研究目的：
本研究旨在利用潛在類別分析（Latent Class Analysis）來探討骨科手術後噁心嘔吐及頭暈的潛在分群及相關因子。
研究方法：
以回溯性研究，於高雄榮民總醫院2021年1月至2022年7月，收集了病患術前評估，術中處置及術後狀態，包括噁心嘔吐、頭暈以及其他相關因子。並提出驗證資料集為2022年8月至2023年5月同條件之病患。

首先，使用傳統T檢定及卡方檢定挑選連續及類別變數重要因子。接下來使用潛在類別分析來識別造成手術後噁心嘔吐及頭暈的類別。結果顯示，根據噁心嘔吐和頭暈的有無，患者可以被分為六個不同的類別，不同類別有其不同的特性及重要變數。

結果共收集骨科手術共3751筆，噁心發生率8.93 % ，嘔吐發生率約14.53 % ，頭暈發生率約11.81%。男性/女性噁心嘔吐及頭暈的發生率分別為28.66%/71.34%，24.04%/75.96%，31.83%/68.17%。另外全膝關節置換術/全髖關節置換術/其他手術之噁心嘔吐及頭暈的發生率為 12.8%/11%/4.6%，27.4%/34.9%/3.5%，15.2%/17.1%/7%。其次，根據潛在類別分析最顯著的因子：性別及手術類別，進一步分為六類並進行了六種類別的迴歸分析與噁心嘔吐和頭暈相關的其他因素。結果顯示，性別和手術類型等因素對於患者的不適程度可能存在不同的變因。例如，女性在髖關節手術後有無使用類固醇可能影響出現噁心嘔吐和頭暈的症狀。

最後利用外部驗證來證實有其潛在分群的子群體的存在，這些子群體能夠進一步找出手術後噁心嘔吐及頭暈的重要因子。以精準醫學的概念別於傳統的統計分析，找出獨特的因子針對子群體來做適切的手術後噁心嘔吐及頭暈的預防及治療。

Research Objective:
The purpose of this study is to utilize Latent Class Analysis (LCA) to explore the latent subgroups and related factors of postoperative nausea, vomiting, and dizziness after orthopedic surgery.
Research Method:
A retrospective study was conducted at Kaohsiung Veterans General Hospital from January 2021 to July 2022. Data were collected on preoperative assessments, intraoperative interventions, and postoperative conditions, including nausea, vomiting, dizziness, and other relevant factors. A validation dataset was also established, consisting of patients with the same conditions from August 2022 to May 2023.
First, traditional t-tests and chi-square tests were used to select important factors among continuous and categorical variables. Latent Class Analysis was then employed to identify classes associated with postoperative nausea, vomiting, and dizziness. The results showed that patients could be classified into six different classes based on the presence or absence of nausea ,vomiting, and dizziness, with each class exhibiting distinct characteristics and important variables.

The study included a total of 3751 orthopedic surgeries, with an incidence of 8.93% for nausea, approximately 14.53% for vomiting, and around 11.81% for dizziness. Subsequently, based on the significant factors identified through latent class analysis (gender and surgery type), the patients were further categorized into six classes, and regression analyses were performed to investigate other factors related to nausea, vomiting, and dizziness. The results indicated that factors such as gender and surgery type may have different influences on patients' discomfort. For example, in female patients undergoing hip arthroplasty, the use of steroids may affect the occurrence of nausea, vomiting, and dizziness.

Finally, external validation was conducted to confirm the existence of latent subgroups that can further identify important factors for postoperative nausea, vomiting, and dizziness. This approach, distinct from traditional statistical analysis, aims to identify unique factors and implement appropriate preventive and therapeutic measures for specific subgroups based on the concept of precision medicine.

目 錄
論文審定書………………………………………………………...........................…… i
誌謝..................................................................................................................... ii
中文摘要……………………………………...........................…………………….…... iii
英文摘要……………………………………….............................…………………….. iv
圖次...................................................................................................... viii
表次...................................................................................................... ix
第 一 章 緒論…………............................………………………........……..… 1
第一節 前言……………………………………….......................……………… 1
第二節 動機與目的..………………………………………...................……. 1
第 二 章 文獻探討……….…………………………….....................……….….. 2
第一節 術後噁心頭暈含意…………………………………..................... 2
第二節 術後噁心嘔吐頭暈機轉................................................. 2
第三節 術後噁心嘔吐頭暈致病因子相關研究......................... 3
第四節 骨科病人術後噁心嘔吐頭暈相關研究......................... 4
第 三 章 研究方法與步驟................................................................. 5
第一節 研究族群，時間區間，納入及排除條件…...…………….. 5
第二節 研究資料庫..................................................................... 5
第三節 標準麻醉流程................................................................. 6
第四節 主要指標-依變數簡介........................…..................…….. 6
第五節 自變數簡介.............……..............................................…. 6
第六節 研究流程圖及統計方法................................................. 9
第 四 章 結果.......................………………………………………………............. 9
第一節 骨科術後一天噁心嘔吐頭暈發生率.............................. 9
第二節 骨科病人性別年齡分布................................................... 10
第三節 骨科病人手術種類噁心嘔吐頭暈發生率....................... 10
第四節 骨科病人手術時間及麻醉方式分布............................... 11
第五節 骨科病人BMI與噁心嘔吐頭暈之分布.......................... 13
第六節 骨科術後噁心嘔吐頭暈危險因子探討............................ 13
第七節 以潛在分群分析骨科術後噁心嘔吐頭暈之危險............ 17
第 五 章 討論....................................................................................... 29
第一節 潛在類別分析.................................................................... 29
第二節 潛在類別分析步驟............................................................ 30
第三節 潛在類別分析文獻及噁心嘔吐頭暈探討........................ 30
第 六 章 結論............................................................…......................... 32
第一節 研究發現............................................................................. 32
第二節 研究貢獻............................................................................ 32
第三節 研究限制............................................................................ 32
第四節 研究建議............................................................................. 33
參考文獻.................................................................................................. 33
附錄………………………………………………….............................…………………...... 37

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