全身麻醉下膝关节置换术后恶心呕吐诱因和预防

【摘要】 目的 探讨全身麻醉下膝关节置换术后恶心呕吐的诱因,及术后早期咀嚼运动对其术后恶心呕吐的影响。方法 选取全身麻醉下膝关节置换手术治疗患者192例,分为对照组112例和观察组80例,对照组采用常规护理预防术后恶心呕吐,观察组在对照组基础上采用术后早期咀嚼口香糖预防术后恶心呕吐。比较两组患者年龄、性别、吸烟史、手术时间、术前禁食、禁饮时间,术中激素使用、补液量,术后进食、进饮时间、术后使用昂丹司琼和恶心呕吐等情况。结果 观察组手术时间短于对照组（P<0.05）,恶心呕吐发生率低于对照组（P<0.05）。单因素分析显示,膝关节置换术后恶心呕吐患者较术后无恶心呕吐患者手术时间、术前禁食时间和禁饮时间延长（均P<0.05）,术中使用激素比例增高（P<0.05）,术后早期咀嚼口香糖比例降低（P<0.05）。多因素分析显示,手术时间和术前禁饮时间延长及术中使用激素是膝关节置换术后恶心呕吐发生的危险因素（P<0.05）,而术后早期咀嚼口香糖是预防术后恶心呕吐发生的保护性因素（P<0.05）。结论 全身麻醉下膝关节置换术后恶心呕吐与手术时间和术前禁饮时间延长及术中激素使用存在相关性,早期进行咀嚼运动可降低术后恶心呕吐的发生风险。更多还原

【Abstract】 Objective To investigate the causes of nausea and vomiting after knee arthroplasty under general anesthesia and the effect of early masticatory exercise on postoperative nausea and vomiting.Methods 192 patients with knee arthroplasty under general anesthesia were selected and divided into control group（112 cases） and observation group（80 cases）.The control group was given routine nursing to prevent postoperative malignant vomiting,while the observation group was treated with chewing gum early after operation to prevent postoperative malignant vomiting.The age,gender,smoking history,operation time,fasting and drinking time before operation,hormone use and fluid infusion volume,postoperative eating and drinking time,ondansetron and malignant vomiting were compared between the two groups.Results The operation time of the observation group was shorter than that of the control group（P<0.05）,and the incidence of nausea and vomiting was lower than that of the control group（P<0.05）.Univariate analysis showed that the operation time,fasting time and drinking prohibition time of patients with nausea and vomiting after knee arthroplasty were longer than those without nausea and vomiting（all P<0.05）,the proportion of hormone used during operation was significantly increased（P<0.05）,and the proportion of chewing gum in early postoperative period was significantly decreased（P<0.05）.Multivariate analysis showed that prolonged operation time,preoperative fasting time and hormone use were risk factors for nausea and vomiting after knee arthroplasty（P<0.05）,while chewing gum early after operation was a protective factor（P<0.05）.Conclusion Nausea and vomiting after total knee arthroplasty under general anesthesia is closely related to the prolonged operation time and preoperative prohibition time,and the use of hormone during operation.Early chewing exercise can significantly reduce the risk of postoperative nausea and vomiting.更多还原