术中胃减压对神经内镜经鼻颅底手术后恶心呕吐的影响

Effects of intraoperative gastric decompression on postoperative nausea and vomiting in endoscopic endonasal skull base surgery

目的探讨术中胃减压对行神经内镜经鼻颅底手术患者手术后恶心呕吐(PONV)的影响。方法回顾性分析2019年1—8月在复旦大学附属华山医院神经外科接受神经内镜经鼻颅底手术的357例患者的临床资料。根据术中是否进行胃减压,分为胃减压组(146例)和对照组(211例)。比较两组的临床特征和术后24 h内PONV发生率的差异。对于包括胃减压在内的各因素对行神经内镜经鼻颅底手术患者PONV发生的影响,采用单因素和多因素logistic回归分析法探讨。结果所有患者术后24 h内的PONV发生率为11.8%(42/357)。胃减压组的女性比例[58.2%(85/146)对比46.4%(98/211),P=0.029]和Apfel评分为2~3分的比例[64.4%(94/146)对比50.2%(106/211),P=0.008]均高于对照组,而胃减压组PONV的发生率低于对照组[7.5%(11/146)对比14.7%(31/211),P=0.039]。单因素logistic回归分析结果提示,术中采用脂肪填塞修补脑脊液漏、术中采用黏膜瓣修补脑脊液漏、术中胃减压和术中失血量是神经内镜经鼻颅底手术患者PONV发生的影响因素(均P<0.05)。多因素logistic回归分析结果提示,术中胃减压(OR=0.397,95%CI:0.185~0.852,P=0.018)和术中失血量(OR=1.133,95%CI:1.026~1.250,P=0.013)为神经内镜经鼻颅底手术患者PONV发生的独立影响因素。结论实施术中胃减压可降低神经内镜经鼻颅底手术患者PONV的发生率。

Objective To investigate the effects of intraoperative gastric decompression on postoperative nausea and vomiting(PONV)in endoscopic endonasal skull base surgery.Methods A retrospective analysis was conducted on the clinical data of 357 patients who underwent endoscopic endonasal skull base surgery at Department of Neurosurgery,Huashan Hospital,Fudan University from January 2019 to August 2019.According to whether or not intraoperative gastric decompression was performed,357 cases were divided into gastric decompression group(146 cases)and control group(211 cases).Clinical characteristics and the incidence of PONV within 24 hours after surgery were compared between the two groups.Risk factors including intraoperative gastric decompression for the incidence of PONV were assessed by using univariate and multivariate logistic regression analyses in all patients.Results The incidence of PONV 24 h post operation was 11.8%(42/357).The proportions of female[58.2%(85/146)vs.46.4%(98/211),P=0.029]and Apfel risk score 2-3[64.4%(94/146)vs.50.2%(106/211),P=0.008]were higher in the gastric decompression group than those in the control group.The incidence of PONV was lower in the gastric decompression group than that in the control group[7.5%(11/146)vs.14.7%(31/211),P=0.039].Univariate logistic regression analysis showed that intraoperative cerebrospinal fluid leakage repaired with fat or mucosa graft,intraoperative gastric decompression and blood loss might be influencing factors for PONV(all P<0.05).Multivariate logistic regression analysis showed that intraoperative gastric decompression(OR=0.397,95%CI:0.185-0.852,P=0.018)and blood loss(OR=1.133,95%CI:1.026-1.250,P=0.013)were independent factors influencing the incidence of PONV.Conclusion Intraoperative gastric decompression may decrease the incidence of PONV following endoscopic endonasal skull base surgery.