基于酮咯酸和芬太尼的患者自控镇痛对机器人辅助根治性前列腺切除术后急性肾损伤的作用比较  

Comparison of patient-controlled analgesia based on ketorolac and fentanyl for acute kidney injury after robot-assisted radical prostatectomy

作　　者：姜锐 颜西刚 王宏亮 王学佳 张冬 JIANG Rui;YAN Xigang;WANG Hongliang;WANG Xuejia;ZHANG Dong(Department of Anaesthesiology,the Second Affiliated Hospital of Air Force Medical University,Xi'an 710038,China)

机构地区：[1]空军军医大学第二附属医院麻醉科,陕西西安710038

出　　处：《机器人外科学杂志（中英文）》2024年第5期847-852,共6页Chinese Journal of Robotic Surgery

基　　金：陕西省重点研发计划项目(2021SF-054)。

摘　　要：目的:比较应用酮咯酸和芬太尼的患者自控镇痛(PCA)对机器人辅助根治性前列腺切除术(RARP)术后急性肾损伤(AKI)的影响。方法:选取2021年1月—2023年12月于唐都医院接受RARP的300例前列腺癌患者作为研究对象,均在机器人辅助根治性前列腺切除术后给予PCA。采用随机数表法将其分为对照组(n=150)和研究组(n=150),对照组采用基于酮咯酸的PCA,研究者采用基于芬太尼的PCA。比较两组患者术后AKI发生情况,并分析发生AKI的危险因素。结果:与对照组比较,研究组患者恶心、皮肤瘙痒发生率更低(P<0.05)。研究组AKI发生率低于对照组(P<0.05)。将77例发生AKI的患者纳入AKI组,其余纳入为非AKI组。单因素分析结果表明,与非AKI组比较,AKI组年龄、BMI、高血压例数、冠心病例数、贫血例数、低蛋白血症例数、Hb更高(P<0.05),AKI组与非AKI组在性别、糖尿病例数、吸烟史例数、饮酒史例数、手术时间、麻醉时间、术中出血量、术中尿量、总输入量方面,差异无统计学意义(P>0.05)。以组别为因变量,以单因素分析中P<0.05的因素为自变量,经二元Logistic回归分析,高BMI、高血压、冠心病、贫血、低蛋白血症、酮咯酸是RARP术后发生AKI的危险因素(P<0.05)。结论:与芬太尼比较,酮咯酸应用于RARP患者PCA中,术后AKI、恶心、皮肤瘙痒发生率更高。RARP患者术后发生AKI与BMI、高血压、冠心病、贫血、低蛋白血症以及PAC药物有关。Objective:To compare the effects of patient-controlled analgesia(PCA)based on ketorolac and fentanyl on acute kidney injury(AKI)after robot-assisted radical prostatectomy(RARP).Methods:300 prostate cancer patients who underwent RARP in the Second Affiliated Hospital of Air Force Medical University from January 2021 to December 2023 were selected as research objects and given PCA.They were divided into the control group(n=150)and the study group(n=150)using a random number table.The control group received PCA based on ketorolac,while the study group received PCA based on fentanyl.The occurrence of AKI in the two groups were compared,and the risk factors for AKI were analyzed.Results:Compared with the control group,the incidence of nausea and skin itching in the study group was lower(P<0.05)The incidence rate of AKI in the study group was lower than that in the control group(P<0.05).The 77 patients with AKI were included in the AKI group,and therest were included in the non-AKIgroup.Univariate analysis results showed that age,BMI,hypertension,coronary heart disease(CAD),anemia,hypoproteinemia and Hb in AKI group were higher than those in the non-AKI group(P<0.05).The differences in gender,diabetes,smoking history,drinking history,operative time,anesthesia time,intraoperative bleeding,intraoperative urine volume,and total input in the AKI group and non-AKI group were not statistically significant(P>0.05).Taking group as dependent variables and P<0.05 factors in univariate analysis as independent variables,high BP,hypertension,CAD,anaemia,hypoproteinemia and ketorolac were risk factors for AKI after RARP(P<0.05).Conclusion:Compared with fentanyl,PCA based on ketorolac in patients underwent RARP has a higher incidence of postoperative AKI,nausea and skin itching.The postoperative occurrence of AKI in patients underwent RARP is related with BMI,hypertension,coronary heart disease,anemia,hypoalbuminemia and PCA medication.

关 键 词：机器人辅助根治性前列腺切除术 急性肾损伤 酮咯酸 芬太尼 自控镇痛 

分 类 号：R737.25[医药卫生—肿瘤] R61[医药卫生—临床医学]