术中呼气末二氧化碳分压与术后恶心呕吐的相关性

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The association of intraoperative end-tidal carbon dioxide with the risk of postoperative nausea and vomiting

背景与目的

方  法

本项单中心回顾性观察研究仅纳入20~60岁接受择期妇科开腹手术的患者。获取术后24小时内PONV发生率数据。术中每分钟采集一次EtCO2，确定EtCO2的最低值。比较PONV患者和非PONV患者的最低EtCO2。多因素逻辑回归分析评估EtCO2与PONV风险的独立相关性。

结 果  

本研究共纳入146例患者。术后24小时内发生PONV 81例。PONV组患者EtCO2的中位数最低值明显低于无PONV组患者（31 vs 33 mmHg，p=0.02）。在多因素逻辑回归模型中，研究者发现EtCO2≤31 mmHg与PONV风险的增加独立相关（AOR=3.37，p=0.02）。

结 论

本项回顾性观察研究发现，术中低EtCO2与PONV风险增加相关。

原始文献来源及摘要

Fujimoto D,  Egi M,  Makino S,  Mizobuchi S；The association of intraoperative end-tidal carbon dioxide with the risk of postoperative nausea and vomiting；J Anesth 2019 Nov 27.

Purpose Patients undergoing gynecological surgery are considered to be a high-risk cohort for postoperative nausea and vomiting (PONV). The purpose of this study was to assess the association of intraoperative end-tidal carbon dioxide (EtCO2) with risk of PONV in patients underwent gynecological open surgery.

Methods In this single-center retrospective observational study, we included patients aged 20–60 years who underwent elective gynecological open surgery. We obtained data for the incidence of PONV within 24 h after operation. We collected EtCO2 every minute during the operation, and determined the lowest value of EtCO2. We compared the lowest EtCO2 between patients with and without PONV. Multivariate logistic regression analysis was performed to assess the independent association of EtCO2 with the risk of PONV.

Results A total of 146 patients were included in the current study. There were 81 patients with PONV within 24 h after the operation. The median lowest value of EtCO2 in patients with PONV was signifcantly lower than that in patients without PONV (31 vs 33 mmHg, p=0.02). In the multivariate logistic regression model, we found that lowest EtCO2≤31 mmHg was independently associated with increase in the risk of PONV (adjusted odds ratio=3.37, p=0.02).

Conclusion In this retrospective observational study, low intraoperative EtCO2 was shown to be independently associated with increased risk of PONV. However, this result may be skewed by uncollected information including previous PONV, motion sickness or other unknown bias, so future studies should be conducted to refute or confrm our fndings.

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