腹腔镜下子宫切除老年病人术中预防性给予止吐药后恶心呕吐发生的危险因素  

Risk factors for nausea and vomiting after laparoscopic hysterectomy in elderly patients receiving prophylactic antiemetics

作　　者：王琳[1] 汪小海[2] 刘颖 WANG Lin;WANG Xiao-hai;LIU Ying(Department of Anesthesiology,Suqian People＇ s Hospital,Suqian 223800,Chin;Department of Anesthesiology,Nanjing Drum Tower Hospital,Nanjing 210008,China;Department of Emergency,Suqian First Hospital,Suqian 223800,China)

机构地区：[1]南京大学医学院附属南京鼓楼医院集团宿迁市人民医院麻醉科,江苏省宿迁市223800 [2]南京鼓楼医院麻醉科,江苏省南京市210008 [3]宿迁市第一人民医院急诊科,江苏省宿迁市223800

出　　处：《实用老年医学》2018年第8期759-762,共4页Practical Geriatrics

摘　　要：目的分析探讨腹腔镜下子宫切除老年病人预防性给予止吐药后恶心呕吐(PONV)发生情况的影响因素。方法选择2014年10月到2017年10月在我院行腹腔镜下子宫切除术的老年病人248例为研究对象,对病人的临床病历资料进行回顾性分析以明确病人PONV发生的危险因素。结果本研究中PONV的发生率为31.45%;非PONV组与PONV组在吸烟史、体质量指数(BMI)≥25、二氧化碳气腹时间、有PONV史、术前焦虑、麻醉方式、二氧化碳气腹压力、术毕使用新斯的明和术中出现收缩压<80 mm Hg等方面差异有统计学意义(P<0.05);多因素Logistic回归分析显示,BMI≥25、二氧化碳气腹时间≥120 min、有术后恶心呕吐史、术前焦虑、静吸复合麻醉、二氧化碳气腹压力≥14 mm Hg及术中出现收缩压<80 mm Hg是预防性给予止吐药的腹腔镜下子宫切除病人发生PONV的危险因素(P<0.05)。结论即使是术中预防性使用止吐药,腹腔镜下子宫切除老年病人PONV的发生率仍高达31.45%,其和多种因素关系密切,应引起我们的关注。Objective To investigate the risk factors for post operative nausea and vomiting（ PONV） after laparoscopic hysterectomy in the elderly patients administered with prophylactic antiemetics. Methods A total of 248 patients undergoing laparoscopic hysterectomy were enrolled in this study from October 2014 to October 2017. A retrospective analysis of the clinical data was carried out to determine the risk factors for PONV. Results The incidence rate of PONV was 31. 45%.There were significant differences between the PONV group and non-PONV group in the history of smoking,body mass index（ BMI） ≥25,the time of carbon dioxide pneumoperitoneum≥120 min,the history of PONV,preoperative anxiety, intravenous inhalation compound anesthesia, the pressure of carbon dioxide pneumoperitoneum≥14 mm Hg,the use of neostigmine at the end of the operation,and the systolic blood pressure80 mm Hg（ P〈0. 05）. Logistic regression analysis showed that BMI ≥ 25,the time of carbon dioxide pneumoperitoneum≥120 min,the history of PONV,preoperative anxiety,intravenous inhalation compound anesthesia,the pressure of carbon dioxide pneumoperitoneum ≥14 mm Hg,and the systolic blood pressure 〈80 mm Hg were the risk factors of PONV after laparoscopic hysterectomy in the patients administered with prophylactic antiemetics（ P〈0. 05）. Conclusions Even the preventive use of antiemetics during operation,the incidence of PONV after laparoscopic hysterectomy in the elderly patients is still as high as 31. 45%,and it is closely related to a variety of factors,which should attract our high attention.

关 键 词：止吐药 术后恶心呕吐 腹腔镜手术 危险因素 

分 类 号：R614.2[医药卫生—麻醉学]