术中呼气末二氧化碳与术后恶心呕吐风险的关系

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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

接受妇科手术的患者被认为是术后恶心呕吐(PONV)的高危人群。本研究旨在评估术中呼气末二氧化碳(ETCO2)与妇科开腹手术患者发生PONV的风险之间的关系。

方  法

在这项单中心回顾性观察研究中，我们纳入了20~60岁接受择期妇科开腹手术的患者。收集术后24小时内PONV发生率的数据。术中每分钟采集ETCO2，确定ETCO2最低值。比较PONV患者和无PONV患者的最低ETCO2。采用多变量Logistic回归分析评估ETCO2与PONV风险的独立相关性。

结 果  

本次研究共纳入146名患者。术后24小时内发生PONV的患者为 81例。PONV患者ETCO2中位数最低值明显低于无PONV患者(31 vs. 33 mmHg，P=0.02)。在多因素Logistic回归模型中，我们发现最低ETCO2≤31 mmHg，与PONV风险增加独立相关(调整优势比=3.3 7，p=0.02)。

结 论

在这项回顾性观察研究中，术中低ETCO2被证明与PONV风险增加独立相关。然而，这一结果可能会因收集到的信息不全面而存在偏倚，包括术前的PONV、晕动病或其他未知的偏倚，因此结果尚需进一步论证。

原始文献来源及摘要

Fujimoto D, Egi M, Makino S,et,al.The association of intraoperative end‑tidal carbon dioxide with the risk of postoperative nausea and vomiting[J]. Anesth. 2020 Apr;34(2):195-201. doi: 10.1007/s00540-019-02715-4.

Abstract

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 significantly 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 confirm our findings.

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文中所涉及药物使用、疾病诊疗等内容仅供参考。

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