协和医学杂志2024，Vol.15Issue(2)：366-374,9.DOI:10.12290/xhyxzz.2023-0579
手术患者接受患者自控静脉镇痛期间发生术后恶心呕吐的危险因素分析
Risk Factors for Postoperative Nausea and Vomiting in Surgical Patients Undergoing Patient Controlled Intravenous Analgesia
摘要
Abstract
Objective To identify the risk factors for postoperative nausea and vomiting(PONV)in surgical patients undergoing patient controlled intravenous analgesia(PCIA).Methods Our study was a retrospective cohort study,including patients who underwent surgery at Peking Union Medical College Hospital from July 1 to October 31,2023 and received PCIA after surgery.Patient characteristics,medical history,sur-gical information,intraoperative medication information,postoperative analgesia follow-up information were ob-tained through the electronic medical record system.The patients were divided into PCIA-PONV group and non-PCIA-PONV group,depending on the occurrence of PONV during PCIA,and all patients were also divided in-to PCIA-POV group and non-PCIA-POV according to whether postoperative vomiting(POV)occurred.Multi-variate Logistic regression analysis was used to identify the risk factors for PCIA-PONV and PCIA-POV.Results A total of 1373 patients were included in this study,with 676 cases in PCIA-PONV group.The incidence of PCIA-PONV was 49.2%.There were 285 patients in PCIA-POV group,and the incidence of PCIA-POV was 20.8%.The results of multivariate Logistic regression analysis showed that female(OR = 2.134,95%CI:1.590-2.865,P＜0.001)and abdominal surgery(OR=1.655,95%CI:1.253-2.186,P＜0.001)were risk factors for PCIA-PONV,whereas the increase of age(OR=0.990,95%CI:0.982-0.998,P=0.019)and the increase of BMI(OR=0.961,95%CI:0.932-0.991,P=0.012)were protective factors for PCIA-PONV.Female(OR=2.646,95%CI:1.754-3.992,P＜0.001),history of general anesthesia(OR= 1.372,95%CI:1.042-1.806,P= 0.024),and intraoperative use of high-dose opioids(OR = 1.607,95%CI:1.206-2.142,P=0.001)were risk factors for PCIA-POV,whereas no intraoperative use of neuro-muscular blocking antagonists(OR= 0.393,95%CI:0.237-0.651,P＜0.001)was protective factor for PCIA-POV.Conclusions Our study reveals the risk factors for PONV in surgical patients undergoing PCIA,and shows that comprehensive preoperative assessment and reasonable perioperative management strategies are significant in the prevention of PCIA-PONV.关键词
患者自控静脉镇痛/术后恶心呕吐/危险因素Key words
patient controlled intravenous analgesia/postoperative nausea and vomiting/risk factors分类
医药卫生引用本文复制引用
吴觉伦,田园,聂卫华,张越伦,申乐..手术患者接受患者自控静脉镇痛期间发生术后恶心呕吐的危险因素分析[J].协和医学杂志,2024,15(2):366-374,9.基金项目
中央高水平医院临床科研专项(2022-PUMCH-A-147) National High Level Hospital Clinical Research Funding(2022-PUMCH-A-147) （2022-PUMCH-A-147）
