青少年特发性脊柱侧凸术后发生恶心呕吐的危险因素分析

Risk factors for nausea and vomiting after adolescent idiopathic scoliosis surgery

目的探讨术中药物干预对青少年特发性脊柱侧凸(AIS)患者术后发生恶心呕吐的预测因素。方法分析南京鼓楼医院2012年12月~2016年1月986例(男156例,女830例)AIS后路矫形手术患者相关资料。记录美国麻醉医师协会(ASA)分级、体质量指数(BMI)、术前Cobb角、术前呼吸合并症、心血管合并症、手术时间、麻醉方式、输入胶体液总量、晶体液总量、输血总量、术中出血量、尿量、术中平均动脉压(MAP)最低值及中心静脉压(CVP)最低值、术中芬太尼用量、术中应用右美托咪定、应用地塞米松、恩丹司琼以及氟哌利多的情况。记录术后48 h内恶心呕吐的发生情况、手术前后血红蛋白变化值(ΔHb)、术后镇痛的情况、使用止吐药的次数及种类和术后住院时间。进行单因素分析后,应用多因素Logistic回归分析(前进法),筛选术后48 h内发生术后恶心呕吐的预测因素。结果 986例AIS患者中151例发生术后恶心呕吐(发生率15.3%)。多因素Logistic回归分析提示,术中芬太尼用量大(>0.65 mg)[P<0.001,OR=9.303,95%CI 2.373~8.622]、手术前后Hb变化值大(>28.5 g/L)(P<0.001,OR=1.107,95%CI 1.060~1.157)、使用芬太尼自控镇痛(P<0.001,OR=11.671,95%CI 2.381~11.284)是AIS矫形患者发生术后恶心呕吐的危险因素。术中应用右美托咪定(P=0.002,OR=0.027,95%CI 0.006~0.123)、术中应用地塞米松复合恩丹司琼(P=0.032,OR=0.241,95%CI 0.066~0.886)是其保护因素。结论术中芬太尼用量大、ΔHb大以及术后使用芬太尼自控镇痛,增加AIS术中患者发生术后恶心呕吐的风险。术中使用右美托咪定以及使用地塞米松复合恩丹司琼是发生术后恶心呕吐的保护因素。

Objective To explore risk factors for postoperative nausea and vomiting(PONV) that requires intervention with medications during adolescent idiopathic scoliosis(AIS) surgery. Methods We analyzed the data of 986 patients with AIS(including 156 male and 830 female patients) undergoing scoliosis surgery through a posterior approach between December,2012 and January, 2016 in Nanjing Drum Tower Hospital. The data were collected from the patients including ASA grade, body mass index(BMI), Cobb angle, preoperative respiratory and cardiovascular diseases, operation time, type of anesthesia,quantity of intraoperative liquid infusion, blood loss, urine volume, the lowest MAP and CVP, intraoperative fentanyl consumption, and intraoperative administration of dexmedetomidine, dexamethasone, ondansetran and droperidol. The incidence of PONV in 48 h following the surgery, hemoglobin variation after operation(ΔHb), postoperative analgesia, times of use and types of antiemetic drugs, and postoperative hospital stay were recorded for all the patients. The potential risk factors of PONV within 48 h were analyzed using univariate analysis and multivariate logistic regression. Results Of the 986 patients analyzed, 151(15.3%) experienced PONV within 48 h following surgeries for AIS. Multivariate logistic regression analysis suggested that an high intraoperative fentanyl dose(>0.65 mg;OR=9.303, 95% CI: 2.373-8.622, P<0.001), an obviousΔHb(>28.5 g/L;OR=1.107, 95% CI: 1.060-1.157, P<0.001), and postoperative analgesia with fentanyl(OR=11.671, 95% CI:2.381-11.284, P<0.001) were risk factors for PONV. Intraoperative administration of dexmedetomidine(OR=0.027, 95% CI:0.006-0.123, P=0.002) and dexamethasone combined with ondansetron(OR=0.241, 95%CI: 0.066-0.886, P=0.032) were protective factors against PONV. Conclusion A high-dose intraoperative fentanyl consumption, a marked ΔHb, and postoperative analgesia with fentanyl are risk factors for PONV while intraoperative administration of dexmedetomidine and dexamethasone combined with ondansetron are protective factors against PONV following surgeries for AIS.