低流量麻醉中术后恶心和呕吐风险的降低与术前中性粒细胞/淋巴细胞比值值有关吗?

Sevgi Kutlusoy, Ahmet Aydın, Erdinç Koca
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引用次数: 0

摘要

背景/目的:术后恶心和呕吐(PONV)定义为术后24小时内发生的恶心和/或呕吐,常发生在术后2小时内。在PONV高风险的腹腔镜胆囊切除术患者中使用低新鲜气体流量减少吸入器药物消耗的先前研究仅有少数发表。我们的研究旨在确定在低新鲜气体流量(1 L/min)的腹腔镜胆囊切除术病例中,前30分钟和24小时PONV的发生率。此外,我们希望预测术前中性粒细胞/淋巴细胞比值(NLR)≥2是否是我们使用低新鲜气体流量的患者发生PONV的危险因素。方法:我们的前瞻性队列研究纳入了80例年龄在18至65岁之间,美国麻醉学会(ASA)评分为I和II,并计划行选择性腹腔镜胆囊切除术的患者。患者知情同意后,术前计算的NLR限值(术前全血计数所得的中性粒细胞计数除以淋巴细胞计数计算)为2[5]。患者分为两组:(1)NLR- i组,NLR + lt;2) NLR- ii组,NLR≥2。两组均未使用预用药。结果:共纳入80例患者。根据分类目的将患者分为两组:(1)NLR-I (n=40)和(2)NLR-II (n=40)。两组患者的性别分布、ASA评分、吸烟状况、平均年龄、体重指数(BMI)值等特征均无差异。两组七氟醚用量相似(P=0.169)。NLR-II组完成手术所需时间更长(P=0.025)。在nnlr - 1组和nnlr - ii组中,在前30分钟和24小时使用低新鲜气体流量的恶心/呕吐和止吐使用相似(P=0.500)。虽然女性和非吸烟组在治疗前30 min和24 h恶心/呕吐发生率较高,但与男性和吸烟组比较,差异无统计学意义(P=0.325)。然而,ASA II组与ASA I组相比,恶心/呕吐更常见,且差异显著(P=0.046)。完成手术所需的时间更长,恶心和呕吐患者的七氟醚消耗量更高(P=0.001)。结论:两组术前NLR的分类与我们使用低新鲜气体流量的患者PONV风险增加无关。由于新鲜气体流量低,七氟醚消耗量减少,可能导致高危患者患PONV的风险降低。
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Is the reduced risk of post-operative nausea and vomiting in low flow anesthesia applications associated with pre-operative neutrophil/lymphocyte ratio values?
Background/Aim: Post-operative nausea and vomiting (PONV) are defined as nausea and/or vomiting occurring within the first 24 h after surgery and are often observed in the first 2 h after surgery. Only a few previous studies on the use of low fresh gas flow that reduces inhaler agent consumption in laparoscopic cholecystectomy patients at high risk of PONV have been published. Our study aimed to determine the incidence of PONV in the first 30 min and again at 24 h in cases of laparoscopic cholecystectomy in which we applied low fresh gas flow (1 L/min). In addition, we wanted to predict whether the pre-operative neutrophil/lymphocyte ratio (NLR) ≥2 is a risk factor for PONV in our patients to whom we applied low fresh gas flow. Methods: For our prospective cohort study, 80 cases between the ages of 18 and 65, had American Society of Anesthesiologists (ASA) scores of I and II, and who had been scheduled to undergo elective laparoscopic cholecystectomy were included in the study. The NLR limit (calculated by dividing the neutrophil count obtained from the complete blood count before surgery by the lymphocyte count) calculated in the pre-operative period after a patient’s informed consent was obtained was accepted as 2 [5]. Patients were classified into two groups: (1) NLR-I with NLR <2 and (2) NLR-II with NLR ≥2. Premedication was not used in either group. Results: A total of 80 patients were included in the study. They were divided into two groups for classification purposes: (1) NLR-I (n=40) and (2) NLR-II (n=40). The characteristics of the patients in both groups, such as gender distribution, ASA scores, smoking status, mean age, and body mass index (BMI) values, were not different. Sevoflurane consumption in the groups was similar (P=0.169). The time required to complete surgery was longer in the NLR-II group (P=0.025). Nausea/vomiting and antiemetic use were similar in the NLR-I and NLR-II groups in which low fresh gas flow was applied in the first 30 min and 24 h (P=0.500). Although nausea/vomiting was more common in the female and non-smoking group in the first 30 min and 24 h, it was not statistically significantly different from males and smoking groups (P=0.325). However, nausea/vomiting was more common and significantly different in the ASA II versus the ASA I group (P=0.046). The time required to complete surgery was longer, and sevoflurane consumption was higher in patients with nausea and vomiting (P=0.001). Conclusions: Pre-operative NLR as classified by the two groups was not associated with an increase in the risk of PONV in patients to whom we applied low fresh gas flow. A decrease in sevoflurane consumption due to low fresh gas flow may lead to a reduction in the risk of PONV in at-risk patients.
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