骨科手术中芬太尼诱发患儿咳嗽与术后恶心呕吐的相关性

摘要

目的 分析骨科手术中芬太尼诱发患儿咳嗽与全麻术后恶心呕吐(postoperative nausea and vomiting,PONV)的相关性.方法 选择全麻下行骨科四肢手术的患儿159例,男98例,女61例,年龄3～12岁,ASA工级.开放上肢静脉,进行全麻诱导,5s内静推芬太尼3μg/kg,1min内发生咳嗽者纳入咳嗽组(FIC组)(n=61),未发生咳嗽者纳入非咳嗽组(NFIC组)(n=98).记录术后24h两组恶心呕吐的发生例数及严重程度.采用多因素Logistic回归分析评估芬太尼诱导咳嗽和PONV的相关性.结果 FIC组PONV发生率明显高于NFIC组[33例(54.1％) vs 36例(36.7％),P＜0.05].两组PONV严重程度差异无统计学意义.多因素Logistic回归分析结果显示,芬太尼诱发咳嗽是患儿PONV的危险因素(OR=1.508,95％CI 1.263～1.981).结论 在患儿骨科手术中,芬太尼诱发咳嗽者PONV发生率也高,但恶心呕吐的严重程度与未发生咳嗽者无明显区别.%Objective To investigate the correlation analysis between fentanyl-induced cough (FIC) and postoperative nausea and vomiting (PONV) in children.Methods A total of 159 childrenwho underwent orthopedic surgery,98 males and 61 females,aged 3-12 years,ASA physical status Ⅰ,were enrolled in this study.Before being taken to the operating room,venous access was established,a fentanyl bolus (3 μg/kg) was injected in 5 s.According to whether or not coughs occurrence up to 1 min after the bolus were divided into cough group (group FIC) and not cough group (group NFIC).The presence of FIC or non-FIC during induction and the occurrence of PONV were respectively recorded.In addition,the incidence and severity of PONV 24 h after surgery were assessed.FIC and other perioperative variables were subjected to multivariate analysis to determine the association between FIC and PONV.Results The incidence of PONV in group FIC was higher than that in group NFIC [33 (54.1 ％) cases vs 36 (36.7％) cases,P ＜ 0.05].There was no significant difference in the severity of nausea and vomiting between the two groups.Multivariate logistic regression analysis found FIC to be a predictive risk factor for the development of PONV (OR =1.508,95％ CI 1.263-1.981).Condusion Children undergoing orthopedic surgery who develop FIC during induction of anaesthesia have a higher incidence of PONV,but the severity of nausea and vomiting has no significant difference.