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中华肥胖与代谢病电子杂志

中华肥胖与代谢病电子杂志 ›› 2026, Vol. 12 ›› Issue (02) : 108 -114. doi: 10.3877/cma.j.issn.2095-9605.2026.02.004

论著

在手术不同时机使用昂丹司琼对腹腔镜袖状胃切除术后恶心呕吐的影响
张小冠1, 陶雄1, 胡嵩浩2, 贺宝金1, 董志勇2,†()   
  1. 1523770　广东东莞，东莞市大朗医院普通外科/减重代谢外科
    2510630　广州，暨南大学附属第一医院减重代谢外科
  • 收稿日期:2026-05-19 出版日期:2026-05-31
  • 通信作者: 董志勇
  • 基金资助:
    东莞市社会发展科技项目(项目编号：20231800938862)

Effect of ondansetron administration at different surgical timings on postoperative nausea and vomiting after laparoscopic sleeve gastrectomy

Xiaoguan Zhang1, Xiong Tao1, Songhao Hu2, Baojin He1, Zhiyong Dong2,†()   

  1. 1Department of General Surgery/Bariatric and Metabolic Surgery, Dongguan Dalang Hospital
    2Department of Bariatric and Metabolic Surgery, the First Affiliated Hospital of Jinan University, Guangzhou 510630, China
  • Received:2026-05-19 Published:2026-05-31
  • Corresponding author: Zhiyong Dong
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张小冠, 陶雄, 胡嵩浩, 贺宝金, 董志勇. 在手术不同时机使用昂丹司琼对腹腔镜袖状胃切除术后恶心呕吐的影响[J/OL]. 中华肥胖与代谢病电子杂志, 2026, 12(02): 108-114.

Xiaoguan Zhang, Xiong Tao, Songhao Hu, Baojin He, Zhiyong Dong. Effect of ondansetron administration at different surgical timings on postoperative nausea and vomiting after laparoscopic sleeve gastrectomy[J/OL]. Chinese Journal of Obesity and Metabolic Diseases(Electronic Edition), 2026, 12(02): 108-114.

目的

探究在手术不同时机使用昂丹司琼对腹腔镜下胃袖状切除术后恶心呕吐的影响。

方法

回顾性分析东莞市大朗医院减重代谢中心2023年1月至2025年12月择期行腹腔镜袖状胃切除术110例病人的临床资料，其中有效病例93例。所有患者均接受同一手术和麻醉团队行"三孔七步法"袖状胃切除术。其中46例为麻醉诱导时给予昂丹司琼预防性止吐（G1组），另外47例为手术过程中袖胃制作时给予昂丹司琼预防性止吐（G2组）。两组患者术后均采用相同止吐、止痛及补救性止吐、止痛治疗方案，对比分析两组患者的临床特点、术后不同时间阶段，术后0～6 h（T1）、术后6～12 h（T2）、术后12～18 h（T3）、术后18～24 h（T4）及术后24～48 h（T5）的PONV发生次数、PONV强度评分、补救性止吐次数、疼痛VAS评分及止痛次数。

结果

两组患者的年龄、性别、BMI、麻醉时间等临床资料对比差异无统计学意义（P>0.05）。对比两组患者PONV发生次数，在T1、T2、T3三个时间段内G2组发生次数（T1：1（1～1）、T2：2（1～3）、T3：0（0～1））较G1组（T1：2（2～3）、T2：3.5（3～4）、T3：1（0～1））PONV发生次数更少，两组之间存在统计学差异（P<0.05）；对比两组患者PONV强度评分，在T1、T2时间段G2组（T1：2（1～3）、T2：3（2～4））在强度评分中位数、百分位数值均较G1组（T1：3（3～4）、T2：4（3～5））有下降，两组之间存在统计学差异（P<0.05）；两组患者术后疼痛情况对比，在T1、T2、T4时间段，G2组疼痛评分中位数值、百分位数值较G1组均有下降，两组之间存在统计学差异（P<0.05）。

结论

术中预防性使用昂丹司琼相较麻醉诱导时使用，可以更有效降低肥胖患者腹腔镜下胃袖状切除术后早期PONV的发生率和严重程度，减轻术后疼痛的程度。

关键词: 肥胖患者, 袖状胃切除, 昂丹司琼, 术后恶心呕吐
Objective

To investigate the effect of the timing of prophylactic ondansetron administration on postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic sleeve gastrectomy (LSG).

Methods

This retrospective study reviewed the clinical records of 110 patients who underwent elective LSG at the Bariatric and Metabolic Center of Dalang Hospital, Dongguan, China, between January 2023 and December 2025. Among these patients, 93 eligible cases were included in the final analysis. All procedures were performed by the same surgical and anesthesia team using a standardized three-port, seven-step LSG technique. Patients were divided into two groups according to the timing of prophylactic ondansetron administration: 46 patients received ondansetron at anesthesia induction (group G1), whereas 47 patients received the drug during gastric sleeve formation (group G2). Both groups received identical postoperative antiemetic and analgesic regimens, including the same rescue protocols. Baseline clinical characteristics, the frequency and severity of PONV, rescue antiemetic use, postoperative VAS pain scores, and number of rescue analgesic administrations were compared between the two groups at 0-6 h (T1), 6-12 h (T2), 12-18 h (T3), 18-24 h (T4), and 24-48 h (T5) after surgery.

Results

No significant differences were observed between the two groups with respect to baseline characteristics, including age, sex, body mass index (BMI), and anesthesia duration (all P>0.05). Compared with Group G1, Group G2 had significantly fewer episodes of postoperative nausea and vomiting (PONV) at T1 [1 (1-1) vs 2 (2-3)], T2[2 (1-3) vs 3.5 (3-4)], and T3 [0 (0-1) vs 1 (0-1)] (all P<0.05). Similarly, the median PONV severity scores were significantly lower in Group G2 than in Group G1 at T1 [2 (1-3) vs 3 (3-4)] and T2 [3 (2-4) vs 4 (3-5)] (both P<0.05). In addition, the median postoperative visual analog scale (VAS) pain scores were significantly lower in Group G2 than in Group G1 at T1, T2, and T4 (all P<0.05).

Conclusion

Compared with administration during anesthesia induction, prophylactic administration of ondansetron during gastric sleeve creation more effectively reduces the incidence and severity of early postoperative nausea and vomiting and alleviates postoperative pain in patients with obesity undergoing laparoscopic sleeve gastrectomy.

Key words: Obesity, Laparoscopic sleeve gastrectomy, Ondansetron, Postoperative nausea and vomiting
图1 流程图注：腹腔镜袖状胃切除术（LSG）腹腔镜胆囊切除术（LC）静脉自控式镇痛泵（PCIA）G1组：麻醉诱导时给药组，G2组：袖胃切割时给药组
表1 两组患者临床特征对比
临床特征 G1组（n=46） G2组（n=47） χ2值 P值
男（%） 9 (19.6) 7 (14.9) 0.356 0.551a
年龄（岁） 31 (25，36) 28 (25，34) - 0.365
体重（kg) 89.8 (83.0，104.5) 96.8 (83.5，105.0) - 0.532
胸围（cm） 123.0 (105.0，126.0) 115.0 (118.0，125.0) - 0.209
身高（cm） 162.4±7.1 162.2±5.9 - 0.835
颈围（cm） 41.3±3.9 40.87±4.2 - 0.566
腰围（cm） 115.6±11.4 114.9±11.6 - 0.751
臀围（cm） 118.0±8.8 118.2±9.1 - 0.909
吸烟（%） 8 (17.4) 3 (6.4) 2.701 0.100a
住院天数 5 (5，6) 5 (5，6) - 0.622
手术时长（min） 143.80±23.2 142.6±25.8 - 0.806
图2 PONV强度、频率、疼痛评分组间对比注：两组患者术后不同阶段PONV强度、发生频率、术后疼痛评分，经Shapiro-Wilk法检测不复合正态分布，采用Mann-Whitney U秩和检验进行比较。P<0.05有统计学差异。（*：P<0.05，nd：差异无统计学意义）
图3 PONV强度、频率、疼痛评分组内对比注：两组患者术后不同阶段PONV强度、发生频率、术后疼痛评分，经Shapiro-Wilk法检测不复合正态分布，组内两两对比采用Dunn多重比较检验，并用Bonferroni对P值进行校正。P<0.05有统计学差异。（*P<0.05，**P<0.01，***P<0.001，ns：差异无统计学意义）
表2 两组患者48 h内补救性止吐、止痛次数对比
  G1组 G2组 Z值 P值
止吐次数 2（2～2） 1（0～1） -7.104 <0.001
止痛次数 2（2～2） 1（0～1） -4.819 <0.001
秩平均数        
止吐 66.86  27.56    
止痛  59.76 34.51    
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