手术史对化疗所致恶心呕吐影响的病例对照研究

A case-control study of the effects of surgical history on chemotherapy-induced nausea and vomiting

目的探讨手术史对化疗所致恶心呕吐(CINV)的影响及相关因素。方法采用病例对照研究,以824例化疗患者为研究对象,统计患者的人口学资料、病史材料、化疗前检查数据、化疗情况共27项资料,使用Logistic回归模型分析手术史与CINV发生风险之间的关系,通过构建多个模型矫正潜在的混杂因素,并对有手术史的患者进行亚组分析。结果有手术史的患者CINV的发生率更高,未矫正的统计学结果为[OR=1.72,95%CI(1.31,2.28),P<0.001],矫正潜在混杂因素后的统计学结果为[OR=1.78,95%CI(1.28,2.48),P=0.001]。亚组分析结果表明,手术距离化疗的时间(手-化时间)不同,手术史对CINV的影响也不同,差异有统计学意义(P=0.027)。随着手-化时间的延长,CINV的发生风险呈下降趋势,差异有统计学意义(P for trend≤0.050)。相较于未做过手术的患者,1年以内做过手术的患者有较高的CINV发生风险[OR=2.33,95%CI(1.52,3.59),P<0.001]。结论有手术史的患者发生CINV的风险更高,该风险与手-化时间关系密切并随时间的延长呈现下降趋势。

OBJECTIVE To explore the influence of surgical history on chemotherapy-induced nausea and vomiting(CINV).METHODS A retrospective case-control study was adopted,with 824 patients undergoing chemotherapy as the object.A total of 27items were collected,including demographic data,medical history data,pre-chemotherapy data,and chemotherapy treatment status.Logistic regression model was used to analyze the relationship between the history of surgery and the risk of CINV.The multiple models were constructed to correct potential confounding factors,and subgroup analysis was performed on patients with surgical history.RESULTS The incidence of CINV was higher in patients with surgical history.The statistical result before adjustment was [OR=1.72,95%CI(1.31,2.28),P<0.001];after adjusting potential confounding factors,the statistical result was[OR=1.78,95% CI(1.28,2.48),P=0.001].In the subgroup analysis,the time between surgery and chemotherapy was different,and the impact of surgical history on CINV was different,and the results were statistically significant(P=0.027).The risk of CINV showed decreasing trend with the time,and the results were statistically significant(P for trend ≤0.050).Compared with patients who had not undergone surgery,patients who had undergone surgery within one year had a higher risk of CINV [OR=2.33,95%CI(1.52,3.59),P<0.001].CONCLUSIONS Patients with surgical history are more prone to CINV,and the risk of CINV shows a downward trend in the length of time from surgery.