腹腔镜结直肠手术后阿片类药物总剂量是导致术后回肠时间延长的独立风险因素:一项病例对照研究。

IF 4.2 4区 医学 Q1 ANESTHESIOLOGY Korean Journal of Anesthesiology Pub Date : 2024-02-01 Epub Date: 2023-04-25 DOI:10.4097/kja.22792
Hui Ju, Kai Shen, Jiaxin Li, Yi Feng
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引用次数: 0

摘要

背景:术后长期回肠梗阻(PPOI)是结直肠手术的主要并发症。有人认为阿片类药物用量的增加会增加 PPOI 的风险。本研究旨在验证术后阿片类药物总剂量(TPOD)增加与 PPOI 发生率增加相关的假设:在这项匹配病例对照研究中,对2018年1月至2020年6月期间在北京大学人民医院接受择期腹腔镜结直肠手术的患者进行了回顾性研究。有PPOI的患者被分配到回肠组,而没有PPOI的患者(对照组)则根据年龄、美国麻醉医师协会身体状况评分和手术类型按1:1的比例匹配到回肠组。主要结果是回肠组和对照组之间的 TPOD。次要结果是 PPOI 的风险因素:共有 267 名参与者被纳入最终分析。两组患者的基线和手术因素均无差异。TPOD、术后第1天(POD1)静脉注射舒芬太尼的剂量以及使用患者自控基础输注镇痛与PPOI相关(P<0.05)。多变量逻辑回归分析显示,TPOD增加是腹腔镜结直肠手术后发生PPOI的独立风险因素(奇数比:1.67,95% CI [1.03,2.71],P = 0.04):TPOD是腹腔镜结直肠手术后PPOI的独立风险因素。我们需要探索新的术后镇痛策略,以减少TPOD的用量。
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Total postoperative opioid dose is an independent risk factor for prolonged postoperative ileus after laparoscopic colorectal surgery: a case-control study.

Background: Prolonged postoperative ileus (PPOI) is a major complication of colorectal surgery. Increased opioid consumption has been proposed to increase the risk of PPOI. This study aimed to test the hypothesis that an increased total postoperative opioid dose (TPOD) is associated with the increased incidence of PPOI.

Methods: For this matched case-control study, patients who underwent elective laparoscopic colorectal procedures at the Peking University People's Hospital between January 2018 and June 2020 were retrospectively reviewed. Patients with PPOI were assigned to the ileus group, while patients without PPOI (control group) were matched at a 1:1 ratio to the ileus group according to age, American Society of Anesthesiologists physical status score, and type of surgical procedure. The primary outcome was the TPOD between the ileus and control groups. The secondary outcome was risk factors of PPOI.

Results: A total of 267 participants were included in the final analysis. No differences in baseline or operative factors were found between the two groups. The TPOD, intravenous sufentanil dose on postoperative day 1 (POD1), and the use of patient-controlled analgesia with basal infusion were associated with PPOI (P < 0.05). Multivariate logistic regression analysis revealed that an increased TPOD was an independent risk factor for developing PPOI after laparoscopic colorectal procedures (Odd ratio: 1.67, 95% CI [1.03, 2.71], P = 0.04).

Conclusions: The TPOD is an independent risk factor for PPOI after laparoscopic colorectal surgery. We need to explore new strategies of postoperative analgesia to reduce the dosage of TPOD.

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CiteScore
6.20
自引率
6.90%
发文量
84
审稿时长
16 weeks
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