腹腔镜肝胆手术后恶心呕吐的影响因素分析

目的:分析腹腔镜肝胆手术后恶心呕吐(PONV)的影响因素。方法:选择2016年3月至2019年5月364例行肝胆手术的患者作为研究对象。采用PONV评分进行分级,>2分视为发生PONV;回顾性收集患者一般信息、手术与麻醉信息、心理情绪特征、术后镇痛用药。根据是否发生PONV,将364例患者分为PONV组(n=104)与对照组(n=260)。采用Logistic回归分析进行影响因素分析。结果:364例患者中104例发生PONV,发生率为28.6%。单因素分析显示,两组患者女性比例、身体质量指数、合并PONV或晕动病史、吸烟、焦虑、手术时间、麻醉复苏时间、术中气腹压、插管前阿片类药物、麻醉方案差异均有统计学意义(P<0.05)。多因素分析显示,性别、PONV或晕动病史、手术时间、插管前使用阿片类药物、麻醉方案是PONV发生的独立影响因素。结论:腹腔镜肝胆手术后PONV发生率较高,其发生受多种因素影响,应进行预见性评估与干预。

Influencing factors analysis of nausea and vomiting after laparoscopic hepatobiliary surgery

Objective:To analyze the influencing factors of postoperative nausea and vomiting(PONV)of laparoscopic hepatobiliary surgery.Methods:Three hundred and sixty-four patients who underwent hepatobiliary surgery from Mar.2016 to May 2019 were selected as study subjects.The PONV was graded by the PONV score≥2;general information,surgery and anesthesia information,perioperative psychological and emotional characteristics,postoperative analgesics were retrospectively collected.According to the occurrence of PONV,364 patients were divided into PONV group(n=104)and control group(n=260).Logistic regression was used for influencing factors analysis.Results:The incidence of PONV was 28.6%(104/364).Univariate analysis showed that there were statistically significant differences between the two groups in the proportion of females,mean body mass index,history of PONV or kinesia,smoking,anxiety,operation time,anesthesia resuscitation time,intraoperative pneumoperitoneum pressure,opioids before intubation,and anesthesia regimen(P<0.05).Multi-factor analysis showed that gender,history of PONV or kinesia,operative time,opioids before intubation and anesthesia plan were independent influencing factors for PONV.Conclusions:Laparoscopic hepatobiliary surgery has a high incidence of PONV,which is affected by a variety of factors,predictive assessment and intervention should be given before operation.