Evidence-Based Prevention and Treatment Strategies for Postoperative Nausea and Vomiting in Adolescent Idiopathic Scoliosis Surgery: An Efficacy Analysis

目的：探究循证医学指导下的多模式干预方案相较于常规止吐方案，在防治青少年特发性脊柱侧弯(AIS)术后恶心呕吐(PONV)方面的效果差异，为临床提供更有效的防治策略。方法：选取2021年1月至2024年6月于新疆医科大学第六附属医院脊柱外科，行后路脊柱融合术及全身麻醉的180例AIS患儿。按PONV防治方案分为对照组(n = 90，常规止吐，含术后按需用昂丹司琼、定时评估、特定体位及禁食禁水)与观察组(n = 90，多模式循证干预，包括术前风险评估、预防性联合给药、优化麻醉、术后合理用药、早期活动、温姜茶及心理干预)。结果：在主要疗效指标上，观察组术后24小时PONV累计发生率(27.8%)低于对照组(44.4%)，恶心程度(VAS评分 ≥ 40 mm阳性率：20.0% vs. 33.3%)、呕吐事件次数(2.1 ± 1.2次vs. 3.2 ± 1.5次)、干呕发作次数(1.6 ± 1.0次vs. 2.5 ± 1.3次)及止吐药物补救治疗需求率(20.0% vs. 33.3%)均显著低于对照组，差异有统计学意义(P Objective: To investigate the effectiveness of a multimodal intervention protocol guided by evidence-based medicine compared to conventional antiemetic protocols in preventing and treating postoperative nausea and vomiting (PONV) in adolescents with adolescent idiopathic scoliosis (AIS). The aim is to provide more effective clinical strategies for prevention and treatment. Methods: A total of 180 AIS patients who underwent posterior spinal fusion surgery under general anesthesia at the Sixth Affiliated Hospital of Xinjiang Medical University from January 2021 to June 2024 were selected. Participants were divided into two groups based on their PONV prevention and treatment protocols: the control group (n = 90, conventional antiemetics including ondansetron as needed postoperatively, regular assessment, specific positioning, and fasting) and the observation group (n = 90, multimodal evidence-based interventions including preoperative risk assessment, prophylactic combined medication administration, optimized anesthesia, rational postoperative drug use, early mobilization, warm ginger tea, and psychological intervention). Results: In primary efficacy outcomes, the cumulative incidence rate of PONV within 24 hours postoperatively was lower in the observation group (27.8%) compared to the control group (44.4%). Additionally, nausea severity (positive VAS score ≥40 mm: 20.0% vs. 33.3%), frequency of vomiting episodes (2.1 ± 1.2 vs. 3.2 ± 1.5), frequency of retching episodes (1.6 ± 1.0 vs. 2.5 ± 1.3), and rescue antiemetic therapy requirements (20.0% vs. 33.3%) were significantly lower in the observation group than in the control group with statistical significance (P < 0.05). In secondary efficacy outcomes, the Postoperative Nausea and Vomiting-Impact on Morbidity Index (PONV-IMI) scores were lower in the observation group (12.1 ± 2.8), with shorter time to first ambulation after surgery (2.8 ± 0.9 days) and shorter hospital stay duration postoperatively (7.0 ± 1.5 days). Treatment satisfaction scores were higher in this group as well (3.8 ± 0.6), along with relatively fewer incidences of complications such as headache, dizziness, constipation when compared to the control group with statistical significance observed across these measures as well (P < 0.05). Conclusion: Multimodal evidence-based interventions demonstrate significant advantages over conventional antiemetic protocols in reducing PONV incidence rates following AIS surgery; decreasing associated symptoms; shortening hospital stays; enhancing patient satisfaction; and lowering complication rates among other benefits observed during this study period for AIS patients undergoing surgical correction procedures involving general anesthesia.