Biallas R, Rüsch D, de Decker W, Wulf H, Siebrecht D, Scholz J
Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel.
Anaesthesist. 2003 Jul;52(7):586-95. doi: 10.1007/s00101-003-0516-9. Epub 2003 Jun 18.
BACKGROUND AND STUDY GOALS: Strabismus surgery in children is frequently associated with a very high incidence of postoperative nausea and vomiting (PONV). In this study we investigated, whether TIVA is superior to inhalation anaesthesia concerning PONV when a prophylaxis using dimenhydrinate (diphenhydramine chlorotheophyllate) is administered in both groups.
110 patients (3-10 years) were prospectively and randomly allocated to one of the following groups: Group TD (TIVA/dimenhydrinate; n= 55): anaesthesia was induced and maintained using remifentanil and propofol in common clinical dosages. Patients were ventilated with 30% O(2) in air. Group VD (Volatile/ dimenhydrinate; n= 55): anaesthesia was induced and maintained with sevoflurane in common clinical concentrations together with N(2)O in 30% O(2). All patients received dimenhydrinate 1 mg.kg(-1) i.v. after induction. PONV was recorded within the first 24 h postoperatively. The chi-square test and a multivariate analysis were used for statistical analysis.
52 patients of group TD and 54 of group VD were analysed. There was a trend in the incidence of postoperative nausea (PN): group TD 17%, 95% CI: 8-30%) compared to group VD 31%, 95% CI: 20-46%), p = 0.09. No difference was seen for PV and PONV: 21% (95% CI: 11-35%) in group TD vs. 35% (95% CI: 23-49%) in group VD, p = 0.109. These non-significant results can be easily attributed to the lack of power about 30%) of this study. According to the results of the multivariate analysis volatile anaesthesia was identified as an independent risk factor for PONV (OR: 2.92, 95% CI: 1.02-8.36). Other variables that were found to be an independent risk factor included history of PONV (OR: 8.19, 95% CI: 1.84-36.43), surgery lasting longer than 30 min (OR: 5.89, 95% CI: 1.82-19.82) and "Faden-operations" (retroequatorial myopexy) (OR: 5.48, 95% CI: 1.74-17.21).
TD only showed a trend to lower PN incidences and no differences as for PV and PONV incidences, most likely due to a lack of power of this study. However, according to the results of the multivariate analysis, inhalation anaesthesia was shown to be an independent risk factor for PONV, as were history of PONV, surgery >30 min and "Faden-operations".
背景与研究目的：儿童斜视手术术后恶心呕吐（PONV）的发生率通常非常高。在本研究中，我们调查了在两组均使用茶苯海明（氯茶碱苯海拉明）进行预防的情况下，全凭静脉麻醉（TIVA）在PONV方面是否优于吸入麻醉。
110例3至10岁的患者被前瞻性随机分配至以下组之一：TD组（TIVA/茶苯海明；n = 55）：使用临床常用剂量的瑞芬太尼和丙泊酚诱导并维持麻醉。患者使用30%氧气与空气混合通气。VD组（挥发性麻醉药/茶苯海明；n = 55）：使用临床常用浓度的七氟醚与30%氧气中的氧化亚氮一起诱导并维持麻醉。所有患者在诱导后静脉注射1mg/kg茶苯海明。术后24小时内记录PONV情况。采用卡方检验和多因素分析进行统计分析。
分析了TD组的52例患者和VD组的54例患者。术后恶心（PN）发生率有一定趋势：TD组为17%，95%可信区间：8 - 30%），而VD组为31%，95%可信区间：20 - 46%），p = 0.09。PV和PONV未见差异：TD组为21%（95%可信区间：11 - 35%），VD组为35%（95%可信区间：23 - 49%），p = 较显著结果很可能归因于本研究约30%）的检验效能不足。根据多因素分析结果，挥发性麻醉被确定为PONV的独立危险因素（比值比：2.92，95%可信区间：1.02 - 8.36）。其他被发现为独立危险因素的变量包括PONV病史（比值比：8.19，95%可信区间：1.84 - 36.43）、手术持续时间超过30分钟（比值比：5.89，95%可信区间：1.82 - 19.82）以及“缝线手术”（赤道后巩膜固定术）（比值比：5.48，95%可信区间：1.74 - 17.21）。
TD组仅显示出PN发生率降低的趋势，而PV和PONV发生率无差异，很可能是由于本研究检验效能不足。然而，根据多因素分析结果，吸入麻醉被证明是PONV的独立危险因素，PONV病史、手术时间>30分钟和“缝线手术”也是如此。
