摘要
Abstract
Objective:To analyze the risk factors for severe postoperative nausea and vomiting(PONV)following laparoscopic cholecystectomy(LC)and to develop a predictive model.Methods:Clinical data of 1023 patients who underwent LC from Dec.2021 to Dec.2023 were retrospectively collected as the modeling cohort.The patients,aged 18～83 years with a male-to-female ratio of 1∶2 and ASA status Ⅱ or Ⅲ,were divided into a positive group(n=164)or a negative group(n=859)based on their need for rescue antie-metics postoperatively.Risk factors were identified using stepwise logistic regression to construct a prediction model and a nomogram.The model's discrimination,consistency,and clinical utility were validated using receiver operating characteristic(ROC)curve,calibra-tion curve,and decision curve.An external validation group of 388 patients who underwent elective LC from Jan.2024 to Dec.2024 was selected,and R language software was used for external validation of the model.Results:A total of 1411 patients were included,of whom 214 required antiemetics,resulting in an overall PONV incidence of 15.2％.Logistic analysis results showed that in the modeling group,female gender,history of PONV,gastritis,dizziness,and the need for additional analgesia were independent risk factors for PONV after LC(OR＞1,P＜0.05),while BMI was an independent protective factor(OR＜1,P＜0.05).The risk prediction model based on these independent influencing factors achieved an area under the ROC curve of 0.780(95％CI=0.742～0.817),with a sensitivity of 72％and a specificity of 68％.The C-index was 0.780,and the Hosmer-Lemeshow goodness-of-fit test showed X2=7.322,P=0.502.In the validation cohort,the area under curve was 0.799(95％CI=0.734～0.865).Conclusions:Patient gender,BMI,history of PONV,gastritis,dizziness,and the need for additional analgesia are independent factors influencing PONV after LC.The risk prediction model constructed based on these factors demonstrates good predictive capability and can provide a basis for early identification of high-risk patients in clinical practice.关键词
胆囊切除术,腹腔镜/手术后恶心呕吐/预测模型/验证Key words
Cholecystectomy,laparoscopic/Postoperative nausea and vomiting/Prediction model/Validation分类
临床医学
