神经外科患者麻醉恢复期恶心呕吐的情况分析及护理

Incidence and nursing of postoperative nausea and vomiting following neurosurgery in the postanesthesia care unit

目的探讨不同神经外科手术患者麻醉恢复期恶心呕吐的发生情况及护理对策。方法回顾性分析5078例神经外科手术患者的临床资料，对其麻醉恢复期恶心呕吐的发生情况及护理对策进行总结。结果5078例神经外科患者中，麻醉恢复期发生恶心呕吐798例，发生率为15．7％。其中颅咽管瘤组28．4％（25／88）、脑室肿瘤组26．7％（35／131）、后颅窝肿瘤组24．2％（157／650）、脑血管病组20．8％（87／418）、幕上肿瘤组19．3％（297／1535）、癫痫组15．8％（16／101）、经蝶垂体瘤组8．8％（88／991）、脊髓肿瘤组8．4％（52／619）。全部病例经及时治疗和护理均得到有效控制。结论神经外科不同部位的手术患者麻醉恢复期恶心呕吐的发生情况不同，需要针对不同的病种、严密观察及护理。

Objective To analyze incidence and nursing strategies of postoperative nausea and vomiting after different neurosurgery in the postanesthesia care unit （PACU）. Methods 5 078 adult patients who had undergone neurosurgery enrolled into PACU were retrospectively investigated. The incidence and nursing strategies of postoperative nausea and vomiting were analyzed. Results The overall incidence of PONV following neurosurgery was 15.7% （798 cases）. The incidence of PONV in patients undergoing craniopharyngioma was 28.4% （25/88）, ventricular tumor 26.7% （35/131）, infratentorial craniotomy 24.2% （ 157/650）, intracranial aneurysm and arteriovenous malformation 20.8% （87/418）, supratentorial tumor 19.3% （297/1 535 ）, epilepsy 15.8% （16/101）, transsphenoidal surgery .of pituitary tumor 8. 8% （88/991）, spinal cord tumor 8.4% （52/619） and others 7.5% respectively. Conclusions The overall incidence of PONV in PACU following neurosurgery was approximately 16%. These results indicate that the incidence o~ PONV following neurosurgery is different and craniopharyngioma, ventricular tumor and posterior fossa tumor are high risk for PONV. Nursing strategies for the prevention of PONV following neurosurgery are required.