纳入康复计划的择期结直肠手术后鼻胃管放置的危险因素：一项多变量分析

Aveline C, Le Roux A, Le Hetet H, Vautier P, Cognet F, Bonnet F

Département d'anesthésie-réanimation chirurgicale, hôpital privé Sévigné, 3, rue du Chêne-Germain, 35510 Cesson-Sévigné, France.

Ann Fr Anesth Reanim. 2013 Jan;32(1):31-6. doi: 10.1016/j.annfar.2012.11.009. Epub 2012 Dec 31.

OBJECTIVE

Nasogastric tube placement (NTP) is no more systematically recommended in patients scheduled for elective colorectal surgery but could be necessary in case of postoperative vomiting. The aim of this study was to determine independent risk factors for NTP after colorectal surgery.

PATIENTS AND METHODS

We performed an observational study including 290 patients scheduled for elective colorectal surgery included in an enhanced recovery programme: immunonutrition, thoracic epidural analgesia, antiemetic prophylaxis, respiratory physiotherapy, absence of NT and drainage, forced mobilization and oral nutrition. The main outcome was the occurrence of vomiting requiring NTP. Univariate analysis included: age, sex, BMI, American Society of Anesthesiologist Physical Status Classification System (ASA), duration of surgery, epidural analgesia, and mobilization, intraoperative fluid, temperature, laparotomy, use of droperidol, parenteral nutrition, stoma, diabetes, hypertension or coronary disease, COPD, type of surgery. A logistic regression was performed to determine independent risk factors of NTP.

RESULTS

Among the 290 patients included, 277 were analyzed. The incidence of NTP was 10.5% (95%CI [7.4-14.6%]). Univariate analysis documented BMI, low temperature in PACU (<35°C), ASA scores, duration of surgery and epidural analgesia, rectal and sigmoid resections, diabetes, transfusion, no use of droperidol, duration of mobilization, conversion to laparotomy. Three independent risk factors were associated with NTP: temperature in SSPI<35.5°C (OR: 14.49; IC95% [4.52-45.45], P<0.0001), BMI<21kg/m(2) (8.40; [1.99-35.71], P=0.0038) and lack of postoperative droperidol administration (3.37 [1.02-11.39], P=0.04).

CONCLUSIONS

After colorectal surgery tolerance to rapid oral feeding is impaired by denutrition and postoperative hypothermia. The combined used of postoperative droperidol should also be considered to avoid postoperative NTP.

目的

对于择期结直肠手术患者，不再系统推荐放置鼻胃管（NTP），但术后呕吐时可能有必要放置。本研究旨在确定结直肠手术后放置NTP的独立危险因素。

患者与方法

我们进行了一项观察性研究，纳入290例计划接受择期结直肠手术且参与强化康复计划的患者，该计划包括免疫营养、胸段硬膜外镇痛、预防性使用止吐药、呼吸物理治疗、不放置鼻胃管和引流管、强制活动及口服营养。主要结局是发生需要放置NTP的呕吐。单因素分析包括：年龄、性别、体重指数（BMI）、美国麻醉医师协会身体状况分类系统（ASA）、手术时长、硬膜外镇痛及活动情况、术中补液量、体温、剖腹手术、使用氟哌利多、肠外营养、造口、糖尿病、高血压或冠心病、慢性阻塞性肺疾病（COPD）、手术类型。进行逻辑回归分析以确定放置NTP的独立危险因素。

结果

纳入的290例患者中，277例进行了分析。放置NTP的发生率为10.5%（95%置信区间[7.4 - 14.6%]）。单因素分析显示BMI、麻醉后监护病房（PACU）低温（<35°C）、ASA评分、手术时长和硬膜外镇痛、直肠和乙状结肠切除术、糖尿病、输血、未使用氟哌利多、活动时长、转为剖腹手术。三个独立危险因素与放置NTP相关：麻醉苏醒室（SSPI）体温<35.5°C（比值比：14.49；95%置信区间[4.52 - 45.45]，P<0.0001）、BMI<21kg/m²（8.40；[1.99 - 35.71]，P = 0.0038）以及术后未使用氟哌利多（3.37 [1.02 - 11.39]，P = 0.04）。