瞳孔对光反射参数作为术后恶心呕吐的预测指标：一项前瞻性研究。

Pupillary Light Reflex Parameters as Predictors of Postoperative Nausea and Vomiting: A Prospective Study.

作者信息

Zhang Yawen, Jin Jin, Sun Leying, Ji Haoyi, Zhu Jinjian, Sheng Dan, Song Qiang, Shi Cunxian

机构信息

The Second School of Clinical Medical of Binzhou Medical University, 264003 Yantai, Shandong, China; Department of Anesthesiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, 264000 Yantai, Shandong, China.

Department of Anesthesiology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, 264000 Yantai, Shandong, China.

出版信息

Ann Ital Chir. 2025;96(5):681-694. doi: 10.62713/aic.3900.

DOI:10.62713/aic.3900

PMID:40375376

Abstract

AIM

This study aims to investigate whether pupillary light reflex (PLR) parameters in dynamic pupillometry can effectively predict postoperative nausea and vomiting (PONV).

METHODS

In this prospective observational study, patients scheduled to undergo elective lobectomy under general anesthesia were enrolled from 1 August 2023 to 7 October 2023 at Yantai Yuhuangding Hospital, a large regional tertiary hospital in Yantai City, Shandong Province, China. Preoperative pupillary parameters were measured using a portable infrared pupillometer, and the patients were followed up within 24 hours postoperatively to assess postoperative nausea and vomiting (PONV) and recovery quality. Logistic regression analysis and receiver operating characteristics (ROC) curves were used to evaluate the predictive efficacy of pupillary parameters, and mediation analysis was conducted to explore the mediating role of PONV between pupillary parameters and recovery quality.

RESULTS

Forty-six patients (29.9%) who experienced PONV had smaller maximum pupil diameter, average constriction velocity (ACV), maximum constriction velocity (MCV), and percentage pupil change. MCV was identified as an independent predictor of PONV, with each 1-unit increase in MCV reducing the risk of PONV by 87%. Gender was a protective factor, with males having a 65% lower risk of PONV compared to females. The ROC analysis showed that the area under the curve (AUC) value of MCV was 0.831 (95% confidence interval (CI): 0.760-0.902), indicating that the model has strong classification ability when using MCV as a predictor. Thus, PONV plays a full mediating role in the relationship between MCV and postoperative recovery quality.

CONCLUSIONS

MCV is a reliable predictor of PONV, which plays a full mediating role in the relationship between MCV and postoperative recovery quality. Thus, with a capability in predicting PONV occurrence, preoperative MCV measurement can be employed for the purpose of improving patient recovery outcomes.

CLINICAL TRIAL REGISTRATION

Chinese Clinical Trial Registry (ChiCTR2300073869).

摘要

目的

本研究旨在探讨动态瞳孔测量中的瞳孔光反射（PLR）参数能否有效预测术后恶心呕吐（PONV）。

方法

在这项前瞻性观察性研究中，于2023年8月1日至2023年10月7日在中国山东省烟台市一家大型区域性三级医院烟台毓璜顶医院招募计划在全身麻醉下接受择期肺叶切除术的患者。使用便携式红外瞳孔计测量术前瞳孔参数，并在术后24小时内对患者进行随访，以评估术后恶心呕吐（PONV）和恢复质量。采用逻辑回归分析和受试者工作特征（ROC）曲线评估瞳孔参数的预测效能，并进行中介分析以探讨PONV在瞳孔参数与恢复质量之间的中介作用。

结果

46例（29.9%）发生PONV的患者最大瞳孔直径、平均收缩速度（ACV）、最大收缩速度（MCV）和瞳孔变化百分比更小。MCV被确定为PONV的独立预测因素，MCV每增加1个单位，PONV风险降低87%。性别是一个保护因素，男性发生PONV的风险比女性低65%。ROC分析显示，MCV的曲线下面积（AUC）值为0.831（95%置信区间（CI）：0.760 - 0.902），表明以MCV作为预测因素时该模型具有较强的分类能力。因此，PONV在MCV与术后恢复质量的关系中起完全中介作用。