耳鼻喉科手术患者术后恶心呕吐的影响因素分析

目的 探讨耳鼻喉科手术患者发生术后恶心呕吐(post operative nausea and vomiting,PONV)的影响因素.方法 统计首都医科大学宣武医院2015年1～12月在全麻下行经口或经鼻人路手术、并进入麻醉术后恢复室(post-anesthesia care unit,PACU)的患者277例,随机分为仰卧位与侧卧位两组,其中仰卧位140例,侧卧位137例,记录患者的年龄、性别、麻醉时间、手术时间等信息.观察并记录所有患者术后24h内首次发生恶心呕吐的时间,按照lh、2h、6h、12h、24h 5个时间段统计PONV发生情况.结果 性别(P=0.002)、手术路径(P=0.028)、PACU体位(P＜ 0.001)对耳鼻喉科手术患者PONV的发生均产生显著影响.女性、经鼻入路及仰卧位可使PONV的首次发生时间显著提前(11.35±1.56)h,P=0.013],并显著增加PONV的发生率(63.04±7.20)％,P=0.022].对于女性仰卧位患者,手术路径(经鼻入路vs.经口入路)对PONV的首次发生时间(11.35±:1.56)h vs.(15.79±1.97)h,P=0.076]及发生率(63.04±7.20)％ vs.(39.29±9.40)％,P=0.107]的影响均未达到显著水平.结论 性别、手术路径及PACU体位是耳鼻喉科手术患者发生PONV的重要影响因素,女性、经鼻入路及仰卧位可能会使PONV的首次发生时间显著提前,并显著增加PONV的发生率.

The analysis of impacting factors of postoperative nausea and vomiting among ENT patients

Objective To investigate the factors that affect postoperative nausea and vomiting (PONV) among ENT patients.Methods A total of 277 ENT patients,who entered post-anesthesia care unit (PACU) after surgery,was enrolled into this study.They were randomized into two groups:supine position group (n=140) and lateral position group (n =137).Age,gender,anesthesia duration and operation duration were drawn from the anesthesia records.The time interval when first PONV occurred within the first 24 h was recorded.And the PONV occurrence was analyzed according to 5 stages,which were 1st hour,2nd hour,6th hour,12th hour and 24th hour.Results Gender (P =0.002),operation access (P =0.028) and position in PACU (P ＜ 0.001) played a remarkable role in the occurrence of PONV.Female,intranasal access and supine position would significantly shorten the time interval when first PONV happened (11.35± 1.56)h,P =0.013] and increase its incidence (63.04±7.20)％,P =0.022].However,for women with supine position,operative access (intranasal access vs.intraoral access) was not a remarkable factor for the duration (11.35±1.56)h vs.(15.79±1.97)h,P =0.076] and incidence (63.04±7.20)％ vs.(39.29±9.40)％,P =0.107].Conclusion Gender,operation access and position in PACU play an important role in the occurrence of PONV among ENT patients.Female,intranasal access and supine position may remarkably shorten the time interval when first PONV happens and increase its incidence.