Study Of Correlated Multiplicity For Postoperative Nausea And Vomiting Following Laparoscopic Cholecystectomy

Objective: By analyzing the clinical index and the level of testosterone of operative period we study the associativity between postoperative nausea and vomiting and each factors, offering the theory for clinical prevention and treatment. Methods: In Qilu Hospital of Shandong University 50 cases female patients who suffered cholecystolithiasis or gall bladder polypi with chronic cholecystitis were random selected prospectively, recording age, body height, body weight, smoking, history of kinesia (car sickness, sea sickness), anesthesia time, pneumoperitoneum pressure, anaesthetic medication, operative time, postanaesthetic recovery time, menstrual cycle history, gastrointestinal tympanites in operation, hospital days, pH, Pa02, PaC02 of arterial blood gas after 5 min relieving pneumoperitoneum, determine the perioperative level of testosterone of blood serum. Recording the number of incidence of PONV, according to the request of experimental data, all of patients were divided into PONV-group and no PONV-group, then comparing age, body height, body weight, history of kinesia, smoking, time of operation and anaesthesia, postoperative pain, time of postanaesthetic recovery, arterial blood gas after operation and so on between both groups, and finding the difference, analyzing the associativity between each factor and PONV of LC, investigating the associativity between the changesof testosterone of blood serum and PONV following LC, analyzing possible mechanism of action of it. Results: All operations were successful, 22 patients occurred postoperative nausea and vomiting(PONV). Non-PONV in 28cases. The incidence of PONV was 44%.There was no difference in ages, body height, body weight, time of operation, preoperative medication, method of anaesthesia and anaesthesia medication between two groups. 12 patients occurred nausea and vomiting within 6 hours after operation, 6 cases occurred within 6-12h after operation, 4 cases occurred in 12~24h after operation, the incidence of PONV was the highest in 6 hours after operation, it was 54. 5%. 6 cases and 8 cases in PONV group and Non-PONV group respectively were appllied proserine to reverse the effectiveness of anesthesia muscle relaxant. There was no difference by x2 test. 12 cases patients of PONV group were in luteal phase of menstrual cycle, 5 cases in ovulation period, 1 case in preovulatory phase. The rate of them is 52%, 40% and 29% respectively. There is apparent associativity between postanaesthetic recovery and PONV after LC. The shorter time of postanaesthetic recovery is, the higher probability of PONV is. The level of testosterone in two groups of patients increased at the end of operation and six hours after operation comparing to preoperation. There was significant difference (K0. 05) ? The level of testosterone of PONV group is apparently higher than that of Non-PONV group and its level increased to the max 6 hour after operation. The level of testosterone in two groups is the most significantly different 6 hour after operation(K0. 05). Conclusions: Patients of history of kinetia, operative time in luteal phase of menstrual cycle and short postanaesthetic recovery time (<20min) induce cutting down of the excitabiliby threshold of stimulus outside, such as laparoscopic operation, pneumoperitoneum, anesthesia and so on. These reasons increase the probability of PONV after LC. There is apparent associativity between changes of the perioperative level of testosteroneand PONV in female patients, because upgrade of the level of testosterone antagonize effectiveness of which glucocorticoid interferes with central chemoreceptor trigger zone, lead to 5-HT3 acceptor increasing, emeticing effect enforced. Antihistamine drug could be given to the high-risk group who suffering kinesia in order to lessen distress. The female patients who are performed laparoscopic operation should avoid luteal phase of menstrual cycle, accordingly cutting down the incidence of PONV. Extending time of postanaesthetic recovery appropriately, manipulus calmative should be given to patients after anaesthesia in order to lessen the incidence of PONV.