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| 机器人辅助根治性前列腺切除术患者术后恶心呕吐的危险因素 |
| Risk factors of postoperative nausea and vomiting in patients undergoing robot-assisted radical prostatectomy |
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| DOI：10.12089/jca.2024.12.010 |
| 中文关键词: 术后恶心呕吐 腹腔镜 机器人辅助根治性前列腺切除术 脑血管疾病史 危险因素 |
| 英文关键词: Postoperative nausea and vomiting Laparoscopic Robot-assisted radical prostatectomy History of cerebrovascular disease Risk factor |
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| 中文摘要: |
目的：探索机器人辅助根治性前列腺切除术（RARP）患者术后恶心呕吐（PONV）的发生率及其影响因素。
方法：回顾性收集接受RARP的男性患者622例，年龄18～90岁，ASA Ⅱ或Ⅲ级。收集基础疾病史、禁食时间和ASA分级，术中手术和麻醉时间、液体出入量、麻醉用药、使用降压药和升压药次数，术后24 h内的去向、头晕头痛情况、质子泵抑制剂使用情况、镇痛药物使用情况和切口疼痛评分，术后住院时间。根据RARP患者术后24 h内是否存在PONV，将患者分为两组：PONV组和非PONV组。采用多因素Logistic回归分析探索RARP患者术后24 h内发生PONV的危险因素。采用受试者工作特征曲线（ROC）下面积（AUC）和95%可信区间（CI）评估多因素Logistic 回归分析的判别效力。
结果：RARP患者术后24 h内发生PONV 67例（10.8%）。与非PONV组比较，PONV组BMI、术中使用地塞米松和术后服用质子泵抑制剂比例明显降低（P<0.05），脑血管疾病史比例、术后头晕、服用氨酚曲马多片和切口疼痛比例明显升高（P<0.05）。多因素Logistic回归分析显示，BMI升高（OR=0.900.95%CI 0.818～0.990.P=0.030）和术中使用地塞米松（OR=0.945， 95%CI 0.894～0.999， P=0.047）与RARP患者术后24 h内PONV的发生率明显负相关，脑血管疾病史（OR=3.788， 95%CI 1.501～9.558， P=0.005）、术后24 h内头晕（OR=4.191， 95%CI 2.111～8.320.P<0.001）和术后切口疼痛（OR=3.881， 95%CI 1.175～12.821， P=0.026）与PONV的发生率明显正相关。脑血管疾病史是RARP患者术后24 h内发生 PONV的独立危险因素，AUC为0.539（95%CI 0.462～0.616），截断值0.5，敏感性11.9%，特异性95.9%。BMI、糖尿病、脑血管疾病史、术中使用地塞米松、术后头晕、服用氨酚曲马多片、服用质子泵抑制剂、切口疼痛联合预测PONV的AUC为0.739（95%CI 0.674～0.804），截断值0.1，敏感性68.7%，特异性67.4%。
结论：脑血管疾病史是RARP患者术后24 h内发生PONV的独立危险因素，术后24 h内的头晕和切口疼痛与PONV明显相关，BMI越高和术中使用地塞米松可明显降低PONV的发生率。 |
| 英文摘要: |
Objective: To explore the incidence and associated factors of postoperative nausea and vomiting (PONV) after robot-assisted radical prostatectomy (RARP).
Methods: A retrospective collection of 622 male patients undergoing RARP, aged 18-90 years, ASA physical status Ⅱ or Ⅲ, was performed.Information on history of underlying diseases, fasting time, and ASA classification were collected.During the surgery, the surgical and anesthesia duration, fluid intake and output, medications used during anesthesia, and times of using antihypertensive and vasopressor drugs were recorded. Postoperative data within 24 hours encompassed the patient's whereabouts, presence of dizziness and headache, use of proton pump inhibitors, use of analgesic medications, incision pain score, and the postoperative length of stay. Patients were divided into two groups; PONV group and non-PONV group according to whether PONV existed within 24 hours after RARP.Multivariate logistic regression analysis was used to explore the risk factors of PONV within 24 hours after RARP.The area under the receiver operating characteristic curve (AUC) and 95% confidence interval (CI) were used to evaluate the discriminative efficacy of multivariate logistic regression analysis.
Results: Sixty-seven cases (10.8%) of patients with RARP suffered from PONV within 24 hours after surgery.Compared with the non-PONV group, the PONV group had significantly lower rates of BMI, intraoperative use of dexamethasone, and postoperative proton pump inhibitor use (P < 0.05), and significantly higher proportions of history of cerebrovascular disease, postoperative dizziness, administration of paracetamol and tramadol hydrochloride tablets, and incisional pain (P < 0.05). Multifactorial logistic regression analysis showed that higher BMI (OR = 0.900.95% CI 0.818-0.990.P = 0.030.and intraoperative ues of dexamethasone (OR = 0.945, 95% CI 0.894-0.999, P = 0.047) were significantly and negatively correlated with the prevalence of PONV during the postoperative period 24 hours in patients with RARP.History of cerebrovascular disease (OR = 3.788, 95% CI 1.501-9.558, P = 0.005), dizziness within 24 hours after surgery (OR = 4.191, 95% CI 2.111-8.320.P < 0.001) and postoperative incision pain (OR = 3.881, 95% CI 1.175-12.821, P = 0.026) were significantly and positively correlated with the incidence of PONV. The history of cerebrovascular disease was an independent risk factor for the development of PONV within 24 hours postoperatively in patients with RARP, with an AUC of 0.539 (95% CI 0.462-0.616), a cutoff value of 0.5, a sensitivity of 11.9%, and a specificity of 95.9%.The combined prediction of BMI, diabetes mellitus, history of cerebrovascular disease, intraoperative use of dexamethasone, postoperative dizziness, taking paracetamol and tramadol hydrochloride tablets, taking proton pump inhibitors, and incisional pain had an AUC for PONV of 0.739 (95% CI 0.674-0.804), a cutoff value of 0.1, a sensitivity of 68.7%, and a specificity of 67.4%.
Conclusion: History of cerebrovascular disease was an independent risk factor for PONV in RARP patients within 24 hours postoperatively, dizziness and incisional pain within 24 hours postoperatively were significantly associated with PONV, and higher BMI and intraoperative use of dexamethasone can significantly reduce the incidence of PONV. |
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