[青少年特发性脊柱侧弯手术后恶心呕吐的危险因素]

[Risk factors for nausea and vomiting after adolescent idiopathic scoliosis surgery].

作者信息

Feng Dandan, Jia Rui, Ma Zhengliang, Gu Xiaoping

机构信息

Department of Anesthesiology, Drum Tower Clinical College, Nanjing Medical University,. Nanjing 210008, China.

Department of Anesthesiology, Zibo Central Hospital, Zibo 255000, China.

出版信息

Nan Fang Yi Ke Da Xue Xue Bao. 2020 Mar 30;40(3):394-399. doi: 10.12122/j.issn.1673-4254.2020.03.18.

DOI:10.12122/j.issn.1673-4254.2020.03.18

PMID:32376591

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7167309/

Abstract

OBJECTIVE

To explore risk factors for postoperative nausea and vomiting (PONV) that requires intervention with medications during adolescent idiopathic scoliosis (AIS) surgery.

METHODS

We analyzed the data of 986 patients with AIS (including 156 male and 830 female patients) undergoing scoliosis surgery through a posterior approach between December, 2012 and January, 2016 in Nanjing Drum Tower Hospital. The data were collected from the patients including ASA grade, body mass index (BMI), Cobb angle, preoperative respiratory and cardiovascular diseases, operation time, type of anesthesia, quantity of intraoperative liquid infusion, blood loss, urine volume, the lowest MAP and CVP, intraoperative fentanyl consumption, and intraoperative administration of dexmedetomidine, dexamethasone, ondansetran and droperidol. The incidence of PONV in 48 h following the surgery, hemoglobin variation after operation (ΔHb), postoperative analgesia, times of use and types of antiemetic drugs, and postoperative hospital stay were recorded for all the patients. The potential risk factors of PONV within 48 h were analyzed using univariate analysis and multivariate logistic regression.

RESULTS

Of the 986 patients analyzed, 151 (15.3%) experienced PONV within 48 h following surgeries for AIS. Multivariate logistic regression analysis suggested that an high intraoperative fentanyl dose (> 0.65 mg; OR=9.303, 95% : 2.373-8.622, < 0.001), an obvious ΔHb (> 28.5 g/L; OR=1.107, 95% : 1.060-1.157, < 0.001), and postoperative analgesia with fentanyl (OR=11.671, 95% : 2.381-11.284, < 0.001) were risk factors for PONV. Intraoperative administration of dexmedetomidine (OR=0.027, 95% : 0.006-0.123, =0.002) and dexamethasone combined with ondansetron (OR=0.241, 95%: 0.066-0.886, =0.032) were protective factors against PONV.

CONCLUSIONS

A high-dose intraoperative fentanyl consumption, a marked ΔHb, and postoperative analgesia with fentanyl are risk factors for PONV while intraoperative administration of dexmedetomidine and dexamethasone combined with ondansetron are protective factors against PONV following surgeries for AIS.

摘要

目的

探讨青少年特发性脊柱侧凸（AIS）手术中需要药物干预的术后恶心呕吐（PONV）的危险因素。

方法

我们分析了2012年12月至2016年1月在南京鼓楼医院通过后路进行脊柱侧凸手术的986例AIS患者（包括156例男性和830例女性患者）的数据。数据收集自患者，包括美国麻醉医师协会（ASA）分级、体重指数（BMI）、Cobb角、术前呼吸和心血管疾病、手术时间、麻醉类型、术中液体输注量、失血量、尿量、最低平均动脉压（MAP）和中心静脉压（CVP）、术中芬太尼用量以及术中右美托咪定、地塞米松、昂丹司琼和氟哌利多的使用情况。记录所有患者术后48小时内PONV的发生率、术后血红蛋白变化（ΔHb）、术后镇痛、止吐药物的使用次数和类型以及术后住院时间。采用单因素分析和多因素logistic回归分析48小时内PONV的潜在危险因素。

结果

在分析的986例患者中，151例（15.3%）在AIS手术后48小时内发生PONV。多因素logistic回归分析表明，术中芬太尼高剂量（>0.65mg；OR=9.303，95%可信区间：2.373 - 8.622，P<0.001）、明显的ΔHb（>28.5g/L；OR=1.107，95%可信区间：1.060 - 1.157，P<0.001）以及术后芬太尼镇痛（OR=11.671，95%可信区间：2.381 - 11.284，P<0.001）是PONV的危险因素。术中使用右美托咪定（OR=0.027，95%可信区间：0.006 - 0.123，P=0.002）以及地塞米松联合昂丹司琼（OR=0.241，95%可信区间：0.066 - 0.886，P=0.032）是预防PONV的保护因素。