中国的机器人外科学杂志 | ISSN 2096-7721 | CN 10-1650/R

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

Vol. 5 No. 5 Oct. 2024 DOI: : 10.12180/j.issn.2096-7721.2024.05.016 发布日期:2024-11-27
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

作者简介:

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 the rest were included in the non-AKI group. 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.

稿件信息

收稿日期:2024-04-16  录用日期:2024-05-29 

Received Date: 2024-04-16  Accepted Date: 2024-05-29 

基金项目:陕西省重点研发计划项目(2021SF-054) 

Foundation Item: Key R&D Plan Project of Shaanxi Province(2021SF-054) 

通讯作者:张冬,Email:zhang.dong.1988@163.com 

Corresponding Author: ZHANG Dong, Email: zhang.dong.1988@163.com 

引用格式:姜锐,颜西刚,王宏亮,等 . 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 [J]. 机器人外科学杂志(中英文),2024,5(5):847-852. 

Citation: JIANG R, YAN X G, WANG H L, et al. Comparison of patient-controlled analgesia based on ketorolac and fentanyl for acute kidney injury after robot-assisted radical prostatectomy [J]. Chinese Journal of Robotic Surgery, 2024, 5(5): 847-852.

参考文献

[1] Arenas-Gallo C, Shoag J E, Hu J C. Optimizing surgical techniques in robot-assisted radical prostatectomy[J]. Urol Clin North Am, 2021, 48(1): 1-9. 

[2] Puccetti M, Cusati E, Antognelli C, et al. Ketorolac loaded poly(lactic-co-glycolic acid) coating of AZ31 in the treatment of bone fracture pain[J]. Polymers (Basel), 2023, 15(10): 2246. 

[3] Kelly E, Sutcliffe K, Cavallo D, et al. The anomalous pharmacology of fentanyl[J]. Br J Pharmacol, 2023, 180(7): 797-812. 

[4] 赵晓楠 , 关雷 , 刘鹏飞 , 等 . 舒芬太尼复合罗哌卡因竖脊肌阻 滞用于肺癌患者术后镇痛的效果 [J]. 中国实验诊断学 , 2020, 24(2): 234-238. 

[5] Kim D H, Jeon Y T, Kim H G, et al. Comparison between ketorolacand fentanyl-based patient-controlled analgesia for acute kidney injury after robot-assisted radical prostatectomy: a retrospective propensity score-matched analysis[J]. World J Urol, 2023, 41(5): 1437-1444. 

[6] Kellum J A, Lameire N, KDIGO AKI Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1)[J]. Crit Care, 2013, 17(1): 204. 

[7] 徐林锋 , 邱雪峰 , 张青 , 等 . 改良后入路机器人辅助根治性前列 腺切除术治疗移行带前列腺癌的安全性和疗效 [J]. 中华泌尿外 科杂志 , 2022, 43(2): 107-110. 

[8] 赵浩辰 , 廖鑫扬 , 鲍一歌 , 等 . 机器人辅助根治性前列腺切除术 技术进展 [J]. 中华外科杂志 , 2024, 62(2): 116-121. 

[9] 王见福 , 孙玉朝 . 机器人辅助根治性前列腺切除术的应用现况 与研究进展 [J]. 临床医学进展 , 2023, 13(12): 18554-18558. 

[10] 吕帅国 , 卢锡华 , 杨铁军 , 等 . 酒石酸布托啡诺与舒芬太尼静脉 自控镇痛对腹腔镜根治性肾切除术后早期康复的影响 [J]. 中华 医学杂志 , 2020, 100(37): 2947-2951. 

[11] 叶冰倩 , 朱钧 , 张雪蓉 . 腰方肌阻滞复合酮咯酸对小儿疝修 补术后镇痛作用及白细胞介素-6 的影响 [J]. 吉林医学 , 2022, 43(10): 2647-2650. 

[12] 汪文 , 龚小刚 , 孙云 . 地佐辛联合舒芬太尼及酮咯酸术后静脉 自控镇痛在腹腔镜手术患者中的效果分析 [J]. 现代诊断与治疗 , 2022, 33(23): 3541-3543. 

[13] 童丽珍 , 林明江 , 邢柏 . 糖尿病、肝硬化及其交互作用对脓毒 症患者并发急性肾损伤的影响 [J]. 中国医药导报 , 2023, 20(23): 131-134. 

[14] 夏岚 , 叶倩倩 , 吴安华 , 等 . 肾功能亢进及低蛋白血症对用万古 霉素谷浓度的影响 [J]. 中国抗生素杂志 , 2020, 45(9): 940-946. 

[15] 艾尼·买买提明 , 汪小海 , 杨春 , 等 . 机器人辅助下前列腺癌根 治术术后发生急性肾损伤的危险因素 [J]. 中国医师进修杂志 , 2020, 43(12): 1105-1108. 

[16] 张万龙 , 王孝军 , 郭芳 , 等 . 舒芬太尼 + 酮咯酸静脉镇痛对剖宫 产术后患者静息切口痛和宫缩痛的影响 [J]. 现代养生 ( 下半月 版 ), 2022, 22(11): 1931-1933.

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