全身麻醉手术中预防性使用止吐药物发生恶心呕吐的危险因素分析  

Risk Factors for Nausea and Vomiting after Intraoperative Prophylactic Administration of Antiemetic Agents in Patients Undergoing General Anesthesia Surgery

作　　者：王瑛琦 汪小海[1] 陈洁[1] 徐鑫[1] 葛卫红[2] WANG Yingqi;WANG Xiaohai;CHEN Jie;XU Xin;GE Weihong(Department of Anesthesiology,Drum Tower Hospital,Medical School of Nanjing University,Nanjing 210008,China;Department of Pharmacy,Drum Tower Hospital,Medical School of Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院麻醉科,南京210008 [2]南京大学医学院附属鼓楼医院药学部,南京210008

出　　处：《药学与临床研究》2022年第1期76-80,共5页Pharmaceutical and Clinical Research

摘　　要：目的:分析了全麻手术患者术中预防性使用止吐药后仍发生术后恶心呕吐(PONV)的危险因素。方法:回顾性分析2019年7月至2019年8月在南京鼓楼医院行全麻手术630例患者的临床资料。采用二项Logistic回归分析影响PONV发生的危险因素。结果:单因素分析显示:性别、术前服用降压药、麻醉诱导用药、手术类型、术中镇痛药种类、术中输注胶体、术中输注乳酸林格氏液、术中使用非阿片类镇痛药、术中预防性止吐药种类等因素组间差异有统计学意义(P<0.05)。多因素Logisitic回归分析显示:联合使用多种降压药(OR=2.944,95%CI 1.228~7.057,P=0.016)、行神经外科手术(OR=5.486,95%CI 1.855~16.220,P=0.002)是PONV的危险因素,男性(OR=0.385,95%CI0.259~0.572,P<0.001)、术中输注乳酸林格氏液(OR=0.962,95%CI 0.927~0.997,P=0.035)、术后疼痛(OR=0.107,95%CI 0.047~0.246,P<0.001)是PONV的保护性因素,相对于术中单独使用昂丹司琼作为预防性止吐药物,使用托烷司琼患者PONV的发生率显著增加(OR=2.322,95%CI 1.256~4.293,P=0.007)。结论:术前联合使用多种降压药、神经外科手术、女性是预防性使用止吐药后发生PONV的危险因素,术中充分补充乳酸林格氏液可显著降低PONV的发生率。Objective:This article analyzed the risk factors for postoperative nausea and vomiting(PONV)after prophylactic antiemetic drugs during the operation under general anesthesia.Methods:The clinical data of 630 patients who underwent general anesthesia between July 2019 and August 2019 in Nanjing Drum Tower Hospital were analyzed retrospectively.Binary logistic regression was used to analyze the independent risk factors for PONV.Results:Univariate analysis showed that there were statistical differences between the two groups in such factors as gender,preoperative antihypertensive medication,anesthesia induction medication,type of operation,intraoperative analgesic,intraoperative infusion colloid,intraoperative lactated Ringer’s solution infusion,non-opioid analgesics and intraoperative antiemetic drugs(P<0.05).Multivariate Logisitic regression analysis showed that Combined use of multiple antihypertensive drugs(OR=2.944,95%CI 1.228~7.057,P=0.016)and neurosurgery(OR=5.486,95%CI1.855~16.220,P=0.002)were risk factors for PONV.Men(OR=0.385,95%CI 0.259~0.572,P<0.001),intraoperative infusion of lactated Ringer’s solution(OR=0.962,95%CI 0.927~0.997,P=0.035)and postoperative pain(OR=0.107,95%CI 0.047~0.246,P<0.001)were protective factors for PONV.The incidence of PONV was significantly higher in patients treated with tropisetron than with ondansetron(OR=2.322,95%CI 1.256~4.293,P=0.007).Conclusions:The combined use of multiple antihypertensive drugs,neurosurgery and female are independent risk factors for PONV after prophylactic use of antiemetics,and intraoperative adequate supplementation of lactated Ringer’s solution can significantly reduce the incidence of PONV.

关 键 词：全身麻醉 预防性止吐药物 术后恶心呕吐 

分 类 号：R969[医药卫生—药理学]