| Objective:This study investigated the changes of autonomic nervous system function during perioperative period by observing heart rate variability in patients undergoing gynecological laparoscopic surgery,and explored its correlation with the incidence and severity of postoperative nausea and vomiting（PONV）.From the perspective of prevention and treatment of PONV,this study explored whether scopolamine could play a better antiemetic effect by regulating the autonomic nervous system function of patients compared with metoclopramide,thus providing guidance for the prevention and treatment of clinical PONV.Methods:Ninety patients undergoing elective laparoscopic total hysterectomy were randomly divided into three groups with 30 patients in each group.Before induction,30min was given scopolamine 0.3mg（group A）,metoclopramide 10mg（group B）and 0.9%saline2ml（group C）.The HRV of 5min（T0）before administration and 5min（T1）after awakening were measured,and the difference of HRV data between T0and T1（△LF,△HF and△LF/HF）was calculated.The patients were followed up after operation,and the occurrence and severity of nausea and vomiting in the three groups within 24 hours after operation were observed and recorded.According to the occurrence of nausea and vomiting,each group was divided into PONV group and non-PONV group,and△LF,△HF and△LF/HF were recorded.Results:There was no significant difference in age,BMI,anesthesia time,pneumoperitoneum use time,sufentanil and remifentanil consumption among the three groups（P>0.05）;The changes of HRV between the three groups were as follows:△LF between the three groups showed no significant difference（P>0.05）,while△HF and△LF/HF showed significant difference（P<0.05）.The pairings of△HF in the three groups were as follows:△HF in group A was higher than that in group B,but there was no significant difference in△HF between group A and group C and between group B and group C（P>0.05）.Pairway comparison of△LF/HF among the three groups:△LF/HF in group C was lower than that in group B,but there was no statistical significance between group A and group B,and between group A and group C（P>0.05）.The HRV changes in the three groups were compared:the△HF of the PONV group was lower than that of the non-PONV group,and the difference was statistically significant（P<0.05）;while the△LF/HF comparison showed no significant difference（P>0.05）.The△LF of PONV group was lower than that of non-PONV group in group A and group C,and the difference was statistically significant（P<0.05）.In group B,there was no significant difference in△LF between PONV group and non-PONV group（P>0.05）.Comparison of the incidence and severity of PONV within 24 hours after operation among the three groups:9 cases（30%）,10 cases（33.33%）and 20 cases（66.67%）in group A,group B and group C respectively within 24 hours after operation occurred in PONV,and the incidence of PONV in group A and B was lower than that in group C,and the difference was statistically significant（P<0.05）.In the comparison of the severity of nausea and vomiting 24 hours after the operation among the three groups,the PONV severity grading of group A and group B was lower than that of group C,and the difference was statistically significant（P<0.05）.There was no significant difference in the incidence and severity of PONV between group A and group B（P>0.05）.Pearson correlation analysis showed that the incidence of PONV was negatively correlated with△LF and△HF（P<0.05）,but not with△LF/HF.Spearman correlation analysis showed that the severity of PONV was negatively correlated with△LF and△HF（P<0.05）,but not with△LF/HF.Conclusion:The changes of autonomic nervous system function in patients undergoing gynecological laparoscopic surgery under general anesthesia were negatively correlated with the incidence and severity of postoperative nausea and vomiting.Preoperative use of scopolamine and metoclopramide are similar in the prevention and treatment of postoperative nausea and vomiting in patients undergoing gynecological laparoscopic surgery. |
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