妇科手术术后患者恶心呕吐的发生率及其影响因素

Incidence and influential factors of post-operative nausea and vomiting following gynecological surgery： analysis of 492 cases

目的探讨妇科手术后恶心呕吐（PONV）发生率及其影响因素，指导临床对其进行有效防治。方法按前瞻性临床队列研究设计，收集合格病例进行分析。应用单因素比较和多因素Logistic回归方法，分析围术期变量和术后PONV发生的关系。术后6h及24h内发生的恶心或呕吐为本研究的结局变量。结果研究期间共492例有效病例。24h内有218例出现PONV，发生率为44．3％。6h内出现PONV的为161例，发生率为32．7％。多因素Logistic回归提示妇科手术术后24h内发生PONV的危险因素为PONV史和围术期阿片类药物应用；而术后6h内发生PONV的危险因素为PONV史、全身麻醉及术毕寒战；两者的保护因素间为地塞米松和氟哌利多的应用。结论对于妇科手术而言，先前PONV史可增加本次手术术后PONV的发生，应当加强预防；围术期阿片类药物的使用可提高术后24h内PONV发生的风险；而全身麻醉及术毕寒战则使术后6h内PONV的风险增高；围术期应用地塞米松或氟哌利多可降低术后6h及24h内PONV发生的风险。

Objective To investigate the incidence and influential factors of post-operative nausea and vomiting （PONV） following gynecologic surgery so as to provide guideline effective for clinical management. Methods The clinical data of 492 qualified consecutive female patients who had undergone gynecological surgery were analyzed. Univariate analysis and multivariate logistic regression were applied to examine the relations between the perioperative variables and occurrence of PONV within 6 h or 24 h following gynecologic procedures. Results PONV developed in 218 patients within 24 h following surgery （44. 3% ） while in 161 patients within 6 h following surgery （ 32. 7% ）. Multivariate logistic regression analysis identified PONV history and perioperative opioids administration as significant predictors of PONV within 24 h following gynecologic surgery, while PONV history, general anesthesia, and postoperative shivering predictors of PONV within 6 h after surgery, and found the administration of dexamethasone or droperidol as consistent protective factors of PONV within 6 h or 24 h following surgery. Conclusion For gynecologic surgery, previous PONV history will increase the risk for PONV following current surgery. Perioperative opioids administration will intensify the risk for the development of PONV within 24 h following surgery, while general anesthesia and postoperative shivering for PONV within 6 h after surgery. Perioperative dexamethasone or droperidol will decrease the incidence of PONV within 6 h or 24 h following gynecologic procedures.