胸科手术病人术后恶心呕吐的危险因素  

Risk factors for postoperative nausea and vomiting in patients undergoing thoracic surgery

作　　者：王若菡 李冰[1] 袁景丽 支慧 孟星 张加强 张伟[1] Wang Ruohan;Li Bing;Yuan Jingli;Zhi Hui;Meng Xing;Zhang Jiaqiang;Zhang Wei(Department of Anesthesiology and Perioperative Medicine,People′s Hospital of Henan University,Zhengzhou 450003,China)

机构地区：[1]河南大学人民医院麻醉与围术期医学科,郑州450003

出　　处：《中华麻醉学杂志》2022年第2期143-146,共4页Chinese Journal of Anesthesiology

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20190607,LHGJ20200059)。

摘　　要：目的:筛选胸科手术病人术后恶心呕吐(PONV)的危险因素。方法:回顾性收集2018年1月至2020年1月择期行胸科手术病人的病历资料,性别不限,年龄18~80岁,ASA分级Ⅰ~Ⅲ级。记录病人年龄、性别、学历、ASA分级、晕动症、吸烟史、饮酒史、心脏病史、高血压病史、糖尿病病史、术前血常规、肝功能、电解质指标;手术方式、手术类型、手术时间、术中神经阻滞、麻醉诱导前地塞米松、术中舒芬太尼、右美托咪定用量和术后PCIA、术后补救性阿片类镇痛药和止吐药使用情况;根据术后24 h内恶心呕吐发生情况,分为PONV组和非PONV组;根据是否发生呕吐,将PONV组分为恶心组(PON组)和呕吐组(POV组)。采用logistic回归分析法筛选胸科病人PONV的危险因素。结果:本研究共纳入3791例病人,PONV组144例,非PONV组3647例。PONV发生率3.80%;POV组38例,POV发生率26.4%。logistic回归分析结果显示,晕动症、女性、肺楔形切除术、术后PCIA和术后补救性阿片类镇痛药用量增多是胸科手术病人PONV的危险因素,术中使用右美托咪定是其保护因素;晕动症、女性和高血压病史是PONV病人发生呕吐的危险因素(P<0.05)。结论:晕动症、女性、肺楔形切除术、术后PCIA和术后补救性阿片类镇痛药用量增多是胸科手术病人PONV的危险因素,术中使用右美托咪定是其保护因素;晕动症、女性和高血压病史是胸科手术PONV病人发生呕吐的危险因素。Objective To identify the risk factors for postoperative nausea and vomiting(PONV)in the patients undergoing thoracic surgery.Methods The medical records of patients of either sex,aged 18-80 yr,of American Society of Anesthesiologists physical statusⅠ-Ⅲ,underwent elective thoracic surgery from January 2018 to January 2020,were collected retrospectively.The age,gender,educational background,American Society of Anesthesiologists physical status,motion sickness,history of smoking,history of drinking,history of heart disease,history of hypertension,history of diabetes,preoperative blood routine,liver function,parameters of electrolytes;operation method,type of operation,operation time,intraoperative nerve block,consumption of dexamethasone before anesthesia induction and intraoperative sufentanil and dexmedetomidine,use of postoperative patient-controlled intravenous analgesia(PCIA),and postoperative rescue opioid analgesics and antiemetics were recorded.The patients were divided into PONV group and non-PONV group depending on the occurrence of nausea and vomiting within 24 h after operation.PONV group was further divided into nausea group(PON group)and vomiting group(POV group)according to whether vomiting occurred.Logistic regression analysis was used to identify the risk factors for PONV.Results A total of 3791 patients were enrolled in this study,with 144 cases in PONV group and 3647 cases in non-PONV group.The incidence of PONV was 3.80%.There were 38 patients in POV group,and the incidence was 26.4%.The results of logistic regression analysis showed that motion sickness,female,pulmonary wedge resection,postoperative PCIA and increased use of postoperative rescue opioid analgesics were risk factors for PONV in the patients undergoing thoracic surgery,intraoperative use of dexmedetomidine was a protective factor for PONV;motion sickness,female and history of hypertension were risk factors for postoperative vomiting in the patients at risk for PONV(P<0.05).Conclusions Motion sickness,female,pulmonary wedge res

关 键 词：胸外科手术 手术后恶心呕吐 危险因素 

分 类 号：R614[医药卫生—麻醉学]