老年患者胃肠道手术术后恶心呕吐的危险因素分析  

Risk factors for postoperative nausea and vomiting following gastrointestinal surgery in elderly patients

作　　者：郭苗苗[1] 朱慧杰 薄晗 张伟[1] 侯百灵[1] 顾小萍[1] 马正良[1] Guo Miaomiao;Zhu Huijie;Bo Han;Zhang Wei;Hou Bailing;Gu Xiaoping;Ma Zhengliang(Department of Anesthesiology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院麻醉科,210008

出　　处：《国际麻醉学与复苏杂志》2019年第1期25-29,共5页International Journal of Anesthesiology and Resuscitation

摘　　要：目的探讨老年患者胃肠道手术术后恶心呕吐(postoperative nausea and vomiting,PONV)的危险因素。方法回顾性分析2016年1月—2017年12月于南京大学医学院附属鼓楼医院行择期胃肠道手术的1021例老年患者(年龄≥65岁)病历资料。根据PONV发生情况分为两组,比较两组患者围手术期因素的差异性,对于有差异的因素采用Logistic回归分析其与PONV的相关性,探寻老年患者PONV独立危险因素。结果1021例老年患者中,PONV发生率为7.3%。本研究中与老年患者PONV显著相关的危险因素有年龄≥75岁[比值比(oddsratio,OR)=1.74,P=0.027]、女性(OR=1.69,P=0.039)、术中使用七氟醚(OR=2.32,P=0.013)、术中低血压(累计时间>20min)(OR=1.64,P=0.048)、术后使用阿片类镇痛药(OR=2.14,P=0.002)及术后感染(OR=2.03,P=0.009)。进一步分析表明,术中低血压时,其相关性有统计学意义(OR=6.28,P=0.006)。结论老年患者胃肠道手术PONV的发生与围手术期多因素相关。维持血流动力学平稳,避免术中低血压的发生,术中避免吸入性麻醉药的使用,积极预防术后感染,合理地减轻患者术后疼痛,减少术后阿片类镇痛药的使用可能是降低老年患者PONV风险的重要措施。Objective To explore the risk factors of postoperative nausea and vomiting (PONV) in elderly patients after gastrointestinal surgery. Methods Clinical data were collected from 1 021 elderly patients (age ≥65 y) who underwent gastrointestinal surgery in Nanjing Drum Tower Hospital from January 2016 to December 2017 and retrospectively analyzed. According to the occurrence of PONV, the patients were divided into two groups. The two groups were compared for the differences in perioperative factors. Furthermore, the Logistic regression analysis was performed to investigate the independent risk factors correlated with PONV. Results The incidence of PONV was 7.3%. The most important risk factors for PONV were aging 75 y or older [odds ratio (OR)=1.74,P=0.027], female (OR=1.69,P=0.039), intraoperative administration of sevoflurane (OR =2.32,P=0.013), duration of intraoperative hypotension >20 min (OR = 1.64,P =0.048), the use of postoperative opioid analgesics (OR =2.14, P =0.002) and postoperative infection (OR =2.03,P=0.009). Further analyses suggested that the association remained to be statistically significant only in patients experiencing duration of intraoperative hypotension>20 min (OR=6.28, P=0.006). Conclusions The occurrence of PONV in elderly patients after gastrointestinal surgery is related to multiple perioperative factors. Maintenance of hemodynamic stability, avoiding the use of inhalational anesthetics, preventing postoperative infection and weakening postoperative pain reasonably may reduce the risk of PONV in elderly patients.

关 键 词：术后恶心呕吐 老年患者 胃肠道手术 

分 类 号：R614[医药卫生—麻醉学]