肥胖症患者行腹腔镜减重手术后严重恶心呕吐危险因素分析

Analysis of risk factors of severe postoperative nausea and vomiting after laparoscopic bariatric surgery

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摘要目的分析行腹腔镜减重手术肥胖症患者的临床资料,探讨其发生严重术后恶心呕吐(PONV)的危险因素.方法2021年1-12月首都医科大学附属北京友谊医院行腹腔镜减重手术的肥胖症患者471例,术中均使用托烷司琼等预防PONV,术后均使用地塞米松和昂丹司琼等预防PONV,根据术后是否需救援性镇吐药物治疗分为无严重PONV组387例和严重PONV组84例,比较2组性别、年龄、体质量指数、吸烟史、合并症、麻醉方法、麻醉诱导药物、麻醉时间、手术时间、手术方式、是否留置腹腔引流管、术中镇吐药物种类、术中输液量、术中舒芬太尼用量、术后舒芬太尼和右美托咪定用量、术后救援性镇痛药物等.采用多因素logistic回归分析行腹腔镜减重手术的肥胖症患者发生严重PONV的影响因素.结果471例患者中严重PONV发生率为17.8%.84例严重PONV患者中,发生于术后24 h内54例,发生于术后24 h后30例;救援性镇吐药物治疗方案为甲氧氯普胺56例,昂丹司琼14例,地塞米松2例,甲氧氯普胺+昂丹司琼10例,甲氧氯普胺+昂丹司琼+地塞米松2例;救援性镇吐药物治疗1次64例,2次13例,3次5例,4次1例,5次1例.严重PONV组女性(85.7%)、腹腔镜袖状胃切除术(88.1%)、留置腹腔引流管(84.5%)、术后救援性镇痛(41.7%)比率均高于无严重PONV组(64.1%、70.3%、72.1%、17.3%)(P<0.05),年龄[32.0(27.0,36.0)岁]、术中输液量[900.0(762.5,1100.0)mL]均小于无严重PONV组[34.0(29.0,39.0)岁、920.0(800.0,1150.0)mL](Z=-2.381,P=0.017;Z=-2.228,P=0.026),麻醉时间[96.5(80.0,126.5)min]、手术时间[80.0(63.5,103.8)min]均短于无严重PONV组[110.0(92.0,140.0)、93.0(70.0,120.0)min](Z=-3.335,P=0.001;Z=-3.399,P=0.001),体质量指数、吸烟史、合并症、麻醉方法、使用依托咪酯麻醉诱导、术中镇吐药物种类、术中舒芬太尼用量、术后舒芬太尼用量、术后右美托咪定用量、使用哌替啶救援性镇痛与无严重PONV组比较差� Objective To analyze the clinical data of obese patients undergoing laparoscopic bariatric surgery and to explore the risk factors of severe postoperative nausea and vomiting(PONV).Methods Totally 471 obese patients underwent laparoscopic bariatric surgery in Beijing Friendship Hospital Affiliated to Capital Medical University from January to December 2021.Troisetron was applied in surgery to prevent PONV,and dexamethasone and ondansetron were applied after surgery to prevent PONV.According to whether postoperative rescuing antiemetics administration was needed,471 patients were divided into no-severe PONV group(n=387)and severe PONV group(n=84).The gender,age,body mass index,smoking habits,comorbidities,anesthesia methods,anesthesia induction drugs,anesthesia time,surgery lasting time,surgery types,indwelling abdominal drainage tubes or not,intraoperative antiemetic types,intraoperative total liquid infusion volume,intraoperative sufentanil dosages,postoperative sufentanil and dexmedetomidine dosages,and postoperative rescuing antiemetics were compared between two groups.Multivariate logistic regression analysis was done to assess the influencing factors of severe PONV after laparoscopic bariatric surgery.Results The incidence of severe PONV in 471 patients was 17.8%.In 84 patients with severe PONV,PONV developed within 24 h after surgery in 54 patients and 24 h after surgery in 30.The rescuing antiemetic therapy used metoclopramide in 56 patients,ondansetron in 14,dexamethasone in 2,metoclopramide+ondansetron in 10,and metoclopramide+ondansetron+dexamethasone in 2.The rescuing antiemetics were used once in 64 patients,twice in 13,three times in 5,4 times in 1,and 5 times in 1.The proportions of females,laparoscopic sleeve gastrectomy,abdominal drainage tube indwelling,and postoperative rescuing analgesia were higher in severe PONV group(85.7%,88.1%,84.5%,41.7%)than those in no-severe PONV group(64.1%,70.3%,72.1%,17.3%)(P<0.05).The patients were younger in severe PONV group[32.0(27.0,36.0)years]than in no-severe

作者万磊柳立伟李文静宋比佳李佳仪邵刘佳子薛富善 WAN Lei;LIU Liwei;LI Wenjing;SONG Bijia;LI Jiayi;SHAO Liujiazi;XUE Fushan(Anesthesia Surgery Center,Beijing Friendship Hospital Affilfated to Ca pital Medical Unitrrsity,Beijing 100050,China)

机构地区首都医科大学附属北京友谊医院麻醉手术中心

出处《中华实用诊断与治疗杂志》 2024年第4期386-391,共6页 Journal of Chinese Practical Diagnosis and Therapy

基金北京市卫生健康科技成果和适宜技术推广项目(BHTPP2022081)

关键词肥胖症腹腔镜减重手术术后恶心呕吐反流性食管炎腹腔镜袖状胃切除术 obesity laparoscopic bariatric surgery postoperative nausea and vomiting reflux esophagitis laparoscopic sleeve gastrectomy

分类号 R656.6 [医药卫生—外科学]