小剂量氟哌利多对腔镜减重手术患者术后恶心呕吐的影响

Effect of low-dose droperidol on postoperative nausea and vomiting in patients undergoing laparoscopic bariatric surgery

目的 回顾性分析小剂量氟哌利多能否降低腔镜减重手术患者术后恶心呕吐(PONV)的发生,并分析其他可能影响腔镜减重患者PONV的相关因素。方法 回顾性选取2019年11月至2021年4月在首都医科大学附属北京友谊医院接受腔镜减重手术的患者资料,通过专门设计的“患者疗效问卷”和电子病历系统于术后第1天收集患者的基本情况、术中和术后用药情况、术后疼痛和PONV评分等。根据麻醉记录单和收费系统确定患者术中和术后是否预防性应用小剂量氟哌利多(1.00~1.25 mg),将患者分为使用氟哌利多组和未使用氟哌利多组,采用Mann-Whitney U检验分析两组PONV评分。并采用有序多分类Logistic回归分析PONV评分与本研究中可能影响PONV的因素(包括是否应用氟哌利多)之间的关系。结果 共收集326例患者的资料,其中氟哌利多组54例,未使用氟哌利多组272例;187例发生PONV,总发生率为57.4%;氟哌利多组和未使用氟哌利多组分别有19例和168例发生PONV,发生率分别为35.2%和61.8%。非参数检验比较氟哌利多组和未使用氟哌利多组的PONV评分,差异有统计学意义(P<0.05)。与未使用氟哌利多相比,氟哌利多组术中、术后舒芬太尼和右美托咪定用量更大,最大的术后疼痛视觉模拟评分法(VAS)评分和术后严重疼痛百分比更低,差异均有统计学意义(P<0.05)。有序多因素Logistic回归分析,PONV评分与性别、年龄、手术时长、术中应用吸入麻醉药物、术后应用舒芬太尼和右美托咪定剂量无关(P>0.05),而与患者体重指数、术中舒芬太尼和瑞芬太尼用量以及应用氟哌利多有关(P<0.05)。结论 在常规临床抗PONV方案的基础上,联用小剂量氟哌利多能明显降低腔镜减重手术患者PONV发生。而PONV发生与患者体重指数、术中舒芬太尼和瑞芬太尼用量以及应用氟哌利多有关。

Objective To retrospectively analyze low-dose droperidol whether reduces the occurrence of postoperative nausea and vomiting(PONV) in patients undergoing laparoscopic bariatric surgery.And to analyze other relevant factors that may affect PONV in patients undergoing laparoscopic bariatric surgery.Methods The data originated from patients who underwent endoscopic bariatric surgery at Beijing Friendship Hospital,Capital Medical University from November 2019 to April 2021.Through specially designed "Patient Efficacy Questionnaire" and electronic medical record system,patients' demographic,intraoperative and postoperative medications,postoperative pain,and PONV occurrence were collected the first day after surgery.According to medical records and the billing system to ascertain whether low-dose droperidol(1.00-1.25 mg) was preventively used during and after surgery,and then patients were divided into the fluperidol group and the non fluperidol group.The Mann-Whitney U test was used to analyzed PONV scores of the two groups,and the ordered multinomial Logistic regression analysis was performed to determine the relationship between PONV scores and factors that may affect PONVin this study(include whether droperidol was used).Results A total of 326 patients were included in data analysis;among them,there were 54 cases in the fluperidol group and 272 cases in the non fluperidol group.In the entire cohort,PONV occurred in 187 patients,with a total incidence of 57.4%.The incidence of PONV was 35.2%(19 of 54) in the fluperidol group and 61.8%(168 of 272) in the non fluperidol group.Compared with the non fluperidol group,moreover,dosages of sufentanil and dexmedetomidine during and after surgery was higher,and the maximum postoperative pain VAS score and percentage of severe postoperative pain were lower in the fluperidol group,the differences were statistically significant(P<0.05).The ordered multiclass Logistic regression analysis showed the PONV score was not related to gender,age,surgical duration,intraoperative use of inhaled anesthetics,postoperative use of sufentanil and dexmedetomidine doses(P>0.05),but was related to patient body mass index,intraoperative use of sufentanil and remifentanil,and use of droperidol(P<0.05).Conclusion On the basis of conventional clinical anti PONV regimen,the combination using of low-dose of droperidol can alleviate the occurrence of PONV in patients undergoing laparoscopic bariatric surgery.The occurrence of PONV is related to the patient's body mass index,the amount of sufentanil and remifentanil used during surgery,and the use of droperidol.