背景:术后恶心和呕吐(PONV)是腹腔镜胆囊切除术后常见的痛苦症状。我们报告费率,以及与术后恶心呕吐相关的因素,预防性止吐处方的模式,以及在JigmeDorjiWangchuck(JDW)国家转诊医院接受腹腔镜胆囊切除术的患者中使用的麻醉技术,不丹.
方法:在JDW国家转诊医院进行了一项横断面研究,2018年1月至12月。全麻下行腹腔镜胆囊切除术的患者全部纳入研究。人口统计学变量,术前用药,诱导剂,肌肉松弛剂,用于维持的吸入剂,阿片类和辅助镇痛药,使用的逆转剂,并记录24h内PONV的发生情况。使用SPSS(版本23)分析数据。连续变量使用t检验或曼-惠特尼检验进行比较,分类变量采用卡方检验或Fisher精确检验。采用二元Logistic回归分析确定术后恶心呕吐的相关因素。
结果:190例患者在全身麻醉下接受了腹腔镜胆囊切除术。腹腔镜胆囊切除术后PONV的发生率为31.1%(59/190)。超过一半(53.7%,102/190)的研究人群年龄在21-40岁之间,超过80%(157/190)是女性,2/3为超重和肥胖。最常用的术前用药是雷尼替丁(39%,34/87)和甲氧氯普胺(31%,27/87)。超过一半(57.4%,109/190)的患者在诱导前接受了吗啡作为阿片类镇痛药。硫喷酮钠是一种常用的诱导剂(65.8%,125/190)。琥珀酰胆碱和阿曲库铵是最优选的肌肉松弛剂。异氟醚和空气是维持麻醉最常用的吸入麻醉剂。昂丹司琼是术中最优选的止吐药。既往晕动病史(OR5.8,95CI2.9-11.2,p<0.001),使用硫喷妥钠(OR4.1,95CI1.9-9.1,p<0.001)是PONV的独立危险因素。止吐药的使用(OR0.1,95CI0.0-0.4,p=0.002),异丙酚(OR0.2,95CI0.1-0.5,p<0.001),辅助镇痛对乙酰氨基酚(OR0.4,95CI0.2-0.8,p=0.026),静脉输液充分水化(OR0.9,95CI0.9-1.0,p=0.042)是PONV的预防因素。
结论:腹腔镜胆囊切除术后PONV的发生率较高。晕动史和使用硫喷妥钠诱导是PONV的独立危险因素。在预防PONV方面,多模式预防性止吐药的使用是稳健的,优于单一疗法。这一发现再次强调了风险分层和适当使用止吐剂和麻醉剂以预防PONV的必要性。
BACKGROUND: Postoperative nausea and vomiting (PONV) are common distressing symptoms experienced after laparoscopic cholecystectomy. We report the rate, and the factors associated with postoperative nausea and vomiting, the patterns of prophylactic antiemetic prescription, and the anesthetic techniques used among patients who underwent laparoscopic cholecystectomy at the Jigme Dorji Wangchuck (JDW) National Referral Hospital, Bhutan.
METHODS: A cross-sectional study was conducted at the JDW National Referral Hospital, from January to December 2018. All the patients who underwent laparoscopic cholecystectomy under general anesthesia were included in the study. The demographic variables, premedication, induction agents, muscle relaxants, inhalational agents for maintenance, opioid and adjuvant analgesics, the reversal agents used, and the occurrence of PONV within 24 h were recorded. Data were analyzed using SPSS (version 23). Continuous variables were compared using a t-test or Mann-Whitney test, categorical variables were tested using chi-square or Fisher\'s exact tests. Binary logistic regression analysis was performed to determine the factors associated with postoperative nausea and vomiting.
RESULTS: 190 patients underwent laparoscopic cholecystectomy under general anesthesia. The rate of PONV after laparoscopic cholecystectomy was 31.1% (59/190). Over half (53.7%, 102/190) of the study population were within 21-40 years of age, over 80% (157/190) were female, and 2/3rd were overweight and obese. The most frequently used premedication was ranitidine (39%, 34/87) and metoclopramide (31%, 27/87). More than half (57.4%, 109/190) of the patients received morphine as an opioid analgesic before induction. Sodium thiopentone was a commonly used induction agent (65.8%, 125/190). Succinylcholine and atracurium were mostly preferred muscle relaxants. Isoflurane and air were the most used inhalational anesthetic agents for the maintenance of anesthesia. Ondansetron was the most preferred anti-emetics during the intraoperative period. Previous history of motion sickness (OR 5.8, 95%CI 2.9-11.2, p < 0.001), and use of sodium thiopental (OR 4.1, 95%CI 1.9-9.1, p < 0.001) were independent risk factors for PONV. The use of antiemetics (OR 0.1, 95%CI 0.0-0.4, p = 0.002), propofol (OR 0.2, 95%CI 0.1-0.5, p < 0.001), adjuvant analgesic paracetamol (OR 0.4, 95%CI 0.2-0.8, p = 0.026), and adequate hydration with IV fluids (OR 0.9, 95%CI 0.9-1.0, p = 0.042) were preventive factors for PONV.
CONCLUSIONS: The rate of PONV after laparoscopic cholecystectomy was high. History of motion sickness and use of sodium thiopental for induction were independent risk factors of PONV. The use of multimodal prophylactic antiemetics was robust and superior to monotherapy in preventing PONV. This finding re-emphasizes the need for risk stratification and appropriate use of antiemetics and anesthetic agents to prevent PONV.