Australia.

BACKGROUND: A novel treatment, chewing gum, may be non-inferior to ondansetron in inhibiting postoperative nausea and vomiting (PONV) in female patients after laparoscopic or breast surgery. In this pilot study, we tested the feasibility of a large randomized controlled trial.

METHODS: We randomized 94 female patients undergoing laparoscopic or breast surgery to ondansetron 4 mg i.v. or chewing gum if PONV was experienced in the postanaesthesia care unit (PACU). The primary outcome was full resolution of PONV, with non-inferiority defined as a difference between groups of <15% in a per protocol analysis. Secondary outcomes were PACU stay duration, anti-emetic rescue use, and acceptability of anti-emetic treatment. The feasibility of implementing the protocol in a larger trial was assessed.

RESULTS: Postoperative nausea and vomiting in the PACU occurred in 13 (28%) ondansetron patients and 15 (31%) chewing gum patients (P=0.75). Three chewing gum patients could not chew gum when they developed PONV. On a per protocol basis, full resolution of PONV occurred in five of 13 (39%) ondansetron vs nine of 12 (75%) chewing gum patients [risk difference 37% (6.3-67%), P=0.07]. There was no difference in secondary outcomes between groups. Recruitment was satisfactory, the protocol was acceptable to anaesthetists and nurses, and data collection was complete.

CONCLUSIONS: In this pilot trial, chewing gum was not inferior to ondansetron for treatment of PONV after general anaesthesia for laparoscopic or breast surgery in female patients. Our findings demonstrate the feasibility of a larger, multicentred randomized controlled trial to investigate this novel therapy.

CLINICAL TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12615001327572.

KEYWORDS: chewing gum; ondansetron; postanaesthesia nursing; postoperative nausea and vomiting

PMID: 28039245

DOI: 10.1093/bja/aew375