妇科腹腔镜手术患者术前超声测量胃形态对术后恶心呕吐发生的预测价值

Predictive value of preoperative ultrasonographic measurement of gastric morphology for the occurrence of postoperative nausea and vomiting among patients undergoing gynecological laparoscopic surgery.

作者信息

Qiu Weiji, Yin Jun, Liang Huazheng, Shi Qiqing, Liu Chang, Zhang Lina, Bai Gang, Chen Guozhong, Xiong Lize

机构信息

Department of Anesthesiology and Perioperative Medicine, Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Clinical Research Center for Anesthesiology and Perioperative Medicine, Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai, China.

Department of Anesthesiology, Parkway Shanghai Hospital, Shanghai, China.

出版信息

Front Oncol. 2024 Jul 23;14:1296445. doi: 10.3389/fonc.2024.1296445. eCollection 2024.

DOI:10.3389/fonc.2024.1296445

PMID:39109288

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11300229/

Abstract

BACKGROUND

Pre-operative prediction of postoperative nausea and vomiting (PONV) is primarily based on the patient's medical history. The predictive value of gastric morphological parameters observed on ultrasonography has not been comprehensively assessed.

METHODS

A prospective observational study was conducted to evaluate the pre-operative ultrasonographic measurement of gastric morphology for predicting PONV. The gastric antrum of the participants was assessed using ultrasound before anesthesia, and the occurrence of PONV in the first 6 hours and during the 6-24 hours after surgery was reported. The main indicators included the thickness of the muscularis propria (TMP) and the cross-sectional area of the inner side of the muscularis propria (CSA-ISMP). These were recorded and analyzed. Logistic regression analysis was applied to identify factors for PONV.

RESULTS

A total of 72 patients scheduled for elective gynecological laparoscopic surgery were investigated in the study. The pre-operative CSA-ISMP of patients with PONV in the first 6 hours was significantly greater than that of those without PONV (2.765 ± 0.865 cm² vs 2.349 ± 0.881 cm², P=0.0308), with an area under the curve of 0.648 (95% CI, 0.518 to 0.778, P=0.031). Conversely, the pre-operative TMP of patients with PONV during the 6-24 hours was significantly smaller than that of those without PONV (1.530 ± 0.473 mm vs 2.038 ± 0.707 mm, P=0.0021), with an area under the curve of 0.722 (95% CI, 0.602 to 0.842, P=0.003). Logistic regression analysis confirmed that CSA-ISMP was an independent risk factor for PONV in the first 6 hours (OR=2.986, P=0.038), and TMP was an independent protective factor for PONV during the 6-24 hours after surgery (OR=0.115, P=0.006).

CONCLUSION

Patients with a larger pre-operative CSA-ISMP or a thinner TMP are prone to develop PONV in the first 6 hours or during the 6-24 hours after surgery, respectively.

CHINA CLINICAL TRIAL REGISTRATION CENTER

http://www.chictr.org.cn (ChiCTR2100055068).

摘要

背景

术后恶心呕吐（PONV）的术前预测主要基于患者的病史。超声检查所观察到的胃形态学参数的预测价值尚未得到全面评估。

方法

进行一项前瞻性观察性研究，以评估术前超声测量胃形态对预测PONV的作用。在麻醉前使用超声评估参与者的胃窦，并报告术后前6小时及术后6 - 24小时内PONV的发生情况。主要指标包括固有肌层厚度（TMP）和固有肌层内侧横截面积（CSA - ISMP）。记录并分析这些指标。应用逻辑回归分析确定PONV的相关因素。

结果

本研究共纳入72例计划行择期妇科腹腔镜手术的患者。术后前6小时发生PONV的患者术前CSA - ISMP显著大于未发生PONV的患者（2.765±0.865 cm² 对 2.349±0.881 cm²，P = 0.0308），曲线下面积为0.648（95%CI，0.518至0.778，P = 0.031）。相反，术后6 - 24小时发生PONV的患者术前TMP显著小于未发生PONV的患者（1.530±0.473 mm对2.038±0.707 mm，P = 0.0021），曲线下面积为0.722（95%CI，0.602至0.842，P = 0.003）。逻辑回归分析证实，CSA - ISMP是术后前6小时PONV的独立危险因素（OR = 2.986，P = 0.038），而TMP是术后6 - 24小时PONV的独立保护因素（OR = 0.115，P = 0.006）。