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中华肝脏外科手术学电子杂志 ›› 2025, Vol. 14 ›› Issue (02) : 245 -249. doi: 10.3877/cma.j.issn.2095-3232.2025042

临床研究

日间腹腔镜胆囊切除术患者术后恶心呕吐的影响因素与防治
刘春熠1, 孙齐1, 史中巍1, 黄静2,()   
  1. 1. 100021 首都医科大学附属北京朝阳医院手术室
    2. 100021 首都医科大学附属北京朝阳医院护理部
  • 收稿日期:2024-11-27 出版日期:2025-04-10
  • 通信作者: 黄静
  • 基金资助:
    北京市属医院科研培育计划项目(PG2024007)

Influencing factors and prevention of postoperative nausea and vomiting in patients undergoing daytime laparoscopic cholecystectomy

Chunyi Liu1, Qi Sun1, Zhongwei Shi1, Jing Huang2,()   

  1. 1. Operating Room,Beijing Chaoyang Hospital Affiliated to Capital Medical University,Beijing 100021,China
    2. Department of Nursing,Beijing Chaoyang Hospital Affiliated to Capital Medical University,Beijing 100021,China
  • Received:2024-11-27 Published:2025-04-10
  • Corresponding author: Jing Huang
引用本文:

刘春熠, 孙齐, 史中巍, 黄静. 日间腹腔镜胆囊切除术患者术后恶心呕吐的影响因素与防治[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(02): 245-249.

Chunyi Liu, Qi Sun, Zhongwei Shi, Jing Huang. Influencing factors and prevention of postoperative nausea and vomiting in patients undergoing daytime laparoscopic cholecystectomy[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(02): 245-249.

目的

探讨日间腹腔镜胆囊切除术(LC)患者发生术后恶心呕吐(PONV)的影响因素与防治。

方法

回顾性分析2019 年6 月至2021 年5 月在首都医科大学附属北京朝阳医院接受日间LC 的495 例胆囊良性疾病患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男176 例,女319 例;年龄19~69 岁,中位年龄43 岁。LC 术后采用多模式预防PONV。收集和分析患者病历资料,包括性别、年龄、腹部手术史、高血压史、吸烟史、心脑血管病史、术前实验室检查和美国麻醉师协会(ASA)分级、术中气腹压、术中出血量、手术时间等手术相关资料。PONV 相关影响因素分析采用Logistic 回归分析。

结果

495 例患者均顺利完成LC,均在手术当天出院。PONV 发生率13.9%(69/495),给予止吐药物后均得到缓解。Logistic 多因素回归分析显示,性别(OR= 0.144,95%CI:0.063~0.330)、年龄(OR=0.956,95%CI:0.931~0.982)、手术时间(OR=1.017,95%CI:1.493~2.876)和气腹压(OR=2.072,95%CI:0.645~1.173)是日间LC 患者PONV 发生的独立影响因素(P<0.05)。

结论

患者性别、年龄、手术时间和气腹压是日间LC 患者PONV 发生的独立影响因素。对于年轻女性患者应积极采取措施加强预防PONV,同时术中尽可能降低气腹压,并加快手术进程。

Objective

To investigate the influencing factors, prevention and treatment of postoperative nausea and vomiting (PONV) in patients undergoing daytime laparoscopic cholecystectomy(LC).

Methods

Clinical data of 495 patients with benign gallbladder diseases who received consecutive daytime LC in Beijing Chaoyang Hospital Affiliated to Capital Medical University from June 2019 to May 2021 were analyzed retrospectively.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them, 176 patients were male and 319 female, aged from 19 to 69 years, with a median age of 43 years.Multi-mode prevention of PONV was adopted after LC.Medical records including gender, age, abdominal surgery, hypertension, smoking and cardiovascular and cerebrovascular diseases were collected and analyzed.Preoperative laboratory examination and American Society of Anesthesiologists (ASA) classification, intraoperative pneumoperitoneal pressure, intraoperative blood loss and operation time were also obtained.Influencing factors of PONV were identified by Logistic regression analysis.

Results

All 495 patients successfully completed LC and were discharged on the day of operation.The incidence of PONV was 13.9%(69/495), which was relieved after use of antiemetic drugs.Multivariate Logistic regression analysis showed that gender (OR=0.144, 95%CI: 0.063-0.330), age(OR=0.956, 95%CI: 0.931-0.982), operation time (OR=1.017, 95%CI: 1.493-2.876) and pneumoperitoneal pressure (OR=2.072, 95%CI: 0.645-1.173) were the independent influencing factors of PONV in patients undergoing daytime LC (all P<0.05).

Conclusions

Gender, age, operation time and pneumoperitoneal pressure are the independent influencing factors of PONV in patients undergoing daytime LC.For young female patients, precaution should be strengthened, the pneumoperitoneal pressure should be reduced as much as possible during operation and surgical process should be accelerated.

表1 日间LC 患者PONV 发生的影响因素单因素分析
表2 日间LC 患者PONV 发生的影响因素Logistic 多因素回归分析
[1]
Agresta F, Campanile FC, Vettoretto N, et al.Laparoscopic cholecystectomy: consensus conference-based guidelines[J].Langenbecks Arch Surg, 2015, 400(4): 429-453.DOI: 10.1007/s00423-015-1300-4.
[2]
赵森峰, 李向军, 豆松萌, 等.5771例日间腹腔镜胆囊切除术的安全性和经济效益分析[J/OL].中华肝脏外科手术学电子杂志, 2018,7(3): 193-196.DOI: 10.3877/cma.j.issn.2095-3232.2018.03.007.Zhao SF, Li XJ, Dou SM, et al.Analysis of safety and economic benefit of 5771 patients undergoing day surgery laparoscopic cholecystectomy[J/OL].Chin J Hepatic Surg (Electronic Edition), 2018, 7(3): 193-196.DOI:10.3877/cma.j.issn.2095-3232.2018.03.007.
[3]
《中华消化外科杂志》编辑委员会.日间手术肝胆疾病标准化流程中国专家共识(2022版)[J].中华消化外科杂志, 2022, 21(2): 185-190.DOI: 10.3760/cma.j.cn115610-20211228-00687.Editorial Board of Chinese Journal of Digestive Surgery.Chinese expert consensus on standardization process of hepatobiliary diseases in day surgery (2022 edition) [J].Chin J Dig Surg, 2022, 21(2): 185-190.DOI: 10.3760/cma.j.cn115610-20211228-00687.
[4]
马俊丽, 魏新川.术后恶心呕吐病因、机制和治疗进展[J].实用医院临床杂志, 2022, 19(1): 190-193.Ma JL, Wei XC.Etiology, mechanism and treatment progress of postoperative nausea and vomiting[J].Pract J Clin Med, 2022, 19(1):190-193.
[5]
Gan TJ, Meyer TA, Apfel CC, et al.Society for Ambulatory Anesthesia guidelines for the management of postoperative nausea and vomiting[J].Anesth Analg, 2007, 105(6): 1615-1628.DOI: 10.1213/01.ane.0000295230.55439.f4.
[6]
Stoops S, Kovac A.New insights into the pathophysiology and risk factors for PONV[J].Best Pract Res Clin Anaesthesiol, 2020, 34(4):667-679.DOI: 10.1016/j.bpa.2020.06.001.
[7]
陈潇, 张玉侠, 周海英, 等.术后恶心呕吐非药物管理的最佳证据总结[J].中华护理杂志, 2021, 56(11): 1721-1727.DOI:10.3761/j.issn.0254-1769.2021.11.021.Chen X, Zhang YX, Zhou HY, et al.Best evidence summary for non-pharmacological management of postoperative nausea and vomiting[J].Chin J Nurs, 2021, 56(11): 1721-1727.DOI:10.3761/j.issn.0254-1769.2021.11.021.
[8]
中华医学会外科学分会,中华医学会麻醉学分会.加速康复外科中国专家共识及路径管理指南(2018版)[J].中国实用外科杂志,2018, 38(1): 1-20.DOI: 10.19538/j.cjps.issn1005-2208.2018.01.01.Chinese Society of Surgery, Chinese Society of Anesthesiology.Chinese consensus and clinical guidelines for Enhanced Recovery After Surgery(2018 editon)[J].Chin J Pract Surg, 2018, 38(1): 1-20.DOI: 10.19538/j.cjps.issn1005-2208.2018.01.01.
[9]
Fujii Y.The utility of antiemetics in the prevention and treatment of postoperative nausea and vomiting in patients scheduled for laparoscopic cholecystectomy[J].Curr Pharm Des, 2005, 11(24):3173-3183.DOI: 10.2174/1381612054864911.
[10]
Apfel CC, Heidrich FM, Jukar-Rao S, et al.Evidence-based analysis of risk factors for postoperative nausea and vomiting[J].Br J Anaesth,2012, 109(5): 742-753.DOI: 10.1093/bja/aes276.
[11]
陈珊.基于循证构建成人患者术后恶心呕吐的护理预防策略研究[D].湖州: 湖州师范学院, 2020.DOI:10.27946/d.cnki.ghzsf.2020.000059.Chen S.A study on evidence-based nursing and prevention strategies for postoperative nausea and vomiting in adult patients[D].Huzhou:Huzhou University, 2020.DOI:10.27946/d.cnki.ghzsf.2020.000059.
[12]
Gan TJ.Risk factors for postoperative nausea and vomiting[J].Anesth Analg, 2006, 102(6): 1884-1898.DOI: 10.1213/01.ANE.0000219597.16143.4D.
[13]
Cohen MM, Duncan PG, DeBoer DP, et al.The postoperative interview: assessing risk factors for nausea and vomiting[J].Anesth Analg, 1994, 78(1): 7-16.DOI: 10.1213/00000539-199401000-00004.
[14]
Apfel CC, Laara E, Koivuranta M, et al.A simplified risk score for predicting postoperative nausea and vomiting: conclusions from crossvalidations between two centers[J].Anesthesiology, 1999, 91(3): 693-700.DOI: 10.1097/00000542-199909000-00022.
[15]
Nesek-Adam V, Grizelj-Stojcić E, Rasić Z, et al.Comparison of dexamethasone, metoclopramide, and their combination in the prevention of postoperative nausea and vomiting after laparoscopic cholecystectomy[J].Surg Endosc, 2007, 21(4): 607-612.DOI:10.1007/s00464-006-9122-7.
[16]
李天佐.日间手术术后恶心呕吐防治策略[J].北京医学, 2015,37(8): 726-727.DOI: 10.15932/j.0253-9713.2015.8.004.Li TZ.Prevention and treatment strategy of nausea and vomiting after daytime operation[J].Beijing Med J, 2015, 37(8): 726-727.DOI:10.15932/j.0253-9713.2015.8.004.
[17]
Buchanan FF, Myles PS, Cicuttini F.Patient sex and its influence on general anaesthesia[J].Anaesth Intensive Care, 2009, 37(2): 207-218.DOI: 10.1177/0310057X0903700201.
[18]
Salazar-Parra M, Guzman-Ramirez BG, Pintor-Belmontes KJ, et al.Gender differences in postoperative pain, nausea and vomiting after elective laparoscopic cholecystectomy[J].World J Surg, 2020, 44(12):4070-4076.DOI: 10.1007/s00268-020-05744-3.
[19]
Hsieh CY, Poon YY, Ke TY, et al.Postoperative vomiting following laparoscopic cholecystectomy is associated with intraoperative fluid administration: a retrospective cohort study[J].Int J Environ Res Public Health, 2021, 18(10): 5305.DOI: 10.3390/ijerph18105305.
[20]
Medina-Diaz-Cortés G, Brancaccio-Pérez IV, Esparza-Estrada I, et al.Differences in postoperative pain, nausea, and vomiting after elective laparoscopic cholecystectomy in premenopausal and postmenopausal Mexican women[J].World J Surg, 2022, 46(2): 356-361.DOI: 10.1007/s00268-021-06367-y.
[21]
Yayla A, Eskiciİlgin V, Kılınç T, et al.Nausea and vomiting after laparoscopic cholecystectomy: analysis of predictive factors[J].J Perianesth Nurs, 2022,37(6): 834-841.DOI: 10.1016/j.jopan.2022.01.002.
[22]
Gan TJ, Belani KG, Bergese S, et al.Fourth consensus guidelines for the management of postoperative nausea and vomiting[J].Anesth Analg,2020, 131(2): 411-448.DOI: 10.1213/ANE.0000000000004833.
[23]
Gin E, Lowen D, Tacey M, et al.Reduced laparoscopic intraabdominal pressure during laparoscopic cholecystectomy and its effect on post-operative pain: a double-blinded randomised control trial[J].J Gastrointest Surg, 2021, 25(11): 2806-2813.DOI: 10.1007/s11605-021-04919-0.
[24]
申海军, 陈广瑜, 詹建兴, 等.腹腔镜胆囊切除术气腹压力相关并发症的研究[J].中国普外基础与临床杂志, 2012, 19(7): 779-781.Shen HJ, Chen GY, Zhan JX, et al.Study on complications associated pneumoperitoneum of laparoscopic cholecystectomy [J].Chin J Bases Clin Gen Surg, 2012, 19(7): 779-781.
[25]
蒋飞, 吴爱玲, 颜渊, 等.胃镜下观察胆汁十二指肠胃反流对腹腔镜胆囊切除术术后恶心呕吐的影响[J].中国当代医药, 2018, 25(10):34-37.Jiang F, Wu AL, Yan Y, et al.Effect of bile duodenogastric reflux on postoperative nausea and vomiting in laparoscopic cholecystectomy[J].China Mod Med, 2018, 25(10): 34-37.
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