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| 超声评估视神经鞘直径对Trendelenburg体位妇科腹腔镜手术后恶心呕吐的预测价值 |
| Predictive value of ultrasound evaluation of optic nerve sheath diameter for nausea and vomiting after gynecological laparoscopic surgery in Trendelenburg position |
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| DOI：10.12089/jca.2025.12.010 |
| 中文关键词: 超声 视神经鞘 Trendelenburg体位 妇科腹腔镜手术 术后恶心呕吐 |
| 英文关键词: Ultrasound Optic nerve sheath Trendelenburg position Gynecological laparoscopic surgery Postoperative nausea and vomiting |
| 基金项目:安徽省重点研究与开发计划项目（2022e07020089）；皖南医学院教学医院科研专项立项（LC2023C10） |
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| 中文摘要: |
目的：探讨超声评估视神经鞘直径（ONSD）对Trendelenburg体位妇科腹腔镜手术后恶心呕吐（PONV）的预测价值。
方法：选择2024年7月至2025年2月行全身麻醉下Trendelenburg体位腹腔镜妇科手术的女性患者。收集患者基本信息和围术期资料。采用超声测量麻醉诱导后手术开始前、腹腔镜气腹后1 min、Trendelenburg体位后10、40 min、气腹结束恢复平卧位后5 min、手术结束后10 min的ONSD。术后24 h内采用Apfel恶心呕吐风险量表评估PONV发生情况。采用多因素Logistic回归分析PONV的危险因素。绘制受试者工作特征（ROC）曲线并计算曲线下面积（AUC），评价ONSD预测PONV的效能。
结果：最终纳入患者106例，其中发生PONV的有31例（29.2%）。多因素Logistic回归分析结果显示，PONV史、Trendelenburg体位后10 min时的ONSD偏大是妇科腹腔镜手术患者PONV的独立危险因素（P<0.05）。校正混杂因素（PONV史）后，Trendelenburg体位后10 min时的ONSD偏大仍是妇科腹腔镜手术患者PONV的独立危险因素（P<0.05）。ROC曲线分析结果显示，Trendelenburg体位后10 min时的ONSD预测妇科腹腔镜手术患者PONV的AUC为0.866（95%CI 0.803～0.929），敏感性为0.825，特异性为0.649。Trendelenburg体位后10 min时的ONSD与PONV史联合预测PONV的AUC为0.910（95%CI 0.864～0.956），敏感性为0.899，特异性为0.818。
结论：超声评估ONSD对于预测PONV具有良好的效能，且联合PONV史能够进一步提高预测效能，具有一定的临床应用价值。 |
| 英文摘要: |
Objective: To investigate the predictive value of optic nerve sheath diameter (ONSD) assessed by ultrasound for postoperative nausea and vomiting (PONV) after gynecological laparoscopic surgery in Trendelenburg position.
Methods: Female patients who underwent laparoscopic gynecological surgery in Trendelenburg position under general anesthesia from July 2024 to February 2025 were selected. The basic information and perioperative data of the patients were collected. The ONSD was measured by ultrasound at six time points: before the operation, 1 minute after laparoscopic pneumoperitoneum, 10 minutes after Trendelenburg position, 40 minutes after Trendelenburg position, 5 minutes after the end of pneumoperitoneum, and 10 minutes after the end of the operation. The Apfel nausea and vomiting risk scale was used to evaluate the occurrence of PONV within 24 hours postoperatively. Multivariate logistic regression was used to analyze the risk factors of PONV. The receiver operating characteristic (ROC) curve was drawn and the area under the curve (AUC) was calculated to evaluate the efficacy of ONSD in predicting PONV.
Results: A total of 106 patients were finally included, of which 31 patients (29.2%) occurred PONV. Multivariate logistic regression analysis showed that previous history of PONV, and increased ONSD 10 minutes after Trendelenburg position were independent risk factors for PONV in patients undergoing gynecological laparoscopic surgery (P < 0.05). After adjusting for confounding factors (PONV history), the increase of ONSD 10 minutes after Trendelenburg position was still an independent risk factor for PONV in patients undergoing gynecological laparoscopic surgery (P < 0.05). The results of ROC curve analysis showed that the AUC of ONSD 10 minutes after Trendelenburg position in predicting PONV in patients undergoing gynecological laparoscopic surgery was 0.866 (95% CI 0.803-0.929), the sensitivity was 0.825, and the specificity was 0.649. The AUC of ONSD 10 minutes after Trendelenburg position combined with PONV history for predicting PONV was 0.910 (95% CI 0.864-0.956), with a sensitivity of 0.899 and a specificity of 0.818.
Conclusion: The evaluation of ONSD by ultrasound has good efficacy in predicting PONV, and the combination of PONV history can further enhance the predictive efficacy, which has certain clinical application value. |
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