在TACE后出现术后恶心和吐的危险因素:前性队列研究
Yuzhu Wang1, Xin Zhou2,3,4, Guoping Li2,3,4
1Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Current oncology (Toronto, Ont.)
|January 24, 2025
概括
手术后的恶心和吐 (PONV) 影响了42%的肝癌跨动脉化血栓化 (TACE) 后患者. 慢性胃炎,疼痛,epirubicin和lipiodol剂量是PONV的关键危险因素.
科学领域:
- 干预性放射学 干预性放射学
- 在瘤学瘤学.
- 麻醉学 麻醉学
背景情况:
- 手术后恶心和吐 (PONV) 是患有肝细胞癌 (HCC) 的患者经过过动脉化学栓塞 (TACE) 后的常见并发症.
- 识别PONV的风险因素对于有效的患者管理和改善TACE程序后的结果至关重要.
研究的目的:
- 为了前性地研究与PONV发生相关的独立风险因素,在接受TACE治疗HCC的患者中.
- 在这个患者群体中开发和验证PONV风险的预测模型.
主要方法:
- 一项前性分析包括212名接受TACE治疗的HCC患者,收集了人口统计,病史和术后因素的数据.
- 用视觉模拟量表 (VAS) 评估疼痛,用GAD-7和PHQ-9问卷评估神经心理状态.
- 多重后勤回归分析确定了独立的风险因素,接收器操作特征 (ROC) 曲线评估了预测模型的性能.
主要成果:
- 在接受TACE的患者中,PONV的发病率为42% (89/212).
- PONV的独立风险因素包括慢性胃炎 (OR = 10.350),VAS疼痛得分 (OR = 3.835),epirubicin管理 (OR = 26.685),以及≥5毫升的利皮多尔剂量 (OR = 1.385).
- 开发的风险预测模型显示出强大的歧视能力,曲线下的面积 (AUC) 为0.902,灵敏度为84.3%,特异性为87%.
结论:
- 在TACE后的HCC患者中,PONV的流行率很高,因此需要针对性的预防和管理策略.
- 慢性胃炎,疼痛强度,epirubicin使用和较高的利皮阿多尔剂量是PONV的显著预测因素.
- 经过验证的风险预测模型为医疗保健提供者提供了一种有价值的工具,以识别高风险患者并改善PONV管理.
相关概念视频
Chemotherapy-Induced Nausea and Vomiting: 5-HT3 Receptor Antagonists
173
5-HT3 receptor antagonists, such as dolasetron, granisetron (Kytril), ondansetron (Zofran), and palonosetron (Axoli), are crucial in managing chemotherapy-induced nausea and vomiting (CINV) and postoperative nausea. These drugs selectively block 5-HT3 receptors in the visceral vagal and spinal afferent nerves, chemoreceptor trigger zone, and the vomiting center. They have a rapid onset of action and can be given as a single dose before chemotherapy. Ondansetron and granisetron, in particular,...
173
Chemotherapy-Induced Nausea and Vomiting: Neurokinin-1 Receptor Antagonists
147
Neurokinin 1 (NK1) receptors are distributed across the GI tract, vagal afferents, and key CNS regions including the central vomiting center and chemoreceptor trigger zone (CTZ) Chemotherapy agents stimulate enterochromaffin cells in the gastrointestinal (GI) tract to release large amounts of substance P (SP). SP is a neuropeptide released by specific sensory nerves in response to many different stressors, including those in the GI mucosa affected by chemotherapy. SP binds and activates...
147
Chemotherapy-Induced Nausea and Vomiting: Cannabinoids
201
Tetrahydrocannabinol (THC) is a phytocannabinoid that primarily interacts with the CB1 receptor, a type of G protein-coupled receptor (GPCR) predominantly in and around the chemoreceptor trigger zone (CTZ) and emetic center. THC also blocks the serotonin receptor activity in the dorsal vagal complex (DVC) by inhibiting serotonin release. THC exerts its anti-emetic effects through these interactions, which are beneficial for patients undergoing chemotherapy.
Two synthetic agonists of THC,...
Two synthetic agonists of THC,...
201
Chemotherapy-Induced Nausea and Vomiting: Dopamine Receptor Antagonists
219
Dopamine receptor antagonists, also known as antipsychotic agents, are critical in managing chemotherapy-induced vomiting. These antiemetic agents block dopamine receptors in the chemoreceptor trigger zone (CTZ), inhibiting signal transmission to the vomiting center. Antipsychotic agents encompass phenothiazines (PTZ), butyrophenones, benzamides, and thienobenzodiazepines (Zyprexa), which are utilized for their antiemetic and sedative properties.
Phenothiazines, such as prochlorperazine...
Phenothiazines, such as prochlorperazine...
219
Radiological Investigation III: Pulmonary Angiogram and PET Scan
82
Radiological investigations are paramount in the diagnosis and management of various pulmonary diseases. Two essential investigations are the Pulmonary Angiogram and the Positron Emission Tomography (PET) Scan.
Pulmonary Angiogram
A Pulmonary Angiogram is an invasive procedure involving injecting a contrast medium through a catheter threaded into the pulmonary artery or the right side of the heart to visualize the pulmonary vasculature. Computed Tomography (CT) scans have mainly replaced this...
Pulmonary Angiogram
A Pulmonary Angiogram is an invasive procedure involving injecting a contrast medium through a catheter threaded into the pulmonary artery or the right side of the heart to visualize the pulmonary vasculature. Computed Tomography (CT) scans have mainly replaced this...
82
Esophageal Varices-II: Clinical Features and Management
45
Esophageal varices often manifest as gastrointestinal bleeding episodes, presenting symptoms like hematemesis (vomiting of blood), hematochezia (passing fresh blood via the rectum), and melena (black, tarry stools). Other signs can include weight loss, anorexia, abdominal discomfort, jaundice, pruritus, altered mental status, and muscle cramps.
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
In the initial assessment, a thorough review of the patient's medical history is vital to identify risk factors such as liver disease, alcohol...
45


