脊柱全麻PONV发生情况调查及风险预测模型构建  

Investigation of occurrence of PONV after spinal general anesthesia surgery and construction of risk prediction model

作　　者：严兆霞 许华 楼怡[1] YAN Zhaoxia;XU Hua;LOU Yi(Department of Anesthesiology,Yueyang Hospital of Integrated Traditional Chinese and Western Medicine,Shanghai University of Traditional Chinese Medicine,Shanghai 200437)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院麻醉科,上海200437

出　　处：《颈腰痛杂志》2025年第1期79-84,共6页The Journal of Cervicodynia and Lumbodynia

基　　金：岳阳医院中医专科建设项目[YW(2023-2024)-01-05]。

摘　　要：目的分析脊柱全麻术后恶心呕吐(PONV)发生情况及影响因素,并构建Logistic风险预测模型。方法选择2021年6月至2023年6月行脊柱全麻术的383例患者,调查其术后48 h内PONV发生情况。根据术后是否发生PONV,将患者分为PONV组、非PONV组,比较两组一般资料、围术期指标,采用多因素Logistic回归分析脊柱全麻PONV发生的影响因素,构建Logistic风险预测模型,Homser-Lemeshow检验模型拟合优度,受试者工作特征曲线(ROC)评估模型的预测效能。结果383例脊柱全麻术患者中57例(14.88%)发生PONV;多因素Logistic回归分析显示,女性、术后使用阿片类药物是影响脊柱全麻PONV发生的危险因素(P<0.05),预防性使用地塞米松、5-羟色胺3受体(5-HT3R)拮抗剂是保护因素(P<0.05);通过筛选的影响因素构建预测模型,logit(P)=1/1+e{[^(-(-0.100+3.406×女性-1.729×预防性使用地塞米松-3.325×预防性使用5-HT3R拮抗剂+2.621×术后使用阿片类药物)])},Hosmer-Lemeshow拟合优度检验显示,该模型校准度良好(χ^(2)=2.519,P=0.143);预测模型预测脊柱全麻PONV的AUC为0.856(95%CI:0.777~0.935),敏感度和特异度分别为78.90%和92.30%。结论预防性使用地塞米松、5-HT3R拮抗剂有利于减少脊柱全麻PONV的发生,而女性、术后使用阿片类药物则会增加PONV的发生风险,基于影响因素构建的风险预测模型具有一定的预测价值,能够为指导脊柱全麻PONV的防控工作提供理论根据。Objective To analyze the occurrence of postoperative nausea and vomiting(PONV)after spinal general anesthesia surgery and its related influencing factors,and to construct a Logistic risk prediction model.Methods 383 patients who received spinal general anesthesia surgery in the hospital from June 2021 to June 2023 were selected as study subjects.The occurrence of PONV within 48 hours after surgery was investigated.The patients were divided into PONV group and non-PONV group according to whether PONV occurred after surgery,and the general data and perioperative indicators were compared.The influencing factors of PONV after spinal general anesthesia surgery were analyzed by multivariate Logistic regression analysis,and Logistic risk prediction model was constructed.The goodness of fit was tested by Homser-Lemeshow model,and the predictive efficiency of the model was evaluated by receiver operating characteristic curve(ROC).Results Among 383 patients undergoing spinal general anesthesia surgery,57 cases(14.88%)developed PONV.Multivariate Logistic regression analysis showed that female and postoperative use of opioids were risk factors for PONV occurrence after spinal general anesthesia surgery(P<0.05),while prophylactic use of dexamethasone and 5-hydroxytryptamine 3 receptor(5-HT3R)antagonist was protective factor(P<0.05).The prediction model was constructed by screening the influencing factors,and logit(P)=1/1+e{^([-(-0.100+3.406×female-1.729×prophylactic use of dexamethasone-3.325×prophylactic use of 5-HT3R antagonist+2.621×postoperative use of opioids)])}.Hosmer-Lemeshow goodness of fit test showed that the model had good calibration(χ^(2)=2.519,P=0.143).The AUC,sensitivity and specificity of the prediction model for predicting PONV after spinal general anesthesia surgery were 0.856(95%CI:0.777-0.935),78.90%and 92.30%respectively.Conclusion Prophylactic use of dexamethasone and 5-HT3R antagonist are beneficial to reducing the occurrence of PONV after spinal general anesthesia surgery,while female and postope

关 键 词：脊柱手术 全麻 术后恶心呕吐 影响因素 风险模型 受试者工作特征曲线 

分 类 号：R681[医药卫生—骨科学]