Clinical Study On The Prevention Of Postoperative Nausea And Vomiting In Patients Undergoing Radical Mastectomy With Neoadjuvant Chemotherapy

Objective: To observe the effect of neoadjuvant chemotherapy on postoperative nausea and vomiting(PONV)in patients undergoing radical mastectomy,and to explore the effect of dexamethasone and tropiseton on PONV in patients undergoing neoadjuvant chemotherapy.Methods: A total of 131 patients undergoing preoperative neoadjuvant chemotherapy in the breast surgery department from July to December 2021,and 136 patients undergoing conventional surgery were randomly selected in the first affiliated of China Medical University.All patients underwent radical mastectomy under general anesthesia.Anesthesia induction was performed with sufentanil,cis-atracumide and etomidade,and sevoflurane was inhaled and propofol / remifentanil was continuously pumped during operation.All patients were randomly given 5 mg dexamethasone or 5 mg tropisetron or5 mg dexamethasone combined with 5 mg tropisetron respectively.The incidence of nausea and vomiting in all patients within 24 hours after operation was observed and recorded.Among them,nausea and vomiting occurred simultaneously only recorded in the cases of vomiting.The influencing factors of postoperative nausea and vomiting were analyzed by multivariate logistics regression.To compare the effects of different preoperative chemotherapy regimen on the incidence of PONV.NRS pain score and Ramsay sedation score were recorded within 24 hours after operation.Results: There was no statistical difference in the general data between the two groups(P > 0.05).The incidence of urgent and delayed nausea and vomiting was no significant difference between conventional and neoadjuvant chemotherapy groups after operation.(P > 0.05).Dexamethasone or tropisetron alone can significantly reduce the incidence of postoperative nausea and vomiting in patients undergoing neoadjuvant chemotherapy.The effect of dexamethasone combined with tropisetron in preventing nausea and vomiting within 24 hours after operation was obviously better than that of single drug(P< 0.05).There was no significant difference in the incidence of postoperative nausea and vomiting among different neoadjuvant chemotherapy regimens including EC(epirubicin+ cyclophosphamide),TEC(docetaxel + epirubicin + cyclophosphamide),THP(docetaxel + herceptin + pertuzumab),TCb HP(docetaxel + carboplatin + trastuzumab+ pertuzumab).The results of multivariate regression analysis of postoperative nausea and vomiting showed that preoperative neoadjuvant chemotherapy was not an independent risk factor for postoperative nausea(P > 0.05)and postoperative vomiting(P > 0.05)in radical mastectomy.There were no significant difference in postoperative pain score and sedation score among the groups.Conclusion: Neoadjuvant chemotherapy is not an independent risk factor for postoperative nausea and vomiting in breast cancer patients.Different preoperative chemotherapy regimens have no obvious effect on postoperative nausea and vomiting.Dexamethasone combined with tropisetron prevents postoperative nausea and vomiting in patients with neoadjuvant chemotherapy,which is obviously better than single prophylactic drug.