Chandrakantan Arvind, Reinsel Ruth A, Jasiewicz Ronald, Jacob Zvi C, Seidman Peggy A
Department of Anesthesiology, Baylor College of Medicine, Houston, Texas.
Department of Neurology, Stony Brook University Medical Center, Stony Brook, New York.
Paediatr Anaesth. 2019 Apr;29(4):353-360. doi: 10.1111/pan.13612.
The factors contributing to postoperative nausea and vomiting in children have been identified, but there have been no reported studies that have studied pediatric postdischarge nausea and vomiting.
This preliminary study aimed to identify the factors affecting postdischarge nausea and vomiting in ambulatory children, specifically whether postoperative nausea and vomiting factors are contributory.
One hundred and twenty-two pediatric patients aged 5-10 years undergoing elective ambulatory surgery participated in this institution-approved study. After obtaining written parental consent and patient assent when indicated, child self-ratings of nausea and pain were completed preoperatively and at discharge, and for 3 days postdischarge. Questionnaires were returned by mail, with a 64% return rate. Using stepwise logistic regression with backward elimination, three separate analyses were undertaken to predict the following outcomes: nausea present in recovery, nausea present on postoperative day 1, and emesis on day of surgery.
Nearly half (47%) of our cohort experienced nausea at the time of discharge; 11% had emesis on day of surgery. On postoperative day 1, there was a 15% incidence of nausea with a 3% incidence of emesis. In the multiple logistic regression analyses, nausea at discharge was predicted by male gender (odds ratio 2.5, 95% CI: 1.0-6.2) and the presence of pain on discharge (odds ratio 3.0, 95% CI: 1.0-9.2). Emesis on day of surgery was predicted by the presence of nausea at discharge (odds ratio 16.9, 95% CI: 1.8-159.3) and having a family history of nausea/vomiting (odds ratio 8.3, 95% CI: 1.6-43.4). The presence of nausea on postoperative day 1 was predicted only by the presence of nausea on discharge (odds ratio 3.7, 95% CI: 1.2-11.1).
Our preliminary data indicate that postoperative nausea and vomiting may persist into the postdischarge period and pain may be a contributing factor.
导致儿童术后恶心呕吐的因素已被确定，但尚无关于儿童出院后恶心呕吐的研究报道。
这项初步研究旨在确定影响门诊患儿出院后恶心呕吐的因素，特别是术后恶心呕吐因素是否起作用。
122名年龄在5至10岁接受择期门诊手术的儿科患者参与了这项经机构批准的研究。在获得家长书面同意和患儿（如有需要）同意后，在术前、出院时以及出院后3天完成患儿恶心和疼痛的自我评分。问卷通过邮寄方式回收，回收率为64%。采用逐步逻辑回归和向后排除法，进行了三项独立分析以预测以下结果：恢复时出现恶心、术后第1天出现恶心以及手术当天呕吐。
近一半（47%）的队列患者在出院时出现恶心；11%在手术当天呕吐。术后第1天，恶心发生率为15%，呕吐发生率为3%。在多元逻辑回归分析中，出院时恶心可由男性性别（比值比2.5，95%置信区间：1.0 - 6.2）和出院时疼痛的存在（比值比3.0，95%置信区间：1.0 - 9.2）预测。手术当天呕吐可由出院时恶心的存在（比值比16.9，95%置信区间：1.8 - 159.3）和有恶心/呕吐家族史（比值比8.3，95%置信区间：1.6 - 43.4）预测。术后第1天恶心的存在仅由出院时恶心的存在预测（比值比3.7，95%置信区间：1.2 - 11.1）。
我们的初步数据表明，术后恶心呕吐可能持续到出院后时期，疼痛可能是一个促成因素。
