青少年脊柱侧弯矫形术后呕吐的危险因素分析

Risk Factors of Postoperative Vomiting in Adolescents Undergoing Scoliosis Surgery

目的:探究全麻下行脊柱侧弯矫形术的青少年患者发生术后呕吐的危险因素,为术后呕吐管理提供临床参考。方法:选择我院2017年7月~2018年8月在全麻下行脊柱侧弯矫形术的青少年患者,记录术后24 h内呕吐的出现情况。采用多因素Logistic回归模型筛选出危险因素。另外,利用倾向评分匹配来排除混杂因素来评估预防性应用镇吐药物的有效性。结果:共纳入了235例青少年患者,其中79例患者出现呕吐,其发生率为33.6%。Logistic回归分析提示,晕动病史或术后恶心呕吐(postoperative nausea and vomiting,PONV)史、术后使用芬太尼是术后呕吐(postoperative vomiting,POV)的独立危险因素。预防性使用镇吐药物的患者POV发生率低于未使用预防性镇吐药物的患者(P<0.01)。结论:有晕动病史或PONV史和术后应用阿片类药物是青少年脊柱侧弯矫形术后呕吐的危险因素,预防性应用地塞米松和(或)昂丹司琼可以降低发生术后呕吐的风险。

Objective:To analyze the risk factors of postoperative vomiting in adolescents following scoliosis surgery,and provide reference for the management of postoperative vomiting.Methods:Adolescents undergoing scoliosis surgery from July 2017 to August 2018 in our hospital were included in this study.Postoperative vomiting was assessed for 24 h after anaesthesia.Multivariate logistic regression analysis was performed to quantify risk factors for POV.We additionally performed a propensity score matched analysis so that subjects who did or did not receive prophylactic antiemetics were comparable.Results:A total of 235 patients were enrolled in this study.Of those 79 suffered from POV.And the incidence of postoperative vomiting was 33.6%.The 24 h POV was predicted by history of PONV or motion sickness and postoperative dose of fentanyl.There was a significant difference between the prophylaxis group and the no prophylaxis group(P<0.01).Conclusion:History of PONV or motion sickness and postoperative dose of fentanyl are risk factors for POV in adolescents following scoliosis surgery.Prophylactic ondansetron and dexamethasone effectively prevent POV.