探索口服莫沙必利预防全麻下关节置换术后恶心呕吐(PONV)发生的有效性及安全性。

前瞻性纳入全麻下行初次全髋关节置换术及全膝关节置换术且术前存在PONV发生危险因素(Apfel评分≥ 1分)的患者，排除并存肝肾功能不全、严重肠蠕动障碍及房室传导阻滞及室性心律失常的患者，随机分为莫沙必利组及对照组。莫沙必利组于术前3 h开始服用莫沙必利(5 mg，3次/d)，对照组口服安慰剂。所有患者均在麻醉结束时给予昂丹司琼作为PONV的基础预防措施。主要观察指标是术后48 h内PONV发生情况，次要观察指标包括术后首次排便时间、术后1~3 d食欲评分、满意度评分及胃肠道、心脏相关并发症的发生率。计量资料组间比较采用t检验或U检验，计数资料组间比较采用卡方检验。

共纳入198例患者，莫沙必利组98例，对照组100例。在术后48 h内，莫沙必利组PONV发生率低于对照组[(22.4% vs 47.0%), χ²＝13.140, P<0.01]。莫沙必利组的重度PONV [(6.1% vs 27.0%), χ²＝15.533, P<0.01]及中重度PONV发生率[(15.3% vs 38.0%)，χ²＝13.004, P<0.01]低于对照组。莫沙必利组PONV中位持续时间0.1 h，低于对照组[(0.1 vs 1.0) h, Z＝-2.708, P <0.01]。莫沙必利组的术后第一次排便时间[(59.9±22.5) h vs (39.2±18.2)h, t＝7.092, P<0.01]、下床时间[(23.7±5.5) h vs (21.0±5.4) h，t＝3.423, P<0.01]及平均住院日[(5.4±1.5) d vs (4.7±1.4) d，t＝3.496，P＝0.001)]更短，术后第1天[(1.9±0.4) vs (2.2±0.5)，t＝-5.112，P<0.01)]、第3天的食欲评分[(2.0±0.8) vs (2.5±0.6)，t ＝-4.977，P<0.01)]及出院时满意度评分[(7.9±1.1) vs (9.1±1.1)，t＝-6.845，P＝0.001)]更高。两组间长QT间期综合征及胃肠道并发症发生率差异无统计学意义(P>0.05)。

口服莫沙必利可安全有效降低全麻下髋膝关节置换术后恶心呕吐的发生率及持续时间；同时，口服莫沙必利还可促进术后肠道功能及食欲的恢复。

To explore whether oral mosapride can prevent postoperative nausea and vomiting (PONV) after total joint arthroplasty under general anesthesia.

The patients undergoing primary total hip or knee arthroplasty under general anesthesia with preoperative PONV risk factors (Apfel score ≥one) were randomly divided into the mosapride group and the control group. The patients with hepatic and renal insufficiency, severe intestinal peristalsis, atrioventricular block or ventricular arrhythmia were excluded. The mosapride group began to take mosapride (5 mg, three times per day) 3 h before the operation, while the control group took placebo. All the patients were given ondansetron as the basic preventive measure for PONV at the end of anesthesia. The primary outcomes were the incidence of PONV within 48 h after the operation. The secondary outcomes included the first defecation time, appetite score and satisfaction score one to three days after the operation, and the incidence of gastrointestinal and cardiac complications. For quantitive data, t test or U test was used for comparison, and chi square test was used for qualitative data.

A total of 198 patients were enrolled, including 98 patients in the mosapride group and 100 patients in the control group. Within 48 h after operation, the incidence of PONV in the mosapride group was lower than that in the control group [(22.4% vs 47.0%), χ²=13.140, P<0.01]. The incidence of severe PONV [(6.1% vs 27.0%), χ²=15.533, P<0.01], the ratio of moderate to severe PONV [(15.3% vs 38.0%, )χ²=13.004, P<0.01] in the mosapride group was lower than that in the control group. The median lasted time of PONV in the mosapride group was 0.1 h, which was less than that in the control group [(0.1 vs 1.0) h, Z=-2.708, P <0.01]. In the mosapride group, the first defecation time[(59.9±22.5) h vs (39.2±18.2)h, t=7.092, P<0.01], ambulation time [(23.7±5.5) h vs (21.0±5.4) h, t=3.423, P<0.01] and the length of hospital stay [(5.4±1.5) d vs (4.7±1.4)d, t=3.496, P<0.01] were shorter. The appetite score on the first day [(1.9±0.4) vs (2.2±0.5), t=-5.112, P<0.01] and the third day [(2.0±0.8) vs (2.5±0.6), t=-4.977, P<0.01] and the satisfaction score at discharge [(7.9±1.1) vs (9.1±1.1), t=-6.845, P<0.01)] were higher. There was no significant difference in the incidence of long QT syndrome and gastrointestinal complications between the two groups (P>0.05).

Oral mosapride is safe and effective in reducing the incidence and duration of nausea and vomiting after total hip and knee arthroplasty under general anesthesia; at the same time, oral mosapride can also promote the recovery of postoperative intestinal function and appetite.