手术患者接受患者自控静脉镇痛期间发生术后恶心呕吐的危险因素分析

吴觉伦, 田园, 聂卫华, 张越伦, 申乐

吴觉伦, 田园, 聂卫华, 张越伦, 申乐. 手术患者接受患者自控静脉镇痛期间发生术后恶心呕吐的危险因素分析[J]. 协和医学杂志, 2024, 15(2): 366-374. DOI: 10.12290/xhyxzz.2023-0579
引用本文: 吴觉伦, 田园, 聂卫华, 张越伦, 申乐. 手术患者接受患者自控静脉镇痛期间发生术后恶心呕吐的危险因素分析[J]. 协和医学杂志, 2024, 15(2): 366-374. DOI: 10.12290/xhyxzz.2023-0579
WU Juelun, TIAN Yuan, NIE Weihua, ZHANG Yuelun, SHEN Le. Risk Factors for Postoperative Nausea and Vomiting in Surgical Patients Undergoing Patient Controlled Intravenous Analgesia[J]. Medical Journal of Peking Union Medical College Hospital, 2024, 15(2): 366-374. DOI: 10.12290/xhyxzz.2023-0579
Citation: WU Juelun, TIAN Yuan, NIE Weihua, ZHANG Yuelun, SHEN Le. Risk Factors for Postoperative Nausea and Vomiting in Surgical Patients Undergoing Patient Controlled Intravenous Analgesia[J]. Medical Journal of Peking Union Medical College Hospital, 2024, 15(2): 366-374. DOI: 10.12290/xhyxzz.2023-0579

手术患者接受患者自控静脉镇痛期间发生术后恶心呕吐的危险因素分析

基金项目: 

中央高水平医院临床科研专项 2022-PUMCH-A-147

详细信息
    通讯作者:

    申乐, E-mail: pumchshenle@163.com

  • 中图分类号: R614.2; R441.1; R442.1

Risk Factors for Postoperative Nausea and Vomiting in Surgical Patients Undergoing Patient Controlled Intravenous Analgesia

Funds: 

National High Level Hospital Clinical Research Funding 2022-PUMCH-A-147

More Information
  • 摘要:
      目的  分析手术患者接受患者自控静脉镇痛(patient controlled intravenous analgesia,PCIA)期间发生术后恶心呕吐(postoperative nausea and vomiting,PONV)的危险因素。
      方法  本研究为回顾性队列研究,纳入2023年7月1日—10月31日在北京协和医院接受外科手术且术后接受PCIA的患者。通过电子病历系统获取患者的一般资料、既往史、手术信息、术中用药信息、术后镇痛随访信息。根据接受PCIA期间PONV的发生情况,将患者分为PCIA-PONV组和非PCIA-PONV组;根据是否发生术后呕吐(postoperative vomiting,POV),将其分为PCIA-POV组和非PCIA-POV组。采用多因素Logistic回归分析法筛选PCIA-PONV和PCIA-POV的危险因素。
      结果  共纳入1373例患者,其中PCIA-PONV组676例,PCIA-PONV的发生率为49.2%;PCIA-POV组285例,PCIA-POV的发生率为20.8%。多因素Logistic回归分析显示,女性(OR=2.134,95% CI:1.590~2.865,P<0.001)、腹部手术(OR=1.655,95% CI:1.253~2.186,P<0.001)是手术患者接受PCIA期间出现PONV的危险因素,而年龄增长(OR=0.990,95% CI:0.982~0.998,P=0.019)、体质量指数增加(OR=0.961,95% CI:0.932~0.991,P=0.012)则是其保护因素;女性(OR=2.646,95% CI:1.754~3.992,P<0.001)、全麻史(OR=1.372,95% CI:1.042~1.806,P=0.024)、术中使用大剂量阿片类药物(OR=1.607,95% CI:1.206~2.142,P=0.001)是手术患者接受PCIA期间出现POV的危险因素,而术中未使用肌松拮抗剂(OR=0.393,95% CI:0.237~0.651,P<0.001)则是其保护因素。
      结论  本研究初步揭示了手术患者接受PCIA期间发生PONV的危险因素,完善的术前评估及合理的围术期管理策略对于预防PCIA-PONV具有重要意义。
    Abstract:
      Objective  To identify the risk factors for postoperative nausea and vomiting (PONV) in surgical patients undergoing patient controlled intravenous analgesia (PCIA).
      Methods  Our study was a retrospective cohort study, including patients who underwent surgery at Peking Union Medical College Hospital from July 1 to October 31, 2023 and received PCIA after surgery. Patient characteristics, medical history, surgical information, intraoperative medication information, postoperative analgesia follow-up information were obtained through the electronic medical record system. The patients were divided into PCIA-PONV group and non-PCIA-PONV group, depending on the occurrence of PONV during PCIA, and all patients were also divided into PCIA-POV group and non-PCIA-POV according to whether postoperative vomiting (POV) occurred. Multivariate Logistic regression analysis was used to identify the risk factors for PCIA-PONV and PCIA-POV.
      Results  A total of 1373 patients were included in this study, with 676 cases in PCIA-PONV group. The incidence of PCIA-PONV was 49.2%. There were 285 patients in PCIA-POV group, and the incidence of PCIA-POV was 20.8%. The results of multivariate Logistic regression analysis showed that female (OR=2.134, 95% CI: 1.590-2.865, P < 0.001) and abdominal surgery (OR=1.655, 95% CI: 1.253-2.186, P < 0.001) were risk factors for PCIA-PONV, whereas the increase of age (OR=0.990, 95% CI: 0.982-0.998, P=0.019) and the increase of BMI (OR=0.961, 95% CI: 0.932-0.991, P=0.012) were protective factors for PCIA-PONV. Female (OR=2.646, 95% CI: 1.754-3.992, P < 0.001), history of general anesthesia (OR=1.372, 95% CI: 1.042-1.806, P=0.024), and intraoperative use of high-dose opioids (OR=1.607, 95% CI: 1.206-2.142, P=0.001) were risk factors for PCIA-POV, whereas no intraoperative use of neuromuscular blocking antagonists (OR=0.393, 95% CI: 0.237-0.651, P < 0.001) was protective factor for PCIA-POV.
      Conclusions  Our study reveals the risk factors for PONV in surgical patients undergoing PCIA, and shows that comprehensive preoperative assessment and reasonable perioperative management strategies are significant in the prevention of PCIA-PONV.
  • 作者贡献:吴觉伦负责研究设计、数据收集、数据处理、统计分析及论文撰写;田园、聂卫华负责数据收集与数据处理;张越伦负责统计分析与论文修改;申乐负责研究设计、统计分析与论文修改。
    利益冲突:所有作者均声明不存在利益冲突
  • 表  1   1373例接受PCIA患者的基线情况(根据PCIA-PONV分组)[n(%)]

    Table  1   Baseline of 1373 patients receiving PCIA(grouping based on PCIA-PONV) [n(%)]

    变量 PCIA-PONV
    (n=676)
    非PCIA-PONV
    (n=697)
    P
    年龄(x±s,岁) 51.2±15.1 54.3±15.0 <0.001
    性别 <0.001
      男性 132(19.5) 255(36.6)
      女性 544(80.5) 442(63.4)
    BMI(x±s,kg/m2) 23.5±3.6 24.3±3.9 <0.001
    ASA分级 0.128
      Ⅰ~Ⅱ 603(89.2) 603(86.5)
      ≥Ⅲ 73(10.8) 94(13.5)
    吸烟史 0.001
      有 35(5.2) 71(10.2)
      无 641(94.8) 626(89.8)
    饮酒史 0.001
      有 22(3.3) 52(7.5)
      无 654(96.7) 645(92.5)
    高血压史 0.033
      有 121(17.9) 157(22.5)
      无 555(82.1) 540(77.5)
    糖尿病史 0.240
      有 52(7.7) 66(9.5)
      无 624(92.3) 631(90.5)
    全麻史 0.731
      有 278(41.1) 293(42.0)
      无 398(58.9) 404(58.0)
    手术种类 0.267
      择期手术 666(98.5) 681(97.7)
      急诊手术 10(1.5) 16(2.3)
    手术方式 <0.001
      腹部手术 515(76.2) 417(59.8)
      非腹部手术 161(23.8) 280(40.2)
    手术时长 0.011
      <3 h 290(42.9) 347(49.8)
      ≥3 h 386(57.1) 350(50.2)
    术中麻醉维持方式 0.079
      全静脉麻醉 150(22.2) 183(26.3)
      静吸复合麻醉 526(77.8) 514(73.7)
    阿片类药物用量 0.026
      <400 μg 325(48.1) 377(54.1)
      ≥400 μg 351(51.9) 520(45.9)
    地塞米松 0.711
      有 633(93.6) 656(94.1)
      无 43(6.4) 41(5.9)
    昂丹司琼 0.008
      有 456(67.5) 422(60.5)
      无 220(32.5) 275(39.5)
    肌松拮抗剂 0.014
      新斯的明 293(43.3) 335(48.1)
      舒更葡糖钠 276(40.8) 228(32.7)
      无拮抗 96(14.2) 116(16.6)
    PCIA(patient controlled intravenous analgesia):患者自控静脉镇痛;PONV(postoperative nausea and vomiting):术后恶心呕吐;BMI(body mass index):体质量指数;ASA(American Society of Anesthesiologists):美国麻醉医师协会
    下载: 导出CSV

    表  2   1373例接受PCIA患者的基线情况(根据PCIA-POV分组)[n(%)]

    Table  2   Baseline of 1373 patients receiving PCIA(grouping based on PCIA-POV) [n(%)]

    变量 PCIA-POV
    (n=285)
    非PCIA-POV
    (n=1088)
    P
    年龄(x±s,岁) 50.6±15.2 53.3±15.1 0.007
    性别 <0.001
      男性 40(14.0) 347(31.9)
      女性 245(86.0) 741(68.1)
    BMI(x±s,kg/m2) 23.4±3.7 24.0±3.7 0.012
    ASA分级 0.249
      Ⅰ~Ⅱ 256(89.8) 950(87.3)
      ≥ Ⅲ 29(10.2) 138(12.7)
    吸烟史 <0.001
      有 8(2.8) 98(9.0)
      无 277(97.2) 990(91.0)
    饮酒史 0.001
      有 4(1.4) 70(6.4)
      无 281(98.6) 1018(93.6)
    高血压史 0.345
      有 52(18.2) 226(20.8)
      无 233(81.8) 862(79.2)
    糖尿病史 0.024
      有 15(5.3) 103(9.5)
      无 270(94.7) 985(90.5)
    全麻史 0.092
      有 131(46.0) 440(40.4)
      无 154(54.0) 648(59.6)
    手术种类 0.495
      择期手术 281(98.6) 1066(98.0)
      急诊手术 4(1.4) 22(2.0)
    手术方式 0.008
      腹部手术 212(74.4) 720(66.2)
      非腹部手术 73(25.6) 368(33.8)
    手术时长 0.614
      <3 h 136(47.7) 501(46.0)
      ≥3 h 149(52.3) 587(54.0)
    术中麻醉维持方式 0.342
      全静脉麻醉 63(22.1) 270(24.8)
      静吸复合麻醉 222(77.9) 818(75.2)
    阿片类药物用量 0.050
      <400 μg 131(46.0) 571(52.5)
      ≥400 μg 154(54.0) 517(47.5)
    地塞米松 0.876
      有 267(93.7) 1022(93.9)
      无 18(6.3) 66(6.1)
    昂丹司琼 0.136
      有 193(67.5) 685(63.0)
      无 92(32.5) 403(37.0)
    肌松拮抗剂 0.006
      新斯的明 130(45.6) 498(45.8)
      舒更葡糖钠 123(43.2) 381(35.0)
      无拮抗 27(9.5) 185(17.0)
    PCIA、BMI、ASA:同表 1;POV(postoperative vomiting):术后呕吐
    下载: 导出CSV

    表  3   PCIA-PONV与术后疼痛及胃肠道功能的关系[n(%)]

    Table  3   The relationship between PCIA-PONV and postoperative pain and gastrointestinal function[n(%)]

    变量 PCIA-PONV
    (n=676)
    非PCIA-PONV
    (n=697)
    P
    术后第1天疼痛NRS评分 <0.001
      0~3分 269(39.8) 435(62.4)
      ≥4分 407(60.2) 262(37.6)
    术后第1天胃肠功能 <0.001
      未排气 487(72.0) 348(49.9)
      已排气 189(28.0) 349(50.1)
    PCIA、PONV:同表 1;NRS(numerical rating scale):数字评定量表
    下载: 导出CSV

    表  4   PCIA-POV与术后疼痛及胃肠道功能的关系[n(%)]

    Table  4   The relationship between PCIA-POV and postoperative pain and gastrointestinal function[n(%)]

    变量 PCIA-POV
    (n=285)
    非PCIA-PONV
    (n=1088)
    P
    术后第1天疼痛NRS评分 <0.001
      0~3分 112(39.3) 592(54.4)
      ≥4分 173(60.7) 496(45.6)
    术后第1天胃肠功能 <0.001
      未排气 211(74.0) 624(57.4)
      已排气 74(26.0) 464(42.6)
    PCIA:同表 1;POV:同表 2;NRS:同表 3
    下载: 导出CSV

    表  5   PCIA-PONV单因素Logistic回归分析结果

    Table  5   PCIA-PONV univariate Logistic regression analysis results

    变量 OR 95% CI P
    年龄(连续变量) 0.986 0.980~0.994 <0.001
    女性(与男性相比) 2.378 1.861~3.037 <0.001
    BMI(连续变量) 0.942 0.915~0.969 <0.001
    ASA分级≥Ⅲ(与ASA分级Ⅰ~Ⅱ相比) 0.777 0.561~1.076 0.128
    吸烟史(与无吸烟史相比) 0.481 0.316~0.732 <0.001
    饮酒史(与无饮酒史相比) 0.417 0.251~0.695 <0.001
    高血压史(与无高血压史相比) 0.750 0.575~0.977 0.033
    糖尿病史(与无糖尿病史相比) 0.797 0.545~1.165 0.241
    全麻史(与无全麻史相比) 0.963 0.777~1.194 0.731
    急诊手术(与择期手术相比) 0.639 0.288~1.418 0.271
    腹部手术(与非腹部手术相比) 2.148 1.702~2.711 <0.001
    手术时长≥3 h(与手术时长<3 h相比) 1.320 1.067~1.632 0.011
    静吸复合麻醉(与全静脉麻醉相比) 1.248 0.975~1.599 0.079
    阿片类药物用量≥400 μg(与<400 μg相比) 1.272 1.029~1.573 0.026
    术中使用地塞米松(与未使用相比) 0.920 0.592~1.431 0.711
    术中使用昂丹司琼(与未使用相比) 1.351 1.083~1.685 0.008
    术中使用舒更葡糖钠(与新斯的明相比) 1.384 1.094~1.751 0.007
    术中未使用肌松拮抗剂(与新斯的明相比) 0.946 0.692~1.293 0.729
    PCIA、PONV、BMI、ASA:同表 1
    下载: 导出CSV

    表  6   PCIA-PONV多因素Logistic回归分析结果

    Table  6   PCIA-PONV multivariate Logistic regression analysis results

    变量 校正OR 95% CI P
    年龄(连续变量) 0.990 0.982~0.998 0.019
    女性(与男性相比) 2.134 1.590~2.865 <0.001
    BMI(连续变量) 0.961 0.932~0.991 0.012
    ASA分级≥Ⅲ(与ASA分级Ⅰ~Ⅱ相比) 0.983 0.689~1.402 0.926
    吸烟史(与无吸烟史相比) 1.025 0.585~1.795 0.931
    饮酒史(与无饮酒史相比) 0.735 0.381~1.416 0.357
    高血压史(与无高血压史相比) 1.105 0.813~1.502 0.523
    腹部手术(与非腹部手术相比) 1.655 1.253~2.186 <0.001
    手术时长≥3 h(与手术时长<3 h相比) 1.265 0.978~1.636 0.073
    静吸复合麻醉(与全静脉麻醉相比) 1.014 0.765~1.343 0.925
    阿片类药物用量≥400 μg(与<400 μg相比) 1.220 0.942~1.581 0.132
    术中使用昂丹司琼(与未使用相比) 1.019 0.790~1.314 0.886
    术中使用舒更葡糖钠(与新斯的明相比) 1.176 0.899~1.537 0.237
    术中未使用肌松拮抗剂(与新斯的明相比) 0.704 0.486~1.020 0.063
    PCIA、PONV、BMI、ASA:同表 1
    下载: 导出CSV

    表  7   PCIA-POV单因素Logistic回归分析结果

    Table  7   PCIA-POV univariate Logistic regression analysis results

    变量 OR 95% CI P
    年龄(连续变量) 0.988 0.980~0.997 0.007
    女性(与男性相比) 2.868 2.006~4.102 <0.001
    BMI(连续变量) 0.955 0.921~0.990 0.012
    ASA分级≥Ⅲ(与ASA分级Ⅰ~Ⅱ相比) 0.780 0.511~1.191 0.250
    吸烟史(与无吸烟史相比) 0.292 0.140~0.607 <0.001
    饮酒史(与无饮酒史相比) 0.207 0.075~0.572 0.002
    高血压史(与无高血压史相比) 0.851 0.609~1.189 0.345
    糖尿病史(与无糖尿病史相比) 0.531 0.304~0.928 0.026
    全麻史(与无全麻史相比) 1.253 0.964~1.629 0.092
    急诊手术(与择期手术相比) 0.690 0.236~2.018 0.498
    腹部手术(与非腹部手术相比) 1.484 1.106~1.992 0.008
    手术时长≥3 h(与手术时长<3 h相比) 0.935 0.720~1.214 0.615
    静吸复合麻醉(与全静脉麻醉相比) 1.163 0.852~1.589 0.342
    阿片类药物用量≥400 μg(与<400 μg相比) 1.298 1.000~1.687 0.050
    术中使用地塞米松(与未使用相比) 0.958 0.559~1.641 0.876
    术中使用昂丹司琼(与未使用相比) 1.234 0.935~1.628 0.137
    术中使用舒更葡糖钠(与新斯的明相比) 1.237 0.934~1.637 0.137
    术中未使用肌松拮抗剂(与新斯的明相比) 0.559 0.357~0.875 0.011
    PCIA、BMI、ASA:同表 1;POV:同表 2
    下载: 导出CSV

    表  8   PCIA-POV多因素Logistic回归分析结果

    Table  8   PCIA-POV multivariate Logistic regression analysis results

    变量 校正OR 95% CI P
    年龄(连续变量) 0.993 0.984~1.003 0.166
    女性(与男性相比) 2.646 1.754~3.992 <0.001
    BMI(连续变量) 0.966 0.930~1.003 0.073
    吸烟史(与无吸烟史相比) 0.815 0.333~1.996 0.655
    饮酒史(与无饮酒史相比) 0.475 0.145~1.554 0.218
    糖尿病史(与无糖尿病史相比) 0.596 0.331~1.073 0.085
    全麻史(与无全麻史相比) 1.372 1.042~1.806 0.024
    腹部手术(与非腹部手术相比) 1.145 0.820~1.600 0.426
    阿片类药物用量≥400 μg(与<400 μg相比) 1.607 1.206~2.142 0.001
    术中使用昂丹司琼(与未使用相比) 0.830 0.605~1.141 0.252
    术中使用舒更葡糖钠(与新斯的明相比) 1.149 0.839~1.574 0.386
    术中未使用肌松拮抗剂(与新斯的明相比) 0.393 0.237~0.651 <0.001
    PCIA、BMI、ASA:同表 1;POV:同表 2
    下载: 导出CSV
  • [1]

    Apfel C C, Läärä E, Koivuranta M, et al. A simplified risk score for predicting postoperative nausea and vomiting: conclusions from cross-validations between two centers[J]. Anesthesiology, 1999, 91(3): 693-700. DOI: 10.1097/00000542-199909000-00022

    [2]

    Gan T J, Belani K G, Bergese S, et al. Fourth consensus guidelines for the management of postoperative nausea and vomiting[J]. Anesth Analg, 2020, 131(2): 411-448. DOI: 10.1213/ANE.0000000000004833

    [3]

    Macintyre P E. Safety and efficacy of patient-controlled analgesia[J]. Br J Anaesth, 2001, 87(1): 36-46. DOI: 10.1093/bja/87.1.36

    [4]

    Oh C S, Jung E, Lee S J, et al. Effect of nefopam- versus fentanyl-based patient-controlled analgesia on postoperative nausea and vomiting in patients undergoing gynecological laparoscopic surgery: a prospective double-blind randomized controlled trial[J]. Curr Med Res Opin, 2015, 31(8): 1599-1607. DOI: 10.1185/03007995.2015.1058251

    [5]

    Darvall J, Handscombe M, Maat B, et al. Interpretation of the four risk factors for postoperative nausea and vomiting in the Apfel simplified risk score: an analysis of published studies[J]. Can J Anaesth, 2021, 68(7): 1057-1063. DOI: 10.1007/s12630-021-01974-8

    [6]

    Weber J, Schmidt J, Wirth S, et al. Context-sensitive decrement times for inhaled anesthetics in obese patients explored with Gas Man®[J]. J Clin Monit Comput, 2021, 35(2): 343-354. DOI: 10.1007/s10877-020-00477-z

    [7]

    El-Serag H B, Graham D Y, Satia J A, et al. Obesity is an Independent risk factor for GERD symptoms and erosive esophagitis[J]. Am J Gastroenterol, 2005, 100(6): 1243-1250. DOI: 10.1111/j.1572-0241.2005.41703.x

    [8]

    Lambert D M, Marceau S, Forse R A. Intra-abdominal pressure in the morbidly obese[J]. Obes Surg, 2005, 15(9): 1225-1232. DOI: 10.1381/096089205774512546

    [9]

    Volkow N D, Wang G J, Fowler J S, et al. Overlapping neuronal circuits in addiction and obesity: evidence of systems pathology[J]. Philos Trans R Soc Lond B Biol Sci, 2008, 363(1507): 3191-3200. DOI: 10.1098/rstb.2008.0107

    [10]

    Boden G, Chen X, Mozzoli M, et al. Effect of fasting on serum leptin in normal human subjects[J]. J Clin Endocrinol Metab, 1996, 81(9): 3419-3423.

    [11]

    Kim J H, Hong M, Kim Y J, et al. Effect of body mass index on postoperative nausea and vomiting: propensity analysis[J]. J Clin Med, 2020, 9(6): 1612. DOI: 10.3390/jcm9061612

    [12]

    Venara A, Neunlist M, Slim K, et al. Postoperative ileus: pathophysiology, incidence, and prevention[J]. J Visc Surg, 2016, 153(6): 439-446. DOI: 10.1016/j.jviscsurg.2016.08.010

    [13]

    Turner D A, Smith G. Evaluation of the combined effects of atropine and neostigmine on the lower oesophageal sphincter[J]. Br J Anaesth, 1985, 57(10): 956-959. DOI: 10.1093/bja/57.10.956

    [14]

    Hood D D, Eisenach J C, Tuttle R. Phase Ⅰ safety assessment of intrathecal neostigmine methylsulfate in humans[J]. Anesthesiology, 1995, 82(2): 331-343. DOI: 10.1097/00000542-199502000-00003

    [15]

    Tramèr M R, Fuchs-Buder T. Omitting antagonism of neuromuscular block: effect on postoperative nausea and vomiting and risk of residual paralysis. A systematic review[J]. Br J Anaesth, 1999, 82(3): 379-386. DOI: 10.1093/bja/82.3.379

    [16]

    Chhabra R, Gupta R, Gupta L K. Sugammadex versus neostigmine for reversal of neuromuscular blockade in adults and children: a systematic review and meta-analysis of randomized controlled trials[J]. Curr Drug Saf, 2024, 19(1): 33-43. DOI: 10.2174/1574886318666230302124634

    [17]

    Hawker G A, Mian S, Kendzerska T, et al. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Question-naire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP)[J]. Arthritis Care Res (Hoboken), 2011, 63(Suppl 11): S240-S252.

    [18] 中华医学会外科学分会, 中华医学会麻醉学分会. 加速康复外科中国专家共识及路径管理指南(2018版)[J]. 中国实用外科杂志, 2018, 38(1): 1-20. https://www.cnki.com.cn/Article/CJFDTOTAL-XHYX201806002.htm

    Chinese Medical Association Surgery Branch, Chinese Medical Association Anesthesiology Branch. Chinese expert consensus and pathway management guidelines for accelerated rehabilitation surgery (2018 Edition)[J]. Chin J Pract Surg, 2018, 38(1): 1-20. https://www.cnki.com.cn/Article/CJFDTOTAL-XHYX201806002.htm

表(8)
计量
  • 文章访问数:  1480
  • HTML全文浏览量:  56
  • PDF下载量:  95
  • 被引次数: 0
出版历程
  • 收稿日期:  2023-11-29
  • 录用日期:  2024-03-10
  • 网络出版日期:  2024-03-18
  • 刊出日期:  2024-03-29

目录

    /

    返回文章
    返回
    x 关闭 永久关闭