术中呼气末二氧化碳分压与术后恶心呕吐的的相关性

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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

妇科手术患者被认为是术后恶心呕吐的高危人群。本研究评估术中呼气末二氧化碳（ETCO₂）与妇科开腹手术患者PONV风险的关系。

方  法

在这项单中心回顾性观察研究中，研究者纳入了20-60岁接受选择性妇科开放手术的患者。获取了术后24小时内PONV发生率的数据。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logistic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EtCO₂的中位最低值明显低于无PONV组（31 vs 33 mmHg，p=0.02）。在多因素logistic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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翻译：王贵龙    编辑：何幼芹  审校：冯玉蓉   王贵龙

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