Yumura Junko, Nakata Erika, Miyata Mami, Ichinohe Tatsuya, Kaneko Yuzuru
Department of Dental Anesthesiology, Tokyo Dental College.
Bull Tokyo Dent Coll. 2011;52(2):113-8. doi: 10.2209/tdcpublication.52.113.
Clinically, the incidence of postoperative nausea and vomiting (PONV) may be higher in mentally challenged patients than in normal healthy patients. The aim of this study was to investigate the risk factors for PONV after day care general anesthesia in mentally challenged patients undergoing dental treatment. We analyzed data on 231 day care general anesthesia cases involving mentally challenged patients undergoing dental treatment. Anesthetic records for the past 5 years were investigated retrospectively. Ten items (age, body weight, sex, duration of general anesthesia, use of propofol, use of sevoflurane, use of nitrous oxide, use of neostigmine, treatment accompanied with bleeding, and transfusion volume) were selected as risk factors for PONV. Postoperative nausea and vomiting was evaluated using the postoperative check sheet and linear discriminant analysis was performed to distinguish PONV incidence using the 10 items as independent variables. The reliability of the linear discriminant function was evaluated using a misjudgment rate and information criteria (AIC). Postoperative nausea and vomiting was observed in 13 cases out of 231 cases. The discriminant function with the smallest AIC (-25.0718) consisted of two independent variables: y=-0.077x(1)-0.001x(2)+0.0716(x(1)=use of propofol, x(2)=age). The misjudgment rate was 31.6%. This result suggests that PONV decreases when propofol is used and that the incidence of PONV decreases with age. To investigate other risk factors, an additional analysis was performed using 83 out of the 231 cases in which sevoflurane was used as an anesthetic agent. The results of the subgroup analysis suggest that the incidence of PONV decreases in male patients and higher weight patients, although the patient's body weight may be related to age, as the study cohort included many children. It is suggested that the major risks for PONV in mentally challenged patients after day care general anesthesia are no use of propofol, lower age, female sex and lower weight.
临床上，智力障碍患者术后恶心呕吐（PONV）的发生率可能高于正常健康患者。本研究的目的是调查接受牙科治疗的智力障碍患者在日间手术全身麻醉后发生PONV的危险因素。我们分析了231例接受牙科治疗的智力障碍患者的日间手术全身麻醉病例数据。回顾性调查了过去5年的麻醉记录。选择了10项因素（年龄、体重、性别、全身麻醉持续时间、丙泊酚使用情况、七氟醚使用情况、氧化亚氮使用情况、新斯的明使用情况、伴有出血的治疗以及输血量）作为PONV的危险因素。使用术后检查表评估术后恶心呕吐情况，并以这10项因素作为自变量进行线性判别分析以区分PONV发生率。使用误判率和信息准则（AIC）评估线性判别函数的可靠性。231例病例中有13例观察到术后恶心呕吐。AIC最小（-25.0718）的判别函数由两个自变量组成：y = -0.077x(1) - 0.001x(2) + 0.0716（x(1)=丙泊酚使用情况，x(2)=年龄）。误判率为31.6%。该结果表明使用丙泊酚时PONV减少，且PONV发生率随年龄降低。为了调查其他危险因素，对231例中使用七氟醚作为麻醉剂的83例病例进行了额外分析。亚组分析结果表明，男性患者和体重较高的患者PONV发生率降低，尽管患者体重可能与年龄有关，因为研究队列包括许多儿童。提示智力障碍患者日间手术全身麻醉后发生PONV的主要危险因素是未使用丙泊酚、年龄较小、女性以及体重较低。
