不同氧流量对改善腹腔镜胆囊切除术后恶心呕吐的效果比较

目的 比较不同的吸氧流量对于改善腹腔镜胆囊切除术（LC）后恶心呕吐的效果.方法 选取2012年1月～2013年6月在上海市浦东医院实施气管插管全身麻醉下行LC术的患者118例,其中男79例,女39例,年龄18～65岁,按随机数字表对手术患者进行分组,A组（2 L/min）40例、B组（4L/min）44例、C组（6L/min）34例.患者从麻醉苏醒、返回病房后开始吸氧计时,时间均限定为术后持续鼻导管吸氧6h.分别于术后6、12、24h按WHO的恶心呕吐评分标准观察患者恶心呕吐发生情况;测定患者入苏醒室时及吸氧6h后的氧饱和度情况;术后6h及24 h时以舒适状况量表评估患者的舒适度.应用SPSS 19.0统计软件包进行统计学分析,运用均数±标准差（-x±s）表示,计量资料组间比较采用单因素方差分析,计数资料采用x2检验,P＜ 0.05为差异有统计学意义.结果 术后6h三组患者恶心呕吐的发生率差异无统计学意义（P=0.712）;术后12h及24h三组患者间恶心呕吐发生率差异有统计学意义（P＜0.05）,A组（75.30±6.04）分]、B组（76.34±7.23）分]与C组（80.32±7.82）分]舒适度比较差异均有统计学意义（P＜0.05）.结论 术后早期（6h内）给予6 L/min的吸氧流量最能有效改善LC术后患者恶心呕吐的情况,降低恶心呕吐的发生率,且患者的舒适度是最高的.

Comparison of different oxygen flow rate on relieving nausea and vomiting after laparoscopic cholecystectomy

Objective To investigate the effect of different oxygen flow rate on relieving postoperative nausea and vomiting after LC with carbon dioxide pneumoperitoneum.Methods During January 2012 to June 2013,118 patients were treated with laparoscopic cholecystectomy under general anesthesia in Shanghai Pudong Hospital.Of them,79 patients were males and 39 patients were females.The age was 18-65 years.All the patients were randomly divided into three groups according to random numbers.There were 40,44 and 34 patients in group A （2 L/min）,group B （4 L/min） and group C （6 L/min）,respectively.The patients immediately began to inhale oxygen when they recovered from the anesthesia and returned the ward.The time limit for postoperative continuous oxygen nasal tube were 6 h.The SPO2 level was measured soon after the operation and 6 hours after the operation.The incidence of nause and vomiting rate and level of comfort were recorded and evaluated according to WHO nause and vomiting evaluation standard and comfortable status scale,respectivley.SPSS 19.0 software package was used for statistical analysis.One-way anova test was used for comparisons of continous variables and x2 test was used for comparisons of categorical variables,P ＜ 0.05 was considered significant.Results The incidence of postoperative nausea and vomiting at 6 h had no significant difference among 3 groups （P =0.712）,while the incidence of postoperative nausea and vomiting at 12 h and 24 h had significant difference among 3 groups （P ＜ 0.05）.The patients of group C （80.32±7.82） scores] were more comfortbale than the patients of group A （75.30±6.04） scores] and group B （76.34±7.23） scores] after laparoscopic cholecystectomy （P ＜ 0.05）.Conclusion The early postoperative period （in the 6 h） oxygen flow （6 L/min） can effectively reduce the incidence of nausea and vomiting and make patients comfortalbe after LC with carbon dioxide pneumoperitoneum.