手术患者接受患者自控静脉镇痛期间发生术后恶心呕吐的危险因素分析

Risk Factors for Postoperative Nausea and Vomiting in Surgical Patients Undergoing Patient Controlled Intravenous Analgesia

目的分析手术患者接受患者自控静脉镇痛(patient controlled intravenous analgesia,PCIA)期间发生术后恶心呕吐(postoperative nausea and vomiting,PONV)的危险因素。方法本研究为回顾性队列研究,纳入2023年7月1日—10月31日在北京协和医院接受外科手术且术后接受PCIA的患者。通过电子病历系统获取患者的一般资料、既往史、手术信息、术中用药信息、术后镇痛随访信息。根据接受PCIA期间PONV的发生情况,将患者分为PCIA⁃PONV组和非PCIA⁃PONV组;根据是否发生术后呕吐(postoperative vomiting,POV),将其分为PCIA⁃POV组和非PCIA⁃POV组。采用多因素Logistic回归分析法筛选PCIA⁃PONV和PCIA⁃POV的危险因素。结果共纳入1373例患者,其中PCIA⁃PONV组676例,PCIA⁃PONV的发生率为49.2%;PCIA⁃POV组285例,PCIA⁃POV的发生率为20.8%。多因素Logistic回归分析显示,女性(OR=2.134,95%CI:1.590~2.865,P<0.001)、腹部手术(OR=1.655,95%CI:1.253~2.186,P<0.001)是手术患者接受PCIA期间出现PONV的危险因素,而年龄增长(OR=0.990,95%CI:0.982~0.998,P=0.019)、体质量指数增加(OR=0.961,95%CI:0.932~0.991,P=0.012)则是其保护因素;女性(OR=2.646,95%CI:1.754~3.992,P<0.001)、全麻史(OR=1.372,95%CI:1.042~1.806,P=0.024)、术中使用大剂量阿片类药物(OR=1.607,95%CI:1.206~2.142,P=0.001)是手术患者接受PCIA期间出现POV的危险因素,而术中未使用肌松拮抗剂(OR=0.393,95%CI:0.237~0.651,P<0.001)则是其保护因素。结论本研究初步揭示了手术患者接受PCIA期间发生PONV的危险因素,完善的术前评估及合理的围术期管理策略对于预防PCIA⁃PONV具有重要意义。

Objective To identify the risk factors for postoperative nausea and vomiting(PONV)in surgical patients undergoing patient controlled intravenous analgesia(PCIA).Methods Our study was a retrospective cohort study,including patients who underwent surgery at Peking Union Medical College Hospital from July 1 to October 31,2023 and received PCIA after surgery.Patient characteristics,medical history,sur⁃gical information,intraoperative medication information,postoperative analgesia follow⁃up information were ob⁃tained through the electronic medical record system.The patients were divided into PCIA⁃PONV group and non⁃PCIA⁃PONV group,depending on the occurrence of PONV during PCIA,and all patients were also divided in⁃to PCIA⁃POV group and non⁃PCIA⁃POV according to whether postoperative vomiting(POV)occurred.Multi⁃variate Logistic regression analysis was used to identify the risk factors for PCIA⁃PONV and PCIA⁃POV.Results A total of 1373 patients were included in this study,with 676 cases in PCIA⁃PONV group.The incidence of PCIA⁃PONV was 49.2%.There were 285 patients in PCIA⁃POV group,and the incidence of PCIA⁃POV was 20.8%.The results of multivariate Logistic regression analysis showed that female(OR=2.134,95%CI:1.590-2.865,P<0.001)and abdominal surgery(OR=1.655,95%CI:1.253-2.186,P<0.001)were risk factors for PCIA⁃PONV,whereas the increase of age(OR=0.990,95%CI:0.982-0.998,P=0.019)and the increase of BMI(OR=0.961,95%CI:0.932-0.991,P=0.012)were protective factors for PCIA⁃PONV.Female(OR=2.646,95%CI:1.754-3.992,P<0.001),history of general anesthesia(OR=1.372,95%CI:1.042-1.806,P=0.024),and intraoperative use of high⁃dose opioids(OR=1.607,95%CI:1.206-2.142,P=0.001)were risk factors for PCIA⁃POV,whereas no intraoperative use of neuro⁃muscular blocking antagonists(OR=0.393,95%CI:0.237-0.651,P<0.001)was protective factor for PCIA⁃POV.Conclusions Our study reveals the risk factors for PONV in surgical patients undergoing PCIA,and shows that comprehensive preoperative assessment and reasonable perioperative management strategies are significant in the prevention of PCIA⁃PONV.