Morita Tomonori, Yamamoto Makiko, Sakamoto Atsuhiro
Department of Anesthesiology, Nippon Medical School.
J Nippon Med Sch. 2021 Nov 17;88(5):418-422. doi: 10.1272/jnms.JNMS.2021_88-510. Epub 2020 Nov 30.
The incidence and risk factors of postoperative nausea and vomiting (PONV) and early PONV (ePONV) were evaluated in patients who underwent breast surgery with volatile anesthesia.
In this retrospective study, multivariate logistic regression was used to determine incidence and identify risk factors for PONV.
Among 928 patients, 166 (18%) and 220 (24%) had ePONV and PONV, respectively. In multivariate analysis, anesthesia duration and use of desflurane were independent risk factors for ePONV. For PONV, anesthesia duration and Apfel score were independent risk factors.
Our results indicate that desflurane was the main cause of ePONV. However, during the delayed phase, a higher Apfel score was the strongest predictor. In the early and delayed phases, long anesthesia duration was associated with high risk of PONV. Thus, prolonged anesthesia and desflurane use should be avoided for patients at high risk of PONV, particularly those with high Apfel scores.
在接受挥发性麻醉的乳腺手术患者中，评估术后恶心呕吐（PONV）和早期PONV（ePONV）的发生率及危险因素。
在这项回顾性研究中，采用多因素逻辑回归分析来确定PONV的发生率并识别其危险因素。
928例患者中，分别有166例（18%）发生ePONV，220例（24%）发生PONV。多因素分析显示，麻醉持续时间和地氟烷的使用是ePONV的独立危险因素。对于PONV，麻醉持续时间和Apfel评分是独立危险因素。
我们的结果表明，地氟烷是ePONV的主要原因。然而，在延迟期，较高的Apfel评分是最强的预测因素。在早期和延迟期，长时间麻醉与PONV的高风险相关。因此，对于PONV高风险患者，尤其是Apfel评分高的患者，应避免长时间麻醉和使用地氟烷。
