摘要
目的:探讨围术期阿片类药物使用对胸腰椎矫形术患者术后胃肠功能障碍(POGD)的影响。方法:前瞻性纳入2022年6月—2023年10月于本院全身麻醉下行胸腰椎矫形手术的181例患者。根据术后72 h内是否发生POGD分为POGD组(61例)与非POGD组(120例)。比较两组患者临床资料,采用单因素及多因素logistic回归分析筛选POGD的独立危险因素,并基于筛选出的变量构建风险预测列线图模型,进一步开发动态列线图。结果:胸腰椎矫形术后POGD发生率为33.7%(61/181)。POGD组患者首次排气、首次排便时间均显著延长(P<0.001),且阿片类药物用量、液体入超量、术后第1天疼痛评分及术后住院时间均高于非POGD组(P<0.05)。多因素分析确定3个独立危险因素:液体入超量>22.5 mL·kg^(-1)(OR=2.971,95%CI:1.454~6.069,P=0.003)、术后使用镇痛泵(OR=3.311,95%CI:1.157~9.472,P=0.026)及术后第1天疼痛评分>3分(OR=2.789,95%CI:1.209~6.434,P=0.016)。基于此构建的列线图预测模型AUC为0.707,校正曲线C-index为0.700,预测价值良好,动态列线图访问地址为https://ibccondsurv.shinyapps.io/DynNomapp_POGD_ZX/。结论:胸腰椎矫形术后POGD的发生与术中液体过负荷、术后阿片类药物镇痛及术后早期疼痛密切相关。建议实施目标导向的液体管理,采用多模式镇痛以减少阿片类药物暴露,并加强术后疼痛控制,以降低POGD风险。
Objective:To investigate the impact of perioperative opioid use on the incidence of postoperative gastrointestinal dysfunction(POGD)in patients undergoing thoracolumbar spinal orthopedic surgery.Methods:In this prospective observational study,181 patients who received thoracolumbar spinal orthopedic surgery under general anesthesia between June 2022 and October 2023 were enrolled.Based on the occurrence of POGD within 72 hours postoperation,they were divided into a POGD group(n=61)and a non-POGD group(n=120).Clinical data were analyzed through univariable and multivariable logistic regression to identify independent risk factors for POGD.A risk prediction nomogram was constructed and further developed into a dynamic nomogram.Results:The incidence of POGD was 33.7%(61/181).Patients in the POGD group had significantly prolonged time to first flatus and defecation(P<0.001),along with higher intraoperative opioid consumption,greater fluid surplus,more severe pain on postoperative day 1,and longer postoperative hospital stay(P<0.05).Multivariable analysis identified three independent risk factors:fluid surplus>22.5 mL·kg^(-1)(OR=2.971,95%CI:1.454-6.069,P=0.003),use of a patient-controlled analgesia pump(OR=3.311,95%CI:1.157-9.472,P=0.026),and pain score>3 on postoperative day 1(OR=2.789,95%CI:1.209-6.434,P=0.016).The nomogram based on these factors showed an AUC of 0.707 and a calibration C-index of 0.700,indicating acceptable discrimination and calibration.Dynamic nomogram access address:https://ibccondsurv.shinyapps.io/DynNomapp_POGD_ZX/.Conclusion:The occurrence of POGD after thoracolumbar spinal orthopedic surgery is associated with intraoperative fluid overload,postoperative opioid-based analgesia and early postoperative pain.Implementing goal-directed fluid therapy,adopting multimodal analgesia to reduce opioid exposure and enhancing postoperative pain management are recommended to mitigate the risk of POGD.
作者
郑旭
董媛媛
史本龙
薄靳华
ZHENG Xu;DONG Yuanyuan;SHI Benlong;BO Jinhua(Department of Anesthesiology,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Spinal Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)
出处
《药学与临床研究》
2026年第1期18-22,共5页
Pharmaceutical and Clinical Research
基金
吴阶平医学基金(320.6750.2024-15-21)。
关键词
阿片类药物
胸腰椎矫形术
术后胃肠功能障碍
Opioids
Thoracolumbar orthopedic surgery
Postoperative gastrointestinal disorders
