晕船还是术后恶心呕吐？对在美国海军“舒适号”医院船上接受海上麻醉患者的回顾性综述。

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中文摘要

引言： 美国海军“舒适号”是一艘拥有1000张床位的医院船，在海上环境中提供完整的围手术期和外科手术能力。患者可能在码头停靠、锚泊或海上航行时接受手术。术后恶心呕吐（PONV）是常见的麻醉并发症，但船舶运动和海上状态引入了传统PONV风险模型未涵盖的额外前庭刺激。本研究评估了在美国海军“舒适号”执行人道主义任务期间，手术环境是否与择期手术后的PONV相关。
材料与方法： 这项经IRB批准的回顾性队列研究回顾了2025年6月11日至8月9日期间在美国海军“舒适号”上接受择期手术的所有患者。从围手术期记录中收集患者人口统计学资料、手术环境、手术类型、麻醉技术、总手术室时间、烟草使用、挥发性麻醉药使用以及术中PONV预防措施。将记录有PONV或术后使用补救性止吐药的患者与无PONV的患者进行比较。连续变量采用Mann-Whitney U检验或Kruskal-Wallis检验分析，分类变量采用卡方检验或Fisher精确检验分析。进行了Bonferroni校正的事后卡方检验以及仅限于全身麻醉病例的敏感性分析。对手术环境、麻醉方法和总手术室时间进行了有限逻辑回归，以生成这些变量的比值比和95%置信区间。
结果： 在241例手术患者中，22例发生PONV，总体发生率为9.13%。PONV因手术环境不同而存在显著差异，从码头停靠时的5.45%增加到锚泊时的15.38%和海上航行时的20.83%（P值 .011）。当直接比较每个手术环境的PONV发生率时，PONV还与全身麻醉（P值 .022）、使用挥发性麻醉药（P值 .010）、女性（P值 .050）、更长的手术室时间（P值 .001）以及更多使用预防性止吐药（P值 .008）相关，这可能反映了提供者对高风险患者的识别。不同手术环境的基线特征总体相似，但锚泊和海上航行时手术室时间更长（P值 .021）。在全身麻醉亚组（118例患者）中，与手术环境的关联持续存在，锚泊时PONV发生率为26.09%，海上航行时为40.00%，而码头停靠时为8.24%（P值 .003）。对所有患者进行的有限多变量回归也显示，与码头停靠相比，锚泊地点（OR 3.34，95% CI：1.15-9.70）或海上航行（OR 4.93，95% CI：1.34-18.14）与PONV存在关联。
结论： 船上手术后的PONV因手术环境不同而存在显著差异，在海上航行时进行手术的发生率最高。这些发现表明，船舶运动和海上状态可能对术后结局产生超出传统麻醉和患者特异性风险因素的影响。本研究提供了真实世界证据，表明在围手术期规划中应考虑海事条件。未来的研究应评估更广泛的术后结局，完善同时针对PONV和晕动病生理学的预防策略，并为海上人道主义、作战和战斗护理中的手术决策提供信息。

英文摘要

INTRODUCTION: The USNS Comfort is a 1,000-bed hospital ship that provides full perioperative and surgical capabilities in a maritime environment. Patients may undergo surgery while the ship is pierside, anchored, or underway at sea. Postoperative nausea and vomiting (PONV) is a common anesthetic complication, but ship motion and sea state introduce an additional vestibular stimulus that is not captured by traditional PONV risk models. This study evaluated whether operating environment was associated with PONV after elective surgery aboard the USNS Comfort during a humanitarian mission.
MATERIALS AND METHODS: This IRB-approved retrospective cohort study reviewed all patients who underwent elective surgery aboard the USNS Comfort between June 11 and August 9, 2025. Patient demographics, operative environment, procedure type, anesthetic technique, total room time, tobacco use, volatile anesthetic use, and intraoperative PONV prophylaxis were collected from perioperative records. Patients with documented PONV or postoperative rescue antiemetic use were compared with those without PONV. Continuous variables were analyzed with Mann-Whitney U or Kruskal-Wallis testing, and categorical variables were analyzed with Chi-square or Fisher's exact testing. Post hoc chi-square testing with Bonferroni correction and a sensitivity analysis limited to general anesthesia cases were performed. Limited logistic regression was performed on the operative environment, anesthetic method, and total room time to generate odds ratios and 95% confidence intervals for these variables.
RESULTS: Among 241 surgical patients, 22 developed PONV, for an overall incidence of 9.13%. PONV differed significantly by operating environment, increasing from 5.45% pierside to 15.38% while anchored and 20.83% while at sea (P value .011). When PONV rates were compared directly at each operating environment, PONV was also associated with general anesthesia (P value .022), volatile anesthetic use (P value .010), female sex (P value .050), longer room time (P value .001), and greater use of prophylactic antiemetics (P value .008), likely reflecting provider recognition of higher-risk patients. Baseline characteristics across operating environments were generally similar, though room times were longer while anchored and at sea (P value .021.) In the general anesthesia subgroup (118 patients), the association with operating environment persisted, with PONV rates of 26.09% anchored and 40.00% at sea when compared to 8.24% pierside (P value .003). Limited multivariable regression for all patients also demonstrated an association between a site of anchored (OR 3.34, 95% CI: 1.15-9.70) or at sea (OR 4.93, 95% CI: 1.34-18.14) compared to pierside.
CONCLUSIONS: PONV after shipboard surgery varied significantly by operating environment, with the highest rates occurring when surgery was performed at sea. These findings suggest that ship motion and sea state may meaningfully influence postoperative outcomes beyond traditional anesthetic and patient-specific risk factors. This study provides real-world evidence that maritime conditions should be considered in perioperative planning. Future studies should evaluate broader postoperative outcomes, refine prophylaxis strategies that address both PONV and motion sickness physiology, and inform surgical decision-making for humanitarian, operational, and combat care at sea.