经鼻蝶垂体瘤手术后恶心呕吐的发生率及危险因素的Logistic回归分析

Incidence and Influencing Factors of Postoperative Nausea and Vomiting after Transsphenoidal Surgery for Pituitary Adenoma: A Logistic Regression Analysis

目的:分析垂体瘤经鼻蝶手术后恶心呕吐(postoperative nausea and vomiting,PONV)的发生情况,并探讨相关危险因素,为改善患者预后及术后生活质量提供参考。方法:采用前瞻性队列研究,收集2015年2月至2017年12月期间在成都市第五人民医院和四川大学华西医院神经外科择期行经鼻蝶垂体瘤手术患者360例,计算术后6h、6~12h、12~24h PONV发生率,按照是否发生PONV分为病例组和对照组,采用多因素Logistic回归模型分析垂体瘤经鼻蝶手术后发生PONV的相关危险因素。结果:经鼻蝶垂体瘤术后PONV总体发生率为26.27%(96/360),其中PONV症状为中、重度者占79.17%;有42例(43.75%)发生在术后6h内。与无功能型垂体瘤相比,泌乳素瘤(PRL)术后PONV发生率的发生率更高,差异有统计学意义(40.00%vs.25.33;χ~2=6.638,P=0.010)。单因素分析显示:性别、垂体瘤大小、手术时间、有无脂肪填塞、术后疼痛、晕动病史是经鼻蝶垂体瘤术后发生PONV的危险因素(P<0.05)。多因素Logistic回归分析显示:女性、手术时间长、术后中重度疼痛、有晕动病史是经鼻蝶垂体瘤术后发生PONV的独立危险因素(P<0.05)。结论:女性、手术时间长、术后中重度疼痛、有晕动病史是其独立危险因素。应针对危险因素,采用综合措施减少PONV的发生。

Objective： To analyze the incidence and influencing factors of postoperative nausea and vomiting（ PONV） after transsphenoidal surgery for pituitary adenoma,and to provide reference for improving the prognosis and improving the quality of life of the patients. Methods： The clinical data of 360 patients with pituitary adenomas who were treated in The Fifth People＇s Hospital of Chengdu and West China Hospital of Sichuan University from February 2015 to December 2017 were analyzed prospectively. PONV was prospectively assessed within 6 hs,6 ～ 12 hs and 12 ～ 24 hs after surgery. According to whether PONV occurs or not the patients were divided into the case group and the control group.Multivariate Logistic regression model was used to analyze the risk factors of PONV after transsphenoidal surgery. Results：The total incidence of PONV after transsphenoidal pituitary adenoma was 26. 27%（ 96/360）,of which 79. 17% of PONV were medium and severe. And 42 cases（ 43. 75%） occurred within 6 hs after operation. Compared with nonfunctioning pituitary adenomas,the incidence of PONV after prolactin tumor（ PRL） was higher,and the difference was statistically significant（ 40% vs. 25. 33; χ2= 6. 638, P = 0. 010）.Univariate analysis showed that sex,pituitary tumor size,operation time,fat free packing,postoperative pain and history of motion sickness were risk factors for PONV after transsphenoidal pituitary tumor surgery（ P 〈0. 05）. Multivariate Logistic regression analysis showed that women,long operation time,moderate and severe postoperative pain,and history of motion sickness were independent risk factors for PONV after transsphenoidal pituitary tumor surgery（ P〈 0. 05）. Conclusion： Female,long operation time,moderate and severe pain after operation,and history of dizzy movement are independent risk factors of PONV. Comprehensive measures should be adopted to reduce the occurrence of PONV according to the risk factors.