影响妇科腹腔镜术后恶心呕吐的因素分析

Logistic regression analysis of factors affecting postoperative nausea and vomiting in patients undergoing gynecologic laparoscopic surgery

目的探讨在全凭静脉麻醉下择期行妇科腹腔镜子宫肌瘤剔除术或腹腔镜卵巢囊肿剥除术的患者发生术后恶心呕吐(PONV)的影响因素。方法选取2017年3月—2018年3月山西医科大学第二医院妇科行腹腔镜下子宫肌瘤剔除术或卵巢囊肿剥除术的患者210例作为研究对象。观察患者术后24 h内有无PONV的发生,以是否发生PONV分为无PONV组和PONV组,先行单因素分析,再将单因素分析中有统计学差异的影响因素纳入多因素Logistic回归分析。结果210例患者术后24 h内PONV的发生率为49.05%(103/210),无PONV组和PONV组在年龄、术前静脉补液量、预防性止吐药、低血压、舒芬太尼用量、晕动病史或PONV史方面差异有统计学意义(P<0.05);多因素Logistic回归分析显示术前静脉补液量>500 ml[O^R=3.427(95%CI:1.321,8.887)]、给予氢化泼尼松20 mg[O^R=0.352(95%CI:0.152,0.817)]、有晕动病史或PONV史[O^R=5.061(95%CI:1.468,17.449)]是妇科腹腔镜手术患者发生PONV的影响因素。结论术前静脉补液量>500 ml和有晕动病史或PONV史可增加妇科腹腔镜手术患者PONV的发生率,给予氢化泼尼松20 mg可降低妇科腹腔镜手术患者PONV的发生率。

Objective To explore correlative factors of postoperative nausea and vomiting(PONV)in patients undergoing elective gynecological laparoscopic myomectomy or laparoscopic ovarian cyst removal under total intravenous anesthesia.Methods The clinical data of 210 patients of gynecological laparoscopic myomectomy or laparoscopic ovarian cyst removal were collected retrospectively,and the occurrence of PONV was observed within 24 hours after operation.According to whether PONV occured or not,it was divided into no PONV group and PONV group.The factors with significant difference in single analysis were then included in the logistic regression analysis to analyze the factors related to the occurrence of PONV in patients undergoing gynecologic laparoscopic surgery.Results The incidence of PONV within 24 hours after operation was 49.05%(103/210).There were significant differences between the two groups in age,preoperative fluid resuscitation,prophylactic antiemesis,hypotension,sufentanil dosage,history of motion sickness or PONV(P<0.05).Multivariate logistic regression analysis based on the results of single factor analysis showed that preoperative fluid rehydration was more than 500 ml[O^R=3.427(95%CI:1.321,8.887)],20 mg hydroprednisone[O^R=0.352(95%CI:0.152,0.817)]and a history of motion sickness or PONV[O^R=5.061(95%CI:1.468,17.449)]were influencing factors for the occurrence of PONV in patients undergoing gynecologic laparoscopic surgery.Conclusion Preoperative fluid resuscitation was more than 500ml and history of motion sickness or PONV increased the incidence of PONV in patients undergoing gynecologic laparoscopic surgery.20 mg hydroprednisone can reduce the incidence of PONV.