【原】【罂粟摘要】全麻胃肠道手术的术中伤害性反应及术后主要并发症：一项前瞻性队列研究

全麻胃肠道手术的术中伤害性反应及术后主要并发症：一项前瞻性队列研究

贵州医科大学  麻醉与心脏电生理课题组

翻译：佟睿  编辑：张中伟  审校：曹莹

背景

    外科手术的刺激会引起患者机体产生伤害性感觉，并使得机体根据伤害性感觉和抗伤害性感觉之间的平衡诱导生理反应。手术刺激的严重程度与术后主要并发症有关。虽然反映术中伤害性刺激的量化指标对于麻醉管理预测和预防主要并发症是有帮助的，但目前还没有这样的指标。

目的

    通过术中伤害性刺激监测，确定胃肠道手术后发生主要并发症与术中量化指标之间的关系。

试验设计

  一项多机构的观察性研究。

范围设置

     两所大学附属医院。

受试人群

     连续就诊的成人患者，并在全麻下接受了胃肠道手术。

主要观察指标测定

     计算手术开始至结束时伤害性刺激反应指数的平均值(平均NR指数)和手术死亡概率模型(S-MPM)的风险评分(Risk Score of Surgical Mortality Probability Model，S-MPM)。测定手术前后血清C反应蛋白(CRP)水平。通过观测者操作特性(ROC)曲线分析，将所有患者分为平均伤害性反应指数高与低两组。采用Logistic回归分析，研究平均伤害性反应指数与发生术后主要并发症(定义为Clavien-Dindo分级至少为IIIa级)之间的关系。

结果

          ROC曲线分析显示，伤害性刺激反应指数的主要并发症截止值为0.83，然后我们将患者分为平均伤害性刺激反应指数小于0.83和不低于0.83两组。平均伤害性刺激反应指数不低于0.83组(23.1% ; n=346)的患者主要并发症发生率明显高于平均伤害性反应指数小于0.83组的患者(7.7% ; n=443; p < 0.001)。多变量分析显示急诊手术、 S-MPM风险评分、平均伤害性反应指数和术后C反应蛋白水平是主要并发症的独立危险因素。

结论

     术中平均伤害性反应指数可能与胃肠道手术后主要并发症相关。

原始文献来源

           Hiroki Ogata, Yuka Matsuki, Takuma Okamoto, et al. Intra-operative nociceptive responses and postoperative major complications after gastrointestinal surgery under general anaesthesia: A prospective cohort study.[J].Eur J Anaesthesiol 2021;38:1215–1222.

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Intra-operative nociceptive responses and postoperative

major complications after gastrointestinal surgery under

general anaesthesia

A prospective cohort study

Abstract

BACKGROUND Surgical procedures stimulate nociception and induce physiological responses according to the balance between nociception and antinociception. The severity of surgical stimuli is associated with major postoperative complications. Although an intra-operative quantitative index representing surgical invasiveness would be useful for anaesthetic management to predict and prevent major complications, no such index is available.

OBJECTIVES To identify associations between major complications after gastrointestinal surgery and intra-operative quantitative values from intra-operative nociception monitoring.

DESIGN A multi-institutional observational study.

SETTING Two university hospitals.

PATIENTS Consecutive adult patients undergoing gastrointestinal surgery under general anaesthesia.

MAIN OUTCOME MEASURES Averaged values of nociceptive response index from start to end of surgery (mean NR index) and risk scores of the Surgical Mortality Probability Model (S-MPM) were calculated. Pre and postoperative serum C-reactive protein (CRP) levels were obtained. After receiver-operating characteristic (ROC) curve analysis, all patients were divided into groups with high and low mean nociceptive response index. Associations between mean nociceptive response index and postoperative major complications, defined as Clavien-Dindo grade at least IIIa, were examined using logistic regression analysis.

RESULTS ROC curve analysis showed a nociceptive response index cut-off value for major complications of 0.83, and we divided patients into two groups with mean nociceptive response index less than 0.83 and at least 0.83. The incidence of major complications was significantly higher in patients with mean nociceptive response index at least 0.83 (23.1%;n=346) than in patients with mean nociceptive response index less than 0.83 (7.7%; n=443;P<0.001). Multivariate analysis revealed emergency surgery, S-MPM risk score, mean nociceptive response index and postoperative CRP levels as independent risk factors for major complications.

CONCLUSION Mean nociceptive response index during surgery likely correlates with major complications after gastrointestinal surgery.

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