阿片类药物用于甲状腺癌手术患者术后镇痛发生呕吐风险预测模型的构建及验证

付尧, 游彤阳, 刘礼, 任建兰

护理学报 ›› 2025, Vol. 32 ›› Issue (6) : 51-56.

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护理学报 ›› 2025, Vol. 32 ›› Issue (6) : 51-56. DOI: 10.16460/j.issn1008-9969.2025.06.051
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阿片类药物用于甲状腺癌手术患者术后镇痛发生呕吐风险预测模型的构建及验证

  • 付尧, 游彤阳, 刘礼, 任建兰
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摘要

目的 构建传统颈部切口甲状腺癌术后使用阿片类药物镇痛泵患者发生术后呕吐风险预测模型。方法 回顾性收集泸州市某三级甲等医院麻醉科于2023年6月—2024年3月住院接受传统颈部切口甲状腺癌手术,并于术后使用阿片类药物镇痛泵患者631例,按照7∶3的比例分为训练集(n=443)和验证集(n=188),将训练集数据采用 LASSO回归和logistic回归分析影响因素,建立模型,绘制列线图。通过验证集数据对模型进行内部验证。结果 631例患者中,392例患者发生术后呕吐,发生率为62.1%,logistic回归分析显示,有饮酒史(OR=2.262)、手术范围扩大至甲状腺全切+双侧中央区淋巴结清扫(OR=4.619)、术后镇痛主要药物为二氢吗啡酮(OR=2.811)是甲状腺癌术后使用阿片类药物镇痛泵患者发生术后呕吐的危险因素,而术后24 h内使用地塞米松(OR=0.46)是其保护因素(P<0.05)。模型的受试者工作特征曲线下面积为0.812,内部验证的受试者工作特征曲线下面积为0.793,模型Hosmer-Lemeshow检验χ2=2.868,P=0.942。Calibration校准曲线显示模型具有较好的校准度。临床影响曲线和临床决策曲线提示模型具有较好的临床实用性。结论 该研究构建的预测模型具有良好的效果和临床实用性,可为临床有效评估甲状腺癌术后使用阿片类药物镇痛泵患者发生术后呕吐风险提供理论参考。

关键词

甲状腺切除 / 阿片类药物 / 术后镇痛 / 术后呕吐 / 风险预测模型 / 列线图

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付尧, 游彤阳, 刘礼, 任建兰. 阿片类药物用于甲状腺癌手术患者术后镇痛发生呕吐风险预测模型的构建及验证[J]. 护理学报. 2025, 32(6): 51-56 https://doi.org/10.16460/j.issn1008-9969.2025.06.051
中图分类号: R473.6   

参考文献

[1] Kaliszewski K, Wojtczak B, Sutkowski K, et al.Thyroid cancer surgery - in what direction are we going? A mini-review[J]. J Int Med Res,2020,48(4):300060520914803. DOI:10.1177/0300060520914803.
[2] Lu Q, Zhu X, Wang P, et al.Comparisons of different approaches and incisions of thyroid surgery and selection strategy[J]. Front Endocrinol (Lausanne),2023,17(14):1166820. DOI:10.3389/fendo.2023.1166820.
[3] Moon PK, Wei EX, Hamid MS, et al.Nonopioid versus opioid analgesics after thyroid and parathyroid surgery: a systematic review[J]. Otolaryngol Head Neck Surg,2024,170(1):13-19. DOI:10.1002/ohn.503.
[4] Chae D, Kim SY, Song Y, et al.Dynamic predictive model for postoperative nausea and vomiting for intravenous fentanyl patient-controlled analgesia[J]. Anaesthesia,2020,75(2):218-226. DOI:10.1111/anae.14849.
[5] Ye H, Gou J, Li S, Ji Q.Preoperative dexamethasone administration in reducing the incidence of nausea and vomiting after thyroidectomy: a systematic review and Meta-analysis of drug dosage[J]. Gland Surg,2024,13(2):189-198. DOI:10.21037/gs-23-260.
[6] 中华人民共和国国家卫生健康委员会医政医管局. 甲状腺癌诊疗指南(2022年版)[J].中国实用外科杂志,2022,42(12):1343-1357; 1363. DOI:10.19538/j.cjps.issn1005-2208.2022.12.02.
[7] Riley RD, Ensor J, Snell KIE, et al.Calculating the sample size required for developing a clinical prediction model[J]. BMJ,2020,368:m441. DOI:10.1136/bmj.m441.
[8] Gan TJ, Belani KG, Bergese S, et al.Fourth consensus guidelines for the management of postoperative nausea and vomiting[J]. Anesthesia and analgesia,2020,131(2):411-448. DOI:10.1213/ANE.0000000000004833.
[9] 刘岩. 甲状腺术后恶心呕吐综合征危险因素的多因素Logistic回归分析[D].青岛:青岛大学,2009.
[10] 赵璇,霍建平,尚游.甲状腺术后恶心呕吐风险分析及列线图模型建立[J].中国老年学杂志,2022,42(5):1109-1112. DOI:10.3969/j.issn.1005-9202.2022.05.027.
[11] 万丽,赵晴,陈军,等. 疼痛评估量表应用的中国专家共识(2020版)[J]. 中华疼痛学杂志,2020,16(3):177-187. DOI:10.3760/cma.j.cn101379-20190915-00075.
[12] Epstein AS, Liou KT, Romero SAD, et al.Acupuncture vs massage for pain in patients living with advanced cancer: the IMPACT randomized clinical trial[J]. JAMA Netw Open,2023,6(11):e2342482. DOI:10.1001/jamanetworkopen.2023.42482.
[13] Apfel CC, Korttila K, Abdalla M, et al.A factorial trial of six interventions for the prevention of postoperative nausea and vomiting[J]. N Engl J Med,2004,350(24):2441-2451. DOI:10.1056/NEJMoa032196.
[14] Kim JH, Hong M, Kim YJ, et al.Effect of body mass index on postoperative nausea and vomiting: propensity analysis[J]. J Clin Med,2020,9(6):1612. DOI:10.3390/jcm9061612.
[15] Chen W, Li G, Jiang K, et al.Dexamethasone for postoperative nausea and vomiting in papillary thyroid carcinoma patients: a randomized clinical trial[J]. J Am Coll Surg,2022,235(3):454-467.DOI:10.1097/XCS.0000000000000309.
[16] Yamamoto Y, Naito Y, Nakatani H, et al.Relationship between preoperative alcohol consumption and postoperative nausea and vomiting in liver resection: a propensity score matched analysis in a single institute[J]. Asian J Anesthesiol,2022,60(2):1-6. DOI: 10.6859/aja.202206_60(2).0005.
[17] Jiang W, Zhang M, Cao R, et al.Different ethanol exposure durations affect cytochrome P450 2E1-mediated sevoflurane metabolism in rat liver[J]. BMC Anesthesiol,2024,24(1):321. DOI:10.1186/s12871-024-02704-5.
[18] Coates S, Lazarus P. Hydrocodone, Oxycodone,Morphine metabolism and drug-drug interactions[J]. J Pharmacol Exp Ther,2023, 387(2):150-169. DOI:10.1124/jpet.123.001651.
[19] 中华医学会内分泌学分会,中华医学会外科学分会甲状腺及代谢外科学组,中国抗癌协会头颈肿瘤专业委员会,等. 甲状腺结节和分化型甲状腺癌诊治指南(第二版)[J]. 中华内分泌代谢杂志,2023,39(3):181-226. DOI:10.3760/cma.j.cn311282-20221023-00589.
[20] Lee MY, Wang JD, Tu CW, et al.Operation time is a major risk factor on postoperative nausea and vomiting in women undergoing breast and thyroid surgery[J]. Asian J Surg,2021,44(3):590-591. DOI: 10.1016/j.asjsur.2020.12.025.
[21] Wang D, Sun Y, Zhu YJ, et al.Comparison of opioid-free and opioid-inclusive propofol anaesthesia for thyroid and parathyroid surgery: a randomised controlled trial[J]. Anaesthesia,2024,79(10):1072-1080. DOI:10.1111/anae.16382.
[22] Russell MD, Kamani D, Randolph GW.Surgical management of the compromised recurrent laryngeal nerve in thyroid cancer[J].Best Pract Res Clin Endocrinol Metab,2019,33(4):101282. DOI:10.1016/j.beem.2019.05.006.
[23] Künzli BM, Walensi M, Wilimsky J, et al.Impact of drains on nausea and vomiting after thyroid and parathyroid surgery: a randomized controlled trial[J].Langenbecks Arch Surg, 2019, 404(6):693-701.DOI:10.1007/s00423-019-01799-6.
[24] 程雪华. 揿针结合常规针刺治疗甲状腺术后恶心呕吐的临床疗效观察[D].乌鲁木齐:新疆医科大学,2021. DOI:10.27433/d.cnki.gxyku.2021.000314.
[25] 张璟瑶. 耳穴压豆防治甲状腺全麻术后恶心呕吐的临床研究[D].济南:山东中医药大学,2021. DOI:10.27282/d.cnki.gsdzu.2021.000724.
[26] Zawadzki M, Kowalski G, Chłopaś-Konowałek A, et al.Rapid determination of sufentanil in human plasma by UHPLC-QqQ-MS-MS[J]. J Anal Toxicol,2021,45(6):605-611. DOI:10.1093/jat/bkaa123.
[27] Trescot AM, Datta S, Lee M, et al.Opioid pharmacology[J]. Pain Physician,2008,11(2 Suppl):S133-S153.
[28] 张海燕,于卫华,张利,等.2型糖尿病老年患者生活空间移动性受限风险预测模型研究[J].护理学报, 2023,30(22):13-19. DOI:10.16460/j.issn1008-9969.2023.22.013.

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