背景:与标准白光经尿道膀胱肿瘤电切术相比,口服5-氨基酮戊酸用于膀胱肿瘤电切术可降低膀胱癌复发。然而,有关该药物不良事件风险的数据尚不清楚.本研究的目的是确定在光动力诊断-经尿道膀胱肿瘤电切术中与口服5-氨基酮戊酸引起的不良事件相关的危险因素。
方法:我们研究了2021年10月至2023年4月的104例5-氨基酮戊酸光动力诊断-经尿道膀胱肿瘤切除术,术前至少2小时口服20mg/kg5-氨基酮戊酸。选择与5-氨基乙酰丙酸相关的四个主要不良事件来确定其发生的危险因素。包括围手术期低血压,恶心和/或呕吐,光敏性,和肝功能障碍。进行单因素和多因素分析以确定这些不良事件的危险因素。
结果:围手术期低血压(11.5%),恶心和/或呕吐(37.5%)光敏性(31.7%),肝功能异常(51.9%)。多因素分析显示脊髓麻醉与低血压相关(p=0.02),而高龄(p<0.01)和高体重指数(p<0.01)与恶心和/或呕吐有关。此外,男性(p<0.01)和手术时间长(p=0.01)与光敏性有关,肾素-血管紧张素系统抑制剂的使用与术后肝功能障碍相关(p<0.01)。
结论:对于服用肾素-血管紧张素系统抑制剂的老年男性肥胖患者,由于口服5-氨基酮戊酸所涉及的不良事件的发生风险较高,因此在脊髓麻醉下光动力诊断-经尿道膀胱肿瘤电切术的围手术期需要特别注意.
BACKGROUND: Oral 5-aminolevulinic acid for transurethral resection of bladder tumor reduces bladder cancer recurrence compared with standard white-light transurethral resection of bladder tumor. However, data regarding risks of adverse events with this drug are unclear. The aim of the present study was to identify risk factors associated with oral 5-aminolevulinic acid induced adverse events in photodynamic diagnosis-transurethral resection of bladder tumor.
METHODS: We studied 104 cases of 5-aminolevulinic acid-photodynamic diagnosis-transurethral resection of bladder tumor from October 2021 to April 2023, administering 20 mg/kg 5-aminolevulinic acid orally at least 2 hours pre-surgery. Four major adverse events associated with 5-aminolevulinic acid were selected to identify risk factors for their occurrence, including perioperative hypotension, nausea and/or vomiting, photosensitivity, and liver dysfunction. Univariate and multivariate analyses were conducted to identify the risk factors of those adverse events.
RESULTS: Perioperative hypotension (11.5%), nausea and/or vomiting (37.5%) photosensitivity (31.7%), and liver dysfunction (51.9%) were observed. Multivariate analyses revealed that spinal anesthesia was associated with hypotension (p=0.02), whereas advanced age (p<0.01) and higher body mass index (p<0.01) were associated with nausea and/or vomiting. Also, male sex (p<0.01) and longer operative time (p=0.01) were associated with photosensitivity, and renin-angiotensin system inhibitors use was associated with postoperative liver dysfunction (p<0.01).
CONCLUSIONS: For elderly male obese patients taking renin-angiotensin system inhibitors, particular attention is needed during the perioperative period of photodynamic diagnosis-transurethral resection of bladder tumor under spinal anesthesia due to the higher risk of onset of the adverse events involved in oral administration of 5-aminolevulinic acid.