老年髋关节置换术后恶心和呕吐发生影响因素及ERAS围术期干预效果  

Influencing Factors of Nausea and Vomiting after Hip Replacement in Elderly Patients and the Effect of Perioperative Intervention of ERAS

作　　者：关凯 王劲东 霍红军 陈政宇 方锐 曹国鹏 胡全文 GUAN Kai;WANG Jin-dong;HUO Hong-jun;CHEN Zheng-yu;FANG Rui;CAO Guo-peng;HU Quan-wen(The Second Department of Orthopedics,the First People's Hospital of Xianyang City,Xianyang,Shaanxi 712000,China)

机构地区：[1]咸阳市第一人民医院骨二科,陕西咸阳712000

出　　处：《临床误诊误治》2021年第11期78-82,共5页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨老年髋关节置换术后恶心和呕吐发生影响因素及快速康复外科(ERAS)围术期干预效果。方法选取2018年5月—2020年7月收治的未接受ERAS围术期干预的老年髋关节置换术172例作为未干预组,根据术后24 h有无发生恶心和呕吐将未干预组分为恶心和呕吐组(43例)及非恶心和呕吐组(129例)两个亚组;另选取同期收治的接受ERAS围术期干预的老年髋关节置换术89例作为干预组。采用单因素和多因素Logistic回归分析对老年髋关节置换术后恶心和呕吐发生影响因素进行分析,观察ERAS围术期干预预防老年髋关节置换术后恶心和呕吐效果。结果女性、焦虑自评量表(SAS)评分>50分、术前静脉补液量>500 ml、静吸复合全身麻醉和术中使用地佐辛是老年髋关节置换术后恶心和呕吐发生的高危因素,吸烟史和术中使用地塞米松是老年髋关节置换术后恶心和呕吐发生的保护因素(P<0.05或P<0.01)。干预组术后恶心和呕吐总发生率低于未干预组(P<0.01)。结论老年髋关节置换术后恶心和呕吐发生与性别、吸烟史、SAS评分、术前静脉补液量、静吸复合全身麻醉、术中使用地佐辛和术中使用地塞米松密切相关,ERAS围术期干预可降低老年髋关节置换术后恶心和呕吐发生率。Objective To explore influencing factors of nausea and vomiting after hip replacement in elderly patients and the effect of perioperative intervention of enhanced recovery after surgery(ERAS).Methods A total of 172 elderly patients who had undergone hip replacement without receiving perioperative intervention of ERAS admitted between May 2018 and July 2020 were selected as non-intervention group.According to presence of nausea and vomiting that occurred within 24 h after operation,the non-intervention group was divided into nausea and vomiting subgroup(n=43)and non-nausea and vomiting subgroup(n=129).In addition,other 89 elderly patients undergoing hip replacement who had received perioperative intervention of ERAS were selected as intervention group.Univariate and multivariate logistic regression analyses were performed to analyze the influencing factors of nausea and vomiting after hip replacement in elderly patients,and the effect of perioperative intervention of ERAS on preventing nausea and vomiting in elderly patients undergoing hip replacement was observed.Results Female,self-rating anxiety scale(SAS)score more than 50 points,preoperative volume of intravenous fluid infusion more than 500 ml,combined intravenous-inhalation general anesthesia,and intraoperative use of Dezocine were high risk factors,while smoking history and intraoperative use of Dexamethasone were protective factors for nausea and vomiting after hip replacement in elderly patients(P<0.05 or P<0.01).The total incidence rate of postoperative nausea and vomiting in intervention group was lower than that in non-intervention group(P<0.01).Conclusion Postoperative nausea and vomiting in elderly patients undergoing hip replacement are closely related to gender,smoking history,SAS score,preoperative volume of intravenous fluid infusion,combined intravenous-inhalation general anesthesia,intraoperative use of Dezocine and intraoperative use of Dexamethasone.Perioperative intervention of ERAS may reduce incidence rate of postoperative nausea and vomi

关 键 词：关节成形术 置换 髋 老年人 术后恶心和呕吐 影响因素分析 快速康复外科 

分 类 号：R687.42[医药卫生—骨科学] R619.9[医药卫生—外科学]