Apfel评分预测腹腔镜胃袖状切除术后恶心呕吐的临床价值

Clinical value of Apfel score in predicting postoperative nausea and vomiting after laparoscopic sleeve gastrectomy

目的分析Apfel评分量表在预测腹腔镜胃袖状切除术(laparoscopicsleeve gastrectomy,LSG)术后恶心呕吐(postoperative nausea and vomiting,PONV)的临床价值。方法收集2022年1月至2023年3月华中科技大学同济医学院附属协和医院胃肠外科行LSG的80例肥胖症病人的病例资料,根据Apfel评分量表所列性别、吸烟史、晕动症状或PONV史、术后使用阿片类药物情况对病人进行评分。结合视觉模拟评分(visual analogue scale,VAS)、语言描述评分(verbal descriptor scale,VDS)和PONV发作频率评分评估上述病人术后72 h内PONV的发生情况,运用Spearman相关系数分析Apfel评分与VAS、VDS和PONV发作频率评分之间的相关性。然后将Apfel评分与上述三种PONV结局评分做受试者操作特征曲线,计算曲线下面积(area under the curve,AUC)以评价Apfel评分对PONV的发生和严重程度的预测效果。结果80例行LSG病人的Apfel评分为(1.76±0.96)分,术后72 h内VAS、VDS和PONV发作频率评分分别为(4.19±2.96)分、(1.09±0.77)分和(2.68±1.81)分,Apfel评分与VAS、VDS、PONV发作频率评分均呈正相关(Spearman相关系数分别为0.3639、0.3563、0.2985,均P<0.05)。在预测是否发生PONV方面,Apfel评分对于VDS评分的预测价值最优(AUC=0.741,P<0.05);而在预测PONV严重程度方面,Apfel评分对于VAS评分的预测价值最优(AUC=0.706,P<0.05)。结论Apfel评分与LSG手术PONV评分相关。但在评价PONV的发生及严重程度方面,该量表对于VAS、VDS和PONV发作频率评分预测效果不同,临床上需根据不同的预测目标针对性使用。

Objective To explore the clinical value of Apfel score in predicting postoperative nausea and vomiting(PONV)after laparoscopic sleeve gastrectomy(LSG).Methods Between January 2022 and March 2023,the relevant clinical data were collected from 80 morbidly obese patients undergoing LSG.They were assessed by the Apfel scoring system,including such factors as gender,smoking history,history of motion sickness or PONV and postoperative opioid use.PONV occurrences within 72 h post-LSG were assessed by visual analogue scale(VAS),verbal descriptor scale(VDS)and PONV frequency score.Spearman's correlation was utilized for examining the relationship between Apfel and VAS/VDS/PONV frequency scores.Receiver operating characteristic(ROC)curve was plotted for evaluating the predictive value of Apfel score for PONV occurrence/severity and the area under the curve(AUC)calculated.Results Mean Apfel score was(1.76±0.96).Within 72 h post-LSG,mean VAS/VDS/PONV frequency scores were(4.19±2.96),(1.09±0.77)and(2.68±1.81).Spearman's correlation coefficients between Apfel and VAS/VDS/PONV frequency scores were 0.3639,0.3563 and 0.2985,all denoting a positive correlation(P<0.05).Apfel score had the highest predictive value for VDS in predicting the occurrence of PONV(AUC=0.741,P<0.05)while it offered the best predictive value for VAS in predicting the severity of PONV(AUC=0.706,P<0.05).Conclusion Apfel score is correlated with PONV score after LSG.However,its predictive value for VAS/VDS/PONV frequency score varies when assessing the occurrence/severity of PONV.Clinically Apfel score should be utilized with a consideration of specific predictive goals.