678例单侧髋、膝关节置换患者术后恶心呕吐风险评估及预防用药回顾性分析

Risk Assessment of Postoperative Nausea and Vomiting and Retrospective Analysis of Prophylactic Antiemetics in 678 Patients with Unilateral Hip and Knee Arthroplasty

目的:了解单侧髋、膝关节置换患者术后恶心呕吐(PONV)的发生风险、发生率以及预防用药情况,为PONV预防提供参考。方法:采用回顾性研究方法,收集2022年在本院骨科行单侧髋、膝关节置换手术患者资料,包括临床特征、预防用药情况和PONV发生率。根据Apfel评分对患者PONV发生风险进行评估。结果:共纳入患者678例,Apfel评分0、1、2、3、4分者分别为5、82、123、298和170例,高危患者占比69.03%。PONV发生率为26.84%(182/678)。随着Apfel评分的升高,PONV发生率逐渐升高,Apfel评分4分患者显著高于其他组(P<0.05)。PONV高危患者中,286例(61.11%)未预防用药或仅使用1种预防药物,预防用药可能存在不足。与使用0~1种药物预防的患者相比,采用2~3种药物联合预防后,高危患者PONV发生率有所降低,但差异无统计学意义(33.57%vs 29.12%,P>0.05)。结论:单侧髋、膝关节置换患者PONV高危人群比例较高,高危患者预防用药存在不足,优化预防用药可能有助于降低PONV发生率。

Objective:To provide references for the prevention of postoperative nausea and vomiting(PONV)by investigating the risk,incidence of PONV and prophylatic antiemetics in patients with unilateral hip and knee arthroplasty.Methods:A retrospective study was conducted to review and analyze the data of patients who underwent unilateral hip and knee arthroplasty surgery in the orthopedics department of Northern Jiangsu People’s Hospital in 2022,including clinical characteristics,prophylatic antiemetics use and incidence of PONV.Risk of PONV was assessed on Apfel simplified risk scores.Results:A total of 678 patients were enrolled in this study.The number of patients with Apfel simplified risk score of 0,1,2,3 and 4 points were 5,82,123,298 and 170,respectively.The proportion of high-risk patients was 69.03%.PONV occurred in 182(26.84%)of the 678 patients.As the risk factors increased,the incidence of PONV increased accordingly.The incidence of PONV in patients with Apfel score of 4 was significantly higher than those in other groups(P<0.05).Among the high-risk patients of PONV,286(61.11%)received no antiemetic or only one for prevention of PONV,which may be insufficient.The incidence of PONV in high-risk patients who had received 2 or 3 combination therapy was lower than those who had no antiemetic or only one for prevention of PONV,but without significant difference(33.57%vs 29.12%,P>0.05).Conclusions:A large proportion of patients with unilateral hip and knee arthroplasty are at high risk of PONV,and antiemetic prophylaxis is not enough for them.Optimizing prophylaxis administration may do help to reduce the incidence of PONV.