Abstract: ［Abstract］ Objevtive To investigate the causes and nursing strategies of refractory vomiting after pancreaticoduodenectomy（PD）. Methods Eighty?two patients who underwent pancreaticoduodenectomy in our hospital from August 2013 to March 2017 were enrolled. Among them, 32 patients with postoperative refractory vomiting were used as observation group, and the other 50 without refractory vomiting served as a control group. ANOVA and Logistic regression were used to analyze the risk factors affecting the occurrence of refractory vomiting after PD operation. Then the specific nursing strategies were proposed and the nursing effect was analyzed by CIVIQ life scale. Results By univariate analysis, age（≥60 years）, preoperative total bilirubin（≥170 μmol/L）, preoperative albumin（≥35 g/L）preoperative fasting blood glucose（≥7.0 mmol/L）, intraoperative blood loss（≥250 mL）and postoperative complications were influenting factors of refractory vomiting after pancreaticoduodenectomy（all P values<0.05）. Risk factors affecting refractory vomiting after pancreaticoduodenectomy included preoperative albumin, preoperative fasting blood glucose, and postoperative complications（all P values<0.05）. The CIVIQ scores of the patients with refractory vomiting after pancreaticoduodenectomy were 70.20±11.21 and 89.38±15.45, respectively（P<0.05）. Conclusion The risk factors for refractory vomiting after pancreaticoduodenectomy include preoperative albumin, preoperative fasting blood glucose, and postoperative complications. The patients should be given the necessary care interventions to improve the quality of life of patients and improve the prognosis of patients.

Key words: nursing care, cause, pancreaticoduodenectomy, refractory vomiting, CIVIQ

摘要： ［摘要］目的 探讨胰十二指肠切除术（PD）后顽固性呕吐发生的原因分析及护理对策。方法 选取2013年8月至2017年3月期间于我院行胰十二指肠切除术的82例患者作为研究对象，其中将术后顽固性呕吐的32例患者作为观察组，将另外的未合并顽固性呕吐的50例患者作为对照组。分别采用单因素与多元Logistic回归模型对影响PD手术术后顽固性呕吐发生的高危因素进行分析，然后提出具体的护理对策，并采用CIVIQ生活量表分析护理效果。结果 ①经单因素分析，年龄≥60岁、术前总胆红素≥170μmol/L、术前白蛋白≥35g/L、术前空腹血糖≥7.0mmol/L、术中出血量≥250mL以及术后有并发症均为胰十二指肠切除术后顽固性呕吐的影响因素（均P<0.05）；②将上述单因素分析所得的因素代入至多元Logistic回归模型之中，结果显示：影响胰十二指肠切除术后顽固性呕吐发生的危险因素包括术前白蛋白、术前空腹血糖以及术后并发症（均P<0.05）；③本组32例胰十二指肠切除术后顽固性呕吐患者护理干预前后CIVIQ评分分别为（70.20±11.21）分及（89.38±15.45）分，差异具有统计学意义（P<0.05）。结论 影响胰十二指肠切除术后顽固性呕吐发生的危险因素包括术前白蛋白、术前空腹血糖以及术后并发症，应注意对这些因素进行仔细观察。对此，应对患者给予必要的护理干预对策，从而提高患者的生活质量及改善患者的预后状况。

关键词: 原因, 胰十二指肠切除术, 顽固性呕吐, 护理, CIVIQ生活量表