针药复合麻醉对肛门部手术后尿潴留的影响:一项基于电子医疗数据的真实世界研究  

Effect of combined acupuncture anesthesia on postoperative urinary retention after anal surgery:a real-world study based on electronic medical data

作　　者：葛茂军[1] 俞杭 梅祖兵[3,4] GE Mao-jun;YU Hang;MEI Zu-bing(Department of General Surgery,Shuguang Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Department of Emergency,Changhai Hospital,Naval Medical University(Second Military Medical University),Shanghai 200433,China;Department of Anorectal Surgery,Shuguang Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China;Institute of Anorectal Disease,Shuguang Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 201203,China)

机构地区：[1]上海中医药大学附属曙光医院普外科,上海201203 [2]海军军医大学(第二军医大学)长海医院急诊科,上海200433 [3]上海中医药大学附属曙光医院肛肠科,上海201203 [4]上海中医药大学附属曙光医院肛肠病研究所,上海201203

出　　处：《第二军医大学学报》2021年第11期1260-1266,共7页Academic Journal of Second Military Medical University

基　　金：国家自然科学基金(81774112);中医药循证能力建设项目(2019XZZX-XH013-2)。

摘　　要：目的基于真实世界数据分析针药复合麻醉对肛门部手术患者发生术后尿潴留(POUR)的影响,为肛门部手术时选择最佳的麻醉方式提供循证依据。方法回顾性收集上海中医药大学附属曙光医院病案管理系统中2012年1月1日至2018年12月31日肛肠科实施肛门部手术的病例资料。提取患者性别、年龄、住院天数、麻醉方法、主要手术国际疾病分类第9版临床修订本第3卷(ICD-9-CM3)代码。以开具留置导尿医嘱和收取导尿管费用作为发生POUR的依据。对于术中麻醉方式变更的病例,以最后采用的麻醉方式纳入研究。结果共11440例肛门部手术患者入组,年龄为39(32,51)岁,男女比例为1.94∶1。其中采用针药复合麻醉6083例(53.2%)、后会阴神经阻滞麻醉3392例(29.7%)、静脉麻醉1420例(12.4%)、局部麻醉408例(3.6%)、椎管内麻醉65例(0.6%)、全身麻醉46例(0.4%)、其他麻醉方式26例(0.2%)。术后留置导尿管395例,POUR发生率为3.5%。单因素logistic回归分析显示,年龄≥60岁(OR=1.76,95%CI 1.36~2.27,P<0.001)和女性(OR=1.36,95%CI 1.11~1.67,P=0.003)是肛门部手术患者发生POUR的危险因素。多因素logistic回归分析显示,与针药复合麻醉相比,后会阴神经阻滞麻醉、静脉麻醉和椎管内麻醉使POUR风险增高(后会阴神经阻滞麻醉:OR=1.42,95%CI 1.13~1.78,P=0.002;静脉麻醉:OR=1.48,95%CI 1.10~1.99,P=0.009;椎管内麻醉:OR=2.75,95%CI 1.09~6.93,P=0.032)。在校正性别、年龄及疾病诊断后进行多因素logistic回归分析,所得结果类似(后会阴神经阻滞麻醉:校正OR=1.33,95%CI 1.06~1.67,P=0.014;静脉麻醉:校正OR=1.43,95%CI 1.06~1.92,P=0.019;椎管内麻醉:校正OR=4.93,95%CI 1.92~12.67,P=0.001)。亚组分析显示,与后会阴神经阻滞麻醉相比,针药复合麻醉能降低女性患者41%的POUR风险(OR=0.59,95%CI 0.42~0.84,P=0.003)及年龄<60岁患者30%的POUR风险(OR=0.70,95%CI 0.54~0.90,P=0.006)。结论年龄≥60岁和女性是肛门部手术患者Objective To evaluate the effect of combined acupuncture anesthesia on the risk of postoperative urinary retention(POUR)in patients after anal surgery based on real-world data,so as to provide evidence-based basis for optimal anesthesia method for anal surgery.Methods The data of patients undergoing anal surgery from Jan.1,2012 to Dec.31,2018 were retrospectively collected from the electronic medical records(EMR)system of Shuguang Hospital,Shanghai University of Traditional Chinese Medicine.The information of gender,age,length of hospital stay,anesthesia method and International Classification of Diseases,Ninth Revision,Clinical Modification Volume 3(ICD-9-CM3)codes were extracted.Ascertainment of POUR was based on the medical order of indwelled catheterization and the charge of catheter.For cases with intraoperative anesthesia change,final anesthesia method was recorded.Results A total of 11440 patients undergoing anorectal surgery were enrolled with an age of 39(32,51)years and a male to female ratio of 1.94∶1.Among them,6083 cases(53.2%)were treated with combined acupuncture anesthesia,3392 cases(29.7%)with posterior perineal nerve block anesthesia,1420(12.4%)cases with intravenous anesthesia,408(3.6%)cases with local anesthesia,65(0.6%)cases with spinal anesthesia,46(0.4%)cases with general anesthesia,and 26(0.2%)cases with other anesthesia methods.The incidence of POUR was 3.5%(395 cases).Univariate logistic regression analysis showed that age≥60 years(odds ratio[OR]=1.76,95%confidence interval[CI]1.36-2.27,P<0.001)and female(OR=1.36,95%CI 1.11-1.67,P=0.003)were risk factors for POUR in patients undergoing anal surgery.Multivariate logistic regression analysis showed that compared with combined acupuncture anesthesia,posterior perineal nerve block anesthesia,intravenous anesthesia and spinal anesthesia were significantly associated with increased risk of POUR(posterior perineal nerve block anesthesia:OR=1.42,95%CI 1.13-1.78,P=0.002;intravenous anesthesia:OR=1.48,95%CI 1.10-1.99,P=0.009;spinal anesthesia:

关 键 词：肛门部手术 针药复合麻醉 术后尿潴留 真实世界研究 

分 类 号：R657.1[医药卫生—外科学]