头颈部肿瘤患者术后呕吐的因素分析和预防措施

Prophylaxis of postoperative nausea and vomiting in patients with head and neck neoplasm

目的评估和分析头颈部肿瘤患者术后呕吐的影响因素及采取预防措施降低术后呕吐发生率。方法回顾性分析137例头颈部肿瘤住院患者的术后呕吐情况及相关信息,分别按麻醉方法、有无应用强效止吐药、性别、年龄、病理、手术类型和静脉用丙泊酚的剂量进行统计学分析,筛选术后呕吐的危险因素。结果接受全身麻醉的患者比接受区域神经阻滞或浸润麻醉患者更容易发生术后呕吐(P<0.05);女性患者比男性患者更容易发生术后呕吐(P<0.01);术前应用高选择性5-HT_3受体拮抗剂类强效止吐药的患者可有效减少术后呕吐的发生率(P<0.01)。结论对采用全身麻醉的头颈部肿瘤手术,女性患者以及身体状况较差的男性患者可予术前应用强效止吐药来降低术后呕吐的发生率。

AIM To evaluate and analyze the inducing factors of postoperative nausea and vomiting （PONV） in patients with head and neck neoplasm for the purpose of reducing PONV occurrences. METHODS The incidence rate of PONV and related clinical data were collected from 137 patients received head and neck surgery. Statistical analyses were performed to compare the effect of anesthesia types, pie-operative 5-HT3 receptor antagonists administration, gender, age, pathological findings, operation types and dose of pmpofol. RESULTS Compared with patients receiving local or cervical nerve block anesthesia, patients receiving general anesthesia had high PONV occurrences （P 〈 0.05）. Lower incidence rates of PONV were observed in female than in male patients（ P 〈 0.01）. Administration of 5-HT3 receptor antagonists prior to operation can significantly lower the incidence rates of PONV （P 〈0.01）. CONCLUSION Type of anesthesia, gender and health status of patients are associated with the incidence of PONV. Therefore, female patients and male patients in bad healthy condition who received head and neck surgery under general anesthesia are recommended to get prophylactic antiemetic therapy.