围手术期管理对胃癌病人术后恶心呕吐影响因素分析  

Effect of perioperative management on postoperative nausea and vomiting in patients with gastric cancer

作　　者：李硕 曾凡荣[1] 张云霄[2] 于玲[2] 马江涛 谭宏宇[2] LI Shuo;ZENG Fan-rong;ZHANG Yun-xiao(Department of Anesthesiology,the First Affiliated Hospital of Jiamusi University,Jiamusi 154002,China)

机构地区：[1]佳木斯大学附属第一医院麻醉科,黑龙江佳木斯154002 [2]北京大学肿瘤医院暨北京市肿瘤防治研究所麻醉科恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《中国实用外科杂志》2020年第2期224-229,共6页Chinese Journal of Practical Surgery

摘　　要：目的探讨围手术期管理中影响胃部肿瘤手术病人术后恶心呕吐(PONV)发生的主要相关因素。方法回顾性分析2015年3月至2018年6月期间北京大学肿瘤医院电子病例系统中接受胃部肿瘤手术的880例病人的临床资料。以术后24 h内病人出现恶心呕吐为因变量,能够直接或间接影响恶心呕吐的因素作为自变量,进行单因素及多因素Logistic回归分析,筛选影响PONV的独立相关因素。结果单因素分析结果显示:女性、饮酒史、不吸烟状态、化疗史、依托咪酯的应用、术中晶体液>20 mL/kg、术中胶体液>10 m L/kg、围手术期地塞米松等效剂量≥10 mg为围手术期管理中影响胃部肿瘤手术病人PONV的相关因素。多因素Logistic回归分析显示:女性(OR 4.32,95%CI 2.89-6.45,P<0.001)、手术时间≥3h(OR 1.66,95%CI 1.00-2.74,P=0.049)是PONV独立危险因素,围手术期地塞米松等效剂量≥10 mg(OR 0.61,95%CI 0.39-0.97,P=0.038)、胶体液量>10 mL/kg(OR 0.48,95%CI 0.32-0.74,P=0.001)降低了PONV的风险。结论女性、手术时间≥3h是PONV的危险因素。胃癌手术病人术中胶体液量>10 mL/kg,围手术期地塞米松等效剂量≥10 mg,可预防术后恶心呕吐。Objective To explore the main related factors of postoperative nausea and vomiting (PONV) in patients with gastric tumor surgery during perioperative management.Methods The clinical data of 880 patients who underwent gastric tumor surgery between March 2015 and June 2018 in Peking University Cancer Hospital & Institute were analyzed retrospectively. The patients with nausea and vomiting within 24 hours after surgery were the dependent variables. The factors that directly or indirectly affected nausea and vomiting were used as independent variables to analyze the independent factors related to PONV by univariate and multivariate logistic regression analysis.Results Univariate analysis showed that female gender, drinking history, non-smoking status, chemotherapy history, etomidate application, intraoperative crystal fluid > 20 m L/kg, intraoperative colloid fluid > 10 mL/kg, and perioperativedexamethasone equivalent dose≥ 10 mg were the related factors of PONV in patients with perioperative management of gastric cancer. Multivariate logistic regression analysis showed that female gender (OR 4.32, 95% CI 2.89- 6.45, P<0.001),duration of surgery≥ 3h(OR 1.66, 95% CI 1.00- 2.74, P=0.049)were independent risk factors for PONV.Perioperative dexamethasone equivalent dose≥ 10mg (OR 0.61, 95%CI 0.39-0.97, P=0.038), colloid fluid>10mL /kg(OR 0.48, 95%CI 0.32-0.74, P=0.001) reduces the risk of PONV.ConclusionFemale gender and duration of surgery≥3h are risk factors for PONV. In patients with gastric cancer surgery, the amount of colloidal fluid>10mL/kg and the equivalent dose of dexamethasone during the perioperative period ≥ 10mg can preventpostoperative nausea and vomiting.

关 键 词：恶心 呕吐 胶体液 地塞米松 胃切除术 

分 类 号：R6[医药卫生—外科学]