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.

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.

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