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Mechanism and risk factors of nausea and vomiting after TACE: a retrospective analysis
经动脉化疗栓塞后恶心和呕吐的机制及风险因素:一项回顾性分析

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Haohao Lu*, Chuansheng Zheng, Bin Liang and Bin Xiong
卢浩浩*, 郑传生, 梁斌 和 熊斌

Abstract 摘要

Purpose: The mechanism of postoperative nausea and vomiting after TACE is not clear. This study retrospectively analyzed the patient data to explore the mechanism and risk factors of postoperative nausea and vomiting after TACE. Materials and methods: The data of 221 patients who underwent TACE in the interventional department from January 2019 to December 2020 were collected. Including: gender, age, liver function before TACE, etiology of liver cirrhosis, BCLC stage of hepatocellular carcinoma, preoperative use of analgesic drugs, preoperative limosis, previous history of vomiting, history of kinetosis, smoking history, history of drinking, chemotherapeutic drugs used during TACE, Dosage of lipiodol, and occurrence of postoperative nausea and vomiting. Results: There were 116 cases of nausea after TACE, using binary logistic regression analysis, Sig: ALT0.003; ALPO.000; history of vomiting 0.043; kinetosis 0.006 ; history of alcohol consumption 0.011 ; preoperative limosis 0.006 ; dosage of lipiodol ( 5 10 mL 5 10 mL 5-10mL5-10 \mathrm{~mL} ) 0.029, dosage of lipiodol ( > 10 mL > 10 mL > 10mL>10 \mathrm{~mL} ) 0.001.There were 89 cases of vomiting after TACE, all accompanied by nausea, Sig: ALP0.000; BCLC stage (B) 0.007; kinetosis 0.034 ; chemotherapeutic drugs 0.015; dosage of lipiodol ( 5 10 ml 5 10 ml 5-10ml5-10 \mathrm{ml} ) 0.015, dosage of lipiodol (> 10 ml ) 0.000; patients used analgesics before TACE 0.034. Conclusions: Causes of post-TACE nausea and vomiting included operative trauma, aseptic inflammation caused by ischemia and hypoxia, chemotherapeutic drugs, ischemia of liver and bile duct, stress and pain during TACE, and patient factors. ALP, BCLC stage, kinetosis, chemotherapeutic drugs, dosage of lipiodol, and preoperative usage of analgesics were risk factors affecting nausea and vomiting after TACE.
目的:经肝动脉化疗栓塞术(TACE)后恶心和呕吐的机制尚不清楚。本研究回顾性分析了患者数据,以探讨 TACE 后恶心和呕吐的机制及风险因素。材料与方法:收集了 2019 年 1 月至 2020 年 12 月在介入科接受 TACE 的 221 名患者的数据,包括:性别、年龄、TACE 前肝功能、肝硬化病因、肝细胞癌 BCLC 分期、术前镇痛药物使用、术前恶心、呕吐病史、晕动病史、吸烟史、饮酒史、TACE 期间使用的化疗药物、碘油用量及术后恶心和呕吐的发生情况。结果:TACE 后有 116 例出现恶心,采用二元逻辑回归分析,显著性:ALT 0.003;ALP 0.000;呕吐病史 0.043;晕动病 0.006;饮酒史 0.011;术前恶心 0.006;碘油用量( 5 10 mL 5 10 mL 5-10mL5-10 \mathrm{~mL} )0.029,碘油用量( > 10 mL > 10 mL > 10mL>10 \mathrm{~mL} )0.001。TACE 后有 89 例出现呕吐,均伴有恶心,显著性:ALP 0.000;BCLC 分期(B)0.007;晕动病 0。034;化疗药物 0.015;碘油剂量( 5 10 ml 5 10 ml 5-10ml5-10 \mathrm{ml} )0.015,碘油剂量(> 10 毫升)0.000;患者在 TACE 前使用镇痛药 0.034。结论:TACE 后恶心和呕吐的原因包括手术创伤、缺血和缺氧引起的无菌炎症、化疗药物、肝脏和胆管缺血、TACE 过程中的压力和疼痛,以及患者因素。ALP、BCLC 分期、晕动病、化疗药物、碘油剂量和术前镇痛药的使用是影响 TACE 后恶心和呕吐的风险因素。

Keywords: Nausea and vomiting, TACE, Risk factors, Regression analysis, Hepatocellular carcinoma, Embolic syndrome, Retrospective analysis
关键词:恶心和呕吐,TACE,风险因素,回归分析,肝细胞癌,栓塞综合症,回顾性分析

Introduction 介绍

Primary hepatocellular carcinoma is one of the malignant tumors with high morbidity and mortality worldwide [1-3], and because there are no obvious specific symptoms and signs in the early stage of the disease, most patients have lost the chance of surgery when
原发性肝细胞癌是全球发病率和死亡率较高的恶性肿瘤之一[1-3],由于该病早期没有明显的特异性症状和体征,大多数患者在发现时已失去手术机会
detected. Transarterial chemoembolization (TACE) is currently one of the effective treatments for advanced hepatocellular carcinoma [ 4 , 5 ] [ 4 , 5 ] [4,5][4,5]. TACE was shown to improve median survival from 16 to 20 months [6]. Its main principle is to superselectively intubate the catheter into the feeding artery of the tumor after establishing a vascular access through femoral artery puncture and inject chemotherapeutic drugs and embolic agents [7]. On the one hand, chemotherapeutic drugs induce apoptosis and inhibit tumor cell proliferation; on the
经动脉化疗栓塞(TACE)目前是晚期肝细胞癌的有效治疗方法之一 [ 4 , 5 ] [ 4 , 5 ] [4,5][4,5] 。研究表明,TACE 可以将中位生存期从 16 个月提高到 20 个月[6]。其主要原理是在通过股动脉穿刺建立血管通路后,超选择性地将导管插入肿瘤的供血动脉,并注入化疗药物和栓塞剂[7]。一方面,化疗药物诱导细胞凋亡并抑制肿瘤细胞增殖;另一方面,
other hand, after tumor supply artery embolization, it leads to tumor cell ischemia, hypoxia and necrosis. TACE is effective in the treatment of liver cancer and plays a very important role in the treatment of hepatocellular carcinoma [8]. The most common side effects after TACE are embolic syndrome, including pain, fever, nausea and vomiting [9-11]. Malignant vomiting, in particular, is one of the major problems faced in clinical practice, which needs to be paid attention to by patients and doctors. Nausea and vomiting will increase the psychological and physical burden of patients, increase the suffering of patients and reduce the compliance of patients with treatment. Severe nausea and vomiting, can lead to water and electrolyte imbalance in patients, prolong hospital stay, and increase treatment costs [12]. At the same time, patients with hepatocellular carcinoma are mostly associated with cirrhosis and gastric esophageal varices, and severe nausea and vomiting will lead to gastric esophageal variceal bleeding, leading to death of patients. The mechanism of postoperative nausea and vomiting after TACE is not clear. This study retrospectively analyzed the patient data to explore the mechanism and risk factors of postoperative nausea and vomiting after TACE.
另一方面,肿瘤供血动脉栓塞后,会导致肿瘤细胞缺血、缺氧和坏死。肝动脉化疗栓塞(TACE)在肝癌治疗中有效,并在肝细胞癌的治疗中发挥着非常重要的作用。TACE 后最常见的副作用是栓塞综合症,包括疼痛、发热、恶心和呕吐。恶性呕吐尤其是临床实践中面临的主要问题之一,需要患者和医生给予关注。恶心和呕吐会增加患者的心理和身体负担,增加患者的痛苦,并降低患者对治疗的依从性。严重的恶心和呕吐可能导致患者水电解质失衡,延长住院时间,并增加治疗费用。同时,肝细胞癌患者大多伴有肝硬化和食管胃静脉曲张,严重的恶心和呕吐会导致食管胃静脉曲张出血,导致患者死亡。TACE 后术后恶心和呕吐的机制尚不清楚。 本研究回顾性分析了患者数据,以探讨 TACE 后术后恶心和呕吐的机制及风险因素。

Materials and methods 材料与方法

General information 一般信息

The data of 221 patients who underwent TACE in the Department of Intervention, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2019 to December 2020 were collected. Inclusion criteria (1) Clinical or pathological diagnosis of primary hepatocellular carcinoma; (2) TACE treatment 2 2 <= 2\leq 2 times; (3) Child-Pugh classification of liver function [13] A or B, performance status score (ECOG) 0 1 0 1 0-10-1; (3) Aged 18-70 years old; (4) No use of molecular targeted drugs or immunotherapy; (5) No central nervous system disease, intestinal obstruction and other primary diseases that can lead to nausea and vomiting. Exclusion criteria: (1) Child-Pugh classification of liver function C, performance status score (ECOG) 2 2 >= 2\geq 2; (2) severe coagulopathy and can not be corrected; (3) cachexia or extensive distant metastasis of the tumor; (4) complete portal vein occlusion and collateral vessels; (5) renal insufficiency.
收集了 2019 年 1 月至 2020 年 12 月在华中科技大学同济医学院联合医院介入科接受 TACE 治疗的 221 名患者的数据。纳入标准:(1) 临床或病理诊断为原发性肝细胞癌;(2) TACE 治疗次数 2 2 <= 2\leq 2 ;(3) 肝功能 Child-Pugh 分级[13] A 或 B,表现状态评分(ECOG) 0 1 0 1 0-10-1 ;(4) 年龄在 18 至 70 岁之间;(5) 未使用分子靶向药物或免疫治疗;(6) 无中枢神经系统疾病、肠梗阻及其他可导致恶心和呕吐的原发疾病。排除标准:(1) 肝功能 Child-Pugh 分级 C,表现状态评分(ECOG) 2 2 >= 2\geq 2 ;(2) 严重凝血功能障碍且无法纠正;(3) 恶病质或肿瘤广泛远处转移;(4) 完全门静脉阻塞及侧支血管;(5) 肾功能不全。

Method 方法

Routine preparation, disinfection, draping. After local anesthesia with 2 % 2 % 2%2 \% lidocaine, the right femoral artery was punctured using the Seldinger technique and a 5 F vascular sheath was placed. The feeding artery of the tumor was identified by catheterization with a 5 F Yashino catheter to the celiac trunk and superior mesenteric artery for angiography. Then 2.7F microcatheter was superselectively cannulated into the tumor feeding artery, appropriate amount of Lipiodol + chemotherapeutic emulsion was slowly injected for embolization, and 300-500 um gelatin sponge particles were supplemented for embolization. The embolization endpoint was forward blood flow stasis in the tumor feeding artery. Chemotherapeutic drugs used during surgery are divided into two types: (1) lobaplatin 50 mg ; (2) epirubicin 30 mg . The amount of iodized oil used was 5 20 ml 5 20 ml 5-20ml5-20 \mathrm{ml}.Evaluation criteria for nausea and vomiting: Common Terminology Criteria for Adverse Events (CTCAE 5.0).
常规准备、消毒、铺巾。在使用 2 % 2 % 2%2 \% 利多卡因进行局部麻醉后,右股动脉采用塞尔丁格技术穿刺,并放置 5 F 血管鞘。通过 5 F Yashino 导管对肿瘤供血动脉进行导管插入,进行腹腔干和上肠系膜动脉的血管造影,确定肿瘤供血动脉。然后将 2.7F 微导管超选择性插入肿瘤供血动脉,缓慢注入适量的碘油+化疗乳剂进行栓塞,并补充 300-500 微米的明胶海绵颗粒进行栓塞。栓塞终点为肿瘤供血动脉前向血流停滞。手术中使用的化疗药物分为两种:(1)洛莫普拉丁 50 毫克;(2)表柔比星 30 毫克。使用的碘油量为 5 20 ml 5 20 ml 5-20ml5-20 \mathrm{ml} 。恶心和呕吐的评估标准:不良事件通用术语标准(CTCAE 5.0)。

Materials and drugs used for TACE: 5F vascular sheath (TERUMO5F-10CM, Terumo, Japan), 0.035 in. (RFGA35153M, Terumo, Japan), 5F Yashino catheter (Terumo, Japan), 2.7F microcatheter (Terumo, Japan). Lobaplatin (GYZZ H20050308, Hainan Chang’an International Pharmaceutical Co., Ltd.), epirubicin (GYZZ H19990280, Zhejiang Hisun Pharmaceutical Co., Ltd.).
TACE 使用的材料和药物:5F 血管鞘(TERUMO5F-10CM,泰尔茂,日本),0.035 英寸(RFGA35153M,泰尔茂,日本),5F Yashino 导管(泰尔茂,日本),2.7F 微导管(泰尔茂,日本)。洛铂(GYZZ H20050308,海南长安国际药业有限公司),表柔比星(GYZZ H19990280,浙江海顺药业有限公司)。

SPSS software (Version 24.0, IBM, Armonk, NewYork) was used to statistically analyze the data. Enumeration data are expressed by number of cases (percentage). Measurement data were expressed as mean ± ± +-\pm standard deviation. The models are multivariate, Binary logistic regression analysis was used, method used Enter, the indicator (first) was used for comparison, and P < 0.05 P < 0.05 P < 0.05P<0.05 was considered statistically significant.
SPSS 软件(版本 24.0,IBM,阿蒙克,纽约)用于对数据进行统计分析。计数数据以案例数(百分比)表示。测量数据以均值 ± ± +-\pm 标准差表示。模型为多变量,采用二元逻辑回归分析,使用的方法为进入法,指标(第一)用于比较, P < 0.05 P < 0.05 P < 0.05P<0.05 被认为具有统计学意义。

Results 结果

Basic information 基本信息

There were 136 (61.5%) male patients and 85 (38.5%) female patients. The age ranged from 24 to 69 years, with an average of 47.9 ± 12.0 47.9 ± 12.0 47.9+-12.047.9 \pm 12.0 years. Seventeen patients (7.7%) were aged 30 30 <= 30\leq 30 years, 133 ( 60.2 % 60.2 % 60.2%60.2 \% ) were aged 30 55 30 55 30-5530-55 years, and 71 ( 32.1 % ) 71 ( 32.1 % ) 71(32.1%)71(32.1 \%) were aged 55 55 >= 55\geq 55 years.
共有 136 名男性患者(61.5%)和 85 名女性患者(38.5%)。年龄范围为 24 至 69 岁,平均年龄为 47.9 ± 12.0 47.9 ± 12.0 47.9+-12.047.9 \pm 12.0 岁。17 名患者(7.7%)年龄为 30 30 <= 30\leq 30 岁,133 名( 60.2 % 60.2 % 60.2%60.2 \% )年龄为 30 55 30 55 30-5530-55 岁, 71 ( 32.1 % ) 71 ( 32.1 % ) 71(32.1%)71(32.1 \%) 名年龄为 55 55 >= 55\geq 55 岁。

Preoperative Child-Pugh classification of liver function: 157 patients ( 71 % 71 % 71%71 \% ) in class A and 64 patients (29%) in class B. ALT: 11-96 U/L, with an average of 44.2 ± 44.2 ± 44.2+-44.2 \pm 19.0 U/L. AST: 8 86 U / L 8 86 U / L 8-86U//L8-86 \mathrm{U} / \mathrm{L}, with an average of 42.0 ± 17.4 42.0 ± 17.4 42.0+-17.442.0 \pm 17.4 U/L. ALP: 40-198 U/L, with an average of 92.0 ± 26.8 U / 92.0 ± 26.8 U / 92.0+-26.8U//92.0 \pm 26.8 \mathrm{U} / L (Table 1). The causes of cirrhosis were hepatitis B in 196 patients ( 88.7 % 88.7 % 88.7%88.7 \% ) and hepatitis C C CC in 25 patients (11.3%). BCLC stage (12): 29 patients (13.1%) in stage A, 123 patients ( 55.7 % 55.7 % 55.7%55.7 \% ) in stage B, and 69 patients ( 31.2 % 31.2 % 31.2%31.2 \% ) in stage C. Preoperative analgesic drugs were used in 64 patients (29%) and no analgesic drugs were used in 157
术前 Child-Pugh 肝功能分级:157 名患者( 71 % 71 % 71%71 \% )属于 A 级,64 名患者(29%)属于 B 级。ALT:11-96 U/L,平均值为 44.2 ± 44.2 ± 44.2+-44.2 \pm 19.0 U/L。AST: 8 86 U / L 8 86 U / L 8-86U//L8-86 \mathrm{U} / \mathrm{L} ,平均值为 42.0 ± 17.4 42.0 ± 17.4 42.0+-17.442.0 \pm 17.4 U/L。ALP:40-198 U/L,平均值为 92.0 ± 26.8 U / 92.0 ± 26.8 U / 92.0+-26.8U//92.0 \pm 26.8 \mathrm{U} / L(表 1)。肝硬化的原因为 196 名患者( 88.7 % 88.7 % 88.7%88.7 \% )感染乙型肝炎,25 名患者(11.3%)感染丙型肝炎( C C CC )。BCLC 分期(12):29 名患者(13.1%)处于 A 期,123 名患者( 55.7 % 55.7 % 55.7%55.7 \% )处于 B 期,69 名患者( 31.2 % 31.2 % 31.2%31.2 \% )处于 C 期。64 名患者(29%)使用了术前镇痛药,157 名患者未使用镇痛药。
Table 1 Descriptive statistics
表 1 描述性统计
Minimum 最小值 Maximum 最大 Mean 平均 Std. Deviation 标准差
Age 年龄 24 69 47.92 11.998
ALT(U/L) ALT(上/下) 11 96 44.22 19.015
AST(U/L) AST(U/L) 8 86 42.06 17.366
ALP(U/L) ALP(U/L) 40 198 92.00 26.774
Minimum Maximum Mean Std. Deviation Age 24 69 47.92 11.998 ALT(U/L) 11 96 44.22 19.015 AST(U/L) 8 86 42.06 17.366 ALP(U/L) 40 198 92.00 26.774| | Minimum | Maximum | Mean | Std. Deviation | | :--- | :--- | :--- | :--- | :--- | | Age | 24 | 69 | 47.92 | 11.998 | | ALT(U/L) | 11 | 96 | 44.22 | 19.015 | | AST(U/L) | 8 | 86 | 42.06 | 17.366 | | ALP(U/L) | 40 | 198 | 92.00 | 26.774 |
Table 2 General information of patients
表 2 患者的一般信息
Frequency 频率 Percent 百分比
Gender 性别
Female 女性 112 50.7
Male 男性 109 49.3
Age group 年龄组
30 30 <= 30\leq 30 17 7.7
30-55 133 60.2
55 55 >= 55\geq 55 71 32.1
Child-Pugh Classification
Child-Pugh 分类
A 157 71.0
B 64 29.0
Etiology of liver cirrhosis
肝硬化的病因
Hepatitis B 乙型肝炎 196 88.7
Hepatitis C 丙型肝炎 25 11.3
BCLC stage BCLC 分期
A 29 13.1
B 123 55.7
C 69 31.2
History of vomiting 呕吐的历史
No  181 81.9
Yes 是的 40 18.1
Kinetosis 动晕症
No  177 80.1
Yes 是的 44 19.9
Smoking history 吸烟历史
No  179 81.0
Yes 是的 42 19.0
Alcohol history 酒精历史
No  172 77.8
Yes 是的 49 22.2
Use of analgesics 使用镇痛剂
No  157 71.0
Yes 是的 64 29.0
Chemotherapeutic drugs 化疗药物
Lobaplatin 洛巴铂 109 49.3
Epirubicin 依柔比星 112 50.7
Dosage of Lipiodol Lipiodol 的剂量
< 5 ml < 5 ml < 5ml<5 \mathrm{ml} 81 36.7
5 10 ml 5 10 ml 5-10ml5-10 \mathrm{ml} 85 38.5
> 10 ml > 10 ml > 10ml>10 \mathrm{ml} 55 24.9
Limosis before operation 手术前的淋巴水肿
No  110 49.8
Yes 是的 111 50.2
Frequency Percent Gender Female 112 50.7 Male 109 49.3 Age group <= 30 17 7.7 30-55 133 60.2 >= 55 71 32.1 Child-Pugh Classification A 157 71.0 B 64 29.0 Etiology of liver cirrhosis Hepatitis B 196 88.7 Hepatitis C 25 11.3 BCLC stage A 29 13.1 B 123 55.7 C 69 31.2 History of vomiting No 181 81.9 Yes 40 18.1 Kinetosis No 177 80.1 Yes 44 19.9 Smoking history No 179 81.0 Yes 42 19.0 Alcohol history No 172 77.8 Yes 49 22.2 Use of analgesics No 157 71.0 Yes 64 29.0 Chemotherapeutic drugs Lobaplatin 109 49.3 Epirubicin 112 50.7 Dosage of Lipiodol < 5ml 81 36.7 5-10ml 85 38.5 > 10ml 55 24.9 Limosis before operation No 110 49.8 Yes 111 50.2| | Frequency | Percent | | :---: | :---: | :---: | | Gender | | | | Female | 112 | 50.7 | | Male | 109 | 49.3 | | Age group | | | | $\leq 30$ | 17 | 7.7 | | 30-55 | 133 | 60.2 | | $\geq 55$ | 71 | 32.1 | | Child-Pugh Classification | | | | A | 157 | 71.0 | | B | 64 | 29.0 | | Etiology of liver cirrhosis | | | | Hepatitis B | 196 | 88.7 | | Hepatitis C | 25 | 11.3 | | BCLC stage | | | | A | 29 | 13.1 | | B | 123 | 55.7 | | C | 69 | 31.2 | | History of vomiting | | | | No | 181 | 81.9 | | Yes | 40 | 18.1 | | Kinetosis | | | | No | 177 | 80.1 | | Yes | 44 | 19.9 | | Smoking history | | | | No | 179 | 81.0 | | Yes | 42 | 19.0 | | Alcohol history | | | | No | 172 | 77.8 | | Yes | 49 | 22.2 | | Use of analgesics | | | | No | 157 | 71.0 | | Yes | 64 | 29.0 | | Chemotherapeutic drugs | | | | Lobaplatin | 109 | 49.3 | | Epirubicin | 112 | 50.7 | | Dosage of Lipiodol | | | | $<5 \mathrm{ml}$ | 81 | 36.7 | | $5-10 \mathrm{ml}$ | 85 | 38.5 | | $>10 \mathrm{ml}$ | 55 | 24.9 | | Limosis before operation | | | | No | 110 | 49.8 | | Yes | 111 | 50.2 |
Table 2 2 2\mathbf{2} General information of patients (Continued)
2 2 2\mathbf{2} 患者的一般信息(续)
Frequency 频率 Percent 百分比
Postoperative pain 术后疼痛
No  112 50.7
Yes 是的 109 49.3
Frequency Percent Postoperative pain No 112 50.7 Yes 109 49.3| | Frequency | Percent | | :--- | :--- | :--- | | Postoperative pain | | | | No | 112 | 50.7 | | Yes | 109 | 49.3 |
patients (71%). Preoperative limosis was performed in 111 patients (50.2%) and non-limosis in 110 patients (49.8%). Forty patients (18.1%) had a previous history of vomiting and 181 patients ( 81.9 % 81.9 % 81.9%81.9 \% ) had no history of vomiting. Forty-four patients (19.9%) had a history of kinetosis and 177 patients ( 80.1 % 80.1 % 80.1%80.1 \% ) had no history of kinetosis. Forty-two patients (19%) had a smoking history and 179 patients ( 81 % 81 % 81%81 \% ) had no smoking history. Forty-nine patients (22.2%) had a history of alcohol consumption and 172 patients ( 77.8 % 77.8 % 77.8%77.8 \% ) had no history of alcohol consumption. Chemotherapeutic drugs were used during surgery: lobaplatin in 109 patients (49.3%) and epirubicin in 112 patients (50.7%). The amount of lipiodol used was: < 5 ml < 5 ml < 5ml<5 \mathrm{ml} in 81 patients (36.7%), 5 10 ml 5 10 ml 5-10ml5-10 \mathrm{ml} in 85 patients (38.5%), and > 10 ml > 10 ml > 10ml>10 \mathrm{ml} in 55 patients (24.9%). Postoperative patients had pain in 109 patients ( 49.3 % 49.3 % 49.3%49.3 \% ) (Table 2). Postoperative nausea occurred in 116 patients (52.5%). Postoperative vomiting occurred in 89 patients ( 40.3 % ) ( 40.3 % ) (40.3%)(40.3 \%), and patients with postoperative vomiting were accompanied by nausea (Table 3) (Figs. 1 and 2).
患者(71%)。111 名患者(50.2%)进行了术前淋巴切除,110 名患者(49.8%)未进行淋巴切除。40 名患者(18.1%)有呕吐的既往史,181 名患者( 81.9 % 81.9 % 81.9%81.9 \% )没有呕吐史。44 名患者(19.9%)有运动病史,177 名患者( 80.1 % 80.1 % 80.1%80.1 \% )没有运动病史。42 名患者(19%)有吸烟史,179 名患者( 81 % 81 % 81%81 \% )没有吸烟史。49 名患者(22.2%)有饮酒史,172 名患者( 77.8 % 77.8 % 77.8%77.8 \% )没有饮酒史。手术中使用了化疗药物:109 名患者(49.3%)使用了洛铂,112 名患者(50.7%)使用了表柔比星。使用的油溶液量为: < 5 ml < 5 ml < 5ml<5 \mathrm{ml} 在 81 名患者(36.7%), 5 10 ml 5 10 ml 5-10ml5-10 \mathrm{ml} 在 85 名患者(38.5%), > 10 ml > 10 ml > 10ml>10 \mathrm{ml} 在 55 名患者(24.9%)。术后 109 名患者( 49.3 % 49.3 % 49.3%49.3 \% )有疼痛(表 2)。术后 116 名患者(52.5%)出现恶心。术后 89 名患者( ( 40.3 % ) ( 40.3 % ) (40.3%)(40.3 \%) )出现呕吐,术后呕吐的患者伴有恶心(表 3)(图 1 和图 2)。

Incidence of nausea after TACE
TACE 后恶心发生率

Nausea occurred in 116 patients (52.5%) after TACE. Binary logistic regression analysis (Table 4) was used, with the method using enter and the contrast using indicator (first).
在 116 名患者中,有 52.5%在 TACE 后出现恶心。使用二元逻辑回归分析(表 4),方法采用进入法,对比使用指标(第一)。

Sig( P P PP value): ALT0.003; ALP0.000; history of vomiting 0.043 ; kinetosis 0.006 ; history of alcohol consumption 0.011 ; preoperative limosis 0.006 ; dosage of lipiodol (510 mL ) 0.029 , dosage of lipiodol ( > 10 mL > 10 mL > 10mL>10 \mathrm{~mL} ) 0.001. The above are risk factors for post-TACE nausea. ( P < 0.05 ) ( P < 0.05 ) (P < 0.05)(P<0.05) OR values, Exp Exp Exp\operatorname{Exp} (B): ALT1.093; ALP0.894; history of vomiting 11.621; kinetosis 20.149; history of alcohol consumption 0.117 ; preoperative limosis 7.257 ; dosage of lipiodol ( 5 10 mL 5 10 mL 5-10mL5-10 \mathrm{~mL} ) 5.862, dosage of lipiodol (> 10 mL ) 43.920 .
Sig( P P PP 值): ALT0.003; ALP0.000; 呕吐史 0.043; 动晕症 0.006; 饮酒史 0.011; 术前淋巴水肿 0.006; 碘油剂量 (510 mL) 0.029, 碘油剂量 ( > 10 mL > 10 mL > 10mL>10 \mathrm{~mL} ) 0.001。以上是 TACE 后恶心的风险因素。 ( P < 0.05 ) ( P < 0.05 ) (P < 0.05)(P<0.05) OR 值, Exp Exp Exp\operatorname{Exp} (B): ALT1.093; ALP0.894; 呕吐史 11.621; 动晕症 20.149; 饮酒史 0.117; 术前淋巴水肿 7.257; 碘油剂量 ( 5 10 mL 5 10 mL 5-10mL5-10 \mathrm{~mL} ) 5.862, 碘油剂量 (> 10 mL) 43.920。
Incidence of vomiting after TACE
TACE 后呕吐发生率

Vomiting occurred in 89 patients (40.3%) after TACE, all of whom had nausea. Binary logistic regression analysis (Table 5) was used, with the method using enter and the contrast using the indicator (first).
在 TACE 后,有 89 名患者(40.3%)出现呕吐,所有患者均有恶心。使用二元逻辑回归分析(表 5),方法采用进入法,对比使用指标(第一)。

Sig ( P Sig ( P Sig(P\operatorname{Sig}(P value): ALPO.000; BCLC stage (B) 0.007; kinetosis 0.034 ; chemotherapeutic drugs 0.015 ; dosage of lipiodol ( 5 10 ml 5 10 ml 5-10ml5-10 \mathrm{ml} ) 0.015, dosage of lipiodol ( > 10 ml > 10 ml > 10ml>10 \mathrm{ml} ) 0.000 ; patients used analgesics before TACE 0.034 .
Sig ( P Sig ( P Sig(P\operatorname{Sig}(P 值): ALPO.000; BCLC 分期 (B) 0.007; 动晕症 0.034; 化疗药物 0.015; 碘油剂量 ( 5 10 ml 5 10 ml 5-10ml5-10 \mathrm{ml} ) 0.015, 碘油剂量 ( > 10 ml > 10 ml > 10ml>10 \mathrm{ml} ) 0.000; 患者在 TACE 之前使用镇痛药 0.034.
Table 3 Incidence of nausea and vomiting after TACE
表 3 TACE 后恶心和呕吐的发生率
Frequency 频率 Percent 百分比
Postoperative nausea 术后恶心
No  105 47.5
Yes 是的 116 52.5
Postoperative vomiting 术后呕吐
No  132 59.7
Yes 是的 89 40.3
Frequency Percent Postoperative nausea No 105 47.5 Yes 116 52.5 Postoperative vomiting No 132 59.7 Yes 89 40.3| | Frequency | Percent | | :--- | :---: | :---: | | | Postoperative nausea | | | No | 105 | 47.5 | | Yes | 116 | 52.5 | | | Postoperative vomiting | | | No | 132 | 59.7 | | Yes | 89 | 40.3 |
The above are risk factors for nausea and vomiting after TACE. ( P < 0.05 ) ( P < 0.05 ) (P < 0.05)(P<0.05) OR values, Exp (B): ALP0.959; BCLC stage (B) 5.906; kinetosis s 2.997; chemotherapeutic drugs 0.357 ; dosage of lipiodol ( 5 10 ml 5 10 ml 5-10ml5-10 \mathrm{ml} ) 3.196, dosage of lipiodol ( > 10 ml > 10 ml > 10ml>10 \mathrm{ml} ) 7.396; patients used analgesics before TACE 0.402 .
上述是 TACE 后恶心和呕吐的风险因素。 ( P < 0.05 ) ( P < 0.05 ) (P < 0.05)(P<0.05) OR 值,Exp (B):ALP 0.959;BCLC 阶段 (B) 5.906;运动病 2.997;化疗药物 0.357;碘油剂量 ( 5 10 ml 5 10 ml 5-10ml5-10 \mathrm{ml} ) 3.196,碘油剂量 ( > 10 ml > 10 ml > 10ml>10 \mathrm{ml} ) 7.396;患者在 TACE 前使用镇痛药 0.402。

Discussion 讨论

Nausea is a feeling of visceral discomfort that eventually reaches the climax of the response with vomiting. Vomiting is a protective reflex that refers to the process by which gastric contents are excreted from the body through the mouth. A variety of receptors have been found to trigger nausea and vomiting [14, 15]. (1) Visceral receptors: Visceral receptors are divided into mechanical and chemical receptors. Mechanical receptors are located in the gastrointestinal wall and are sensitive to traction stimulation of the gastrointestinal wall. Chemoreceptors are mainly located in the gastrointestinal mucosa and can sense changes in the internal environment of the digestive tract, irritation by drugs and poisons [16]. (2) Receptors of the area postrema: The area postrema is located on the dorsal surface of the medulla oblongata and at the level of the base latch of the
恶心是一种内脏不适的感觉,最终以呕吐达到反应的高潮。呕吐是一种保护性反射,指的是胃内容物通过口腔排出体外的过程。已经发现多种受体可以引发恶心和呕吐 [14, 15]。 (1) 内脏受体:内脏受体分为机械受体和化学受体。机械受体位于胃肠壁,对胃肠壁的牵拉刺激敏感。化学受体主要位于胃肠粘膜,能够感知消化道内部环境的变化、药物和毒素的刺激 [16]。 (2) 后区受体:后区位于延髓的背面,位于基底锁的水平。
Fig. 1 Postoperative nausea occurred in 116 patients (52.5%)
图 1 术后恶心发生在 116 名患者中(52.5%)
Fig. 2 Postoperative vomiting occurred in 89 patients (40.3%), and patients with postoperative vomiting were accompanied by nausea
图 2 术后呕吐发生在 89 名患者中(40.3%),术后呕吐的患者伴有恶心。

fourth ventricle. This structure is abundant and lacks the blood-brain barrier and the cerebrospinal fluid-brain barrier. Chemicals, certain peptides in the body, etc., can act on receptors in the area postrema to cause vomiting. (3) Vestibular Receptors: Vestibular receptors are abnormally stimulated (motor stimulation, position change) and can cause nausea and vomiting, but studies have shown that there is insufficient evidence that vestibular receptors play a direct role in vomiting caused by drug stimulation. (4) Descending signals in higher centers: Studies have found that certain psychiatric factors, hypotension, pain, increased intracranial pressure, and craniocerebral injury act descending on vomiting centers through different regions of the cerebral cortex, causing nausea and vomiting [17]. The mechanism of nausea and vomiting is not fully understood, but a variety of transmitters and receptors are known to be involved in this process, such as acetylcholine, epinephrine, norepinephrine, dopamine, histamine, serotonin, substance P, Yaminobutyric acid, and opioid receptors [18, 19].
第四脑室。该结构丰富,缺乏血脑屏障和脑脊液-脑屏障。化学物质、体内某些肽等可以作用于区后区的受体,引起呕吐。(3) 前庭受体:前庭受体受到异常刺激(运动刺激、位置变化),可以引起恶心和呕吐,但研究表明,前庭受体在药物刺激引起的呕吐中直接作用的证据不足。(4) 高级中枢的下行信号:研究发现,某些精神因素、低血压、疼痛、颅内压增高和颅脑损伤通过大脑皮层的不同区域对呕吐中枢产生下行作用,导致恶心和呕吐[17]。恶心和呕吐的机制尚未完全理解,但已知多种递质和受体参与这一过程,如乙酰胆碱、肾上腺素、去甲肾上腺素、多巴胺、组胺、血清素、P 物质、γ-氨基丁酸和阿片受体[18, 19]。

Postoperative nausea and vomiting (PONV)
术后恶心和呕吐 (PONV)

PONV is a common complication after surgical procedures, with an incidence of approximately 30% [20]. Without prevention, the incidence of PONV in the population is as high as 80 % 80 % 80%80 \% [21]. Common causes of PONV are: (1) anesthetic factors. The use of inhaled anesthetics and opioids, is an important factor causing PONV. (2) Surgical factors. Surgical trauma and inflammatory reactions, which can cause the release of serotonin, substance P , and other transmitters, result in nausea and vomiting. Studies have shown that the longer the operation time, the higher the risk of PONV. The
PONV 是手术后常见的并发症,发生率约为 30% [20]。如果不进行预防,PONV 在患者中的发生率高达 80 % 80 % 80%80 \% [21]。PONV 的常见原因有:(1) 麻醉因素。使用吸入麻醉剂和阿片类药物是导致 PONV 的重要因素。(2) 手术因素。手术创伤和炎症反应会导致血清素、P 物质和其他神经递质的释放,从而引起恶心和呕吐。研究表明,手术时间越长,PONV 的风险越高。
Table 4 Postoperative nausea after TACE, Binary logistic regression analysis
表 4 TACE 后术后恶心,二元逻辑回归分析

Hosmer and Lemeshow Test Hosmer 和 Lemeshow 检验
Step 步骤 Chi-square 卡方 df Sig. 签名
1 19.953 8 .611
Step Chi-square df Sig. 1 19.953 8 .611| Step | Chi-square | df | Sig. | | :--- | :--- | :--- | :--- | | 1 | 19.953 | 8 | .611 |
Variables in the Equation
方程中的变量

type of surgery is also one of the causes of PONV, such as hepatobiliary surgery, gynecological surgery, and otolaryngological surgery are more likely to develop PONV than other types of surgery [22]. (3) Patient factors. Young women, no smoking history, history of PONV, and history of kinetosis were risk factors confirmed by the study. Other possible risk factors are BMI, American Society of Anesthesiologists (ASA) classification, history of migraine, and menstrual cycle [23].
手术类型也是术后恶心呕吐(PONV)的原因之一,例如肝胆手术、妇科手术和耳鼻喉手术比其他类型的手术更容易发生 PONV [22]。 (3) 患者因素。年轻女性、无吸烟史、PONV 病史和晕动病史是研究确认的风险因素。其他可能的风险因素包括体重指数(BMI)、美国麻醉医师协会(ASA)分类、偏头痛病史和月经周期 [23]。
Chemotherapy-induced nausea and vomiting (CINV)
化疗引起的恶心和呕吐 (CINV)

Chemotherapy plays an important role in the treatment of malignant tumors, and CINV is one of the common adverse reactions of chemotherapy. Chemotherapeutic drugs can act directly on the intestinal mucosa through the intestinal lumen, or activate the chemoreceptor trigger zone through the blood circulation, which promotes the release of a variety of neurotransmitters and acts on the vomiting center, resulting in nausea and vomiting [24, 25]. The National Comprehensive Cancer Network classifies emetogenic antineoplastic agents into four levels [26], and different antineoplastic agents, have different emetogenic risks.
化疗在恶性肿瘤的治疗中发挥着重要作用,而化疗引起的恶心呕吐(CINV)是化疗常见的不良反应之一。化疗药物可以通过肠腔直接作用于肠粘膜,或通过血液循环激活化学感受器触发区,促进多种神经递质的释放并作用于呕吐中枢,从而导致恶心和呕吐[24, 25]。国家综合癌症网络将致吐性抗肿瘤药物分为四个等级[26],不同的抗肿瘤药物具有不同的致吐风险。

Mechanism of nausea and vomiting after TACE
经动脉化疗栓塞后恶心和呕吐的机制

Similar to surgery, TACE is an invasive treatment that may cause pain and inflammatory reaction of organs, and patients may use analgesics. The differences between TACE and surgical operation include: (1) TACE is usually a local anesthesia operation, which is generally
类似于手术,TACE 是一种侵入性治疗,可能会引起疼痛和器官的炎症反应,患者可能会使用镇痛药。TACE 与手术操作之间的区别包括:(1)TACE 通常是局部麻醉操作,通常
Table 5 Postoperative vomiting after TACE, Binary logistic regression analysis
表 5 TACE 后术后呕吐,二元逻辑回归分析

Hosmer and Lemeshow Test Hosmer 和 Lemeshow 检验
Step 步骤 Chi-square 卡方 df Sig. 签名
1 7.017 8 .535
Step Chi-square df Sig. 1 7.017 8 .535| Step | Chi-square | df | Sig. | | :--- | :--- | :--- | :--- | | 1 | 7.017 | 8 | .535 |
Variables in the Equation
方程中的变量
B Sig. 签名 OR 95% C.I.for OR 95% 置信区间 (C.I.) 对于 OR
Lower 下方 Upper 上部
Step 1a 步骤 1a Gender(1) 性别(1) -015 .969 985 .462 2.101
Age group( < 30 y < 30 y < 30 y<30 y )
年龄组( < 30 y < 30 y < 30 y<30 y
660
Age group(30-55y) (1) 年龄组(30-55 岁)(1) -677 .362 .508 .118 2.181
Age group(>55y) (2) 年龄组(>55 岁) (2) -.593 463 553 .113 2.695
Child-Pugh Classification (1)
Child-Pugh 分类 (1)
1.023 .084 2.783 .871 8.886
ALT .022 .172 1.022 .990 1.055
AST -004 .811 .996 .962 1.031
ALP -.042 .000 959 .939 .979
Etiology of liver cirrhosis (1)
肝硬化的病因 (1)
. 150 .802 1.161 361 3.732
BCLC stage(BCLC A) BCLC 阶段(BCLC A) .001
BCLC stage (BCLC B) (1)
BCLC 阶段(BCLC B)(1)
1.776 .007 5.906 1.641 21.252
BCLC stage (BCLC C) (2)
BCLC 阶段(BCLC C)(2)
.229 .747 1.258 .313 5.060
History of vomiting (1) 呕吐的历史 (1) .712 . 157 2.039 .760 5.470
Kinetosis (1) 运动病 (1) 1.097 .034 2.997 1.087 8.258
Smoking history (1) 吸烟历史 (1) .114 .823 1.121 .412 3.048
Alcohol history (1) 酒精历史 (1) . 141 .787 1.151 414 3.201
Chemotherapeutic drugs (1)
化疗药物 (1)
-1.029 .015 357 .156 .819
Dosage of Lipiodol ( < 5 ml < 5 ml < 5ml<5 \mathrm{ml} )
Lipiodol 的剂量( < 5 ml < 5 ml < 5ml<5 \mathrm{ml}
.001

碘油剂量(5-10 毫升)(1)
Dosage of Lipiodol(5-10ml)
(1)
Dosage of Lipiodol(5-10ml) (1)| Dosage of Lipiodol(5-10ml) | | :--- | | (1) |
1.162 .015 3.196 1.251 8.166

脂溶性碘油剂量(>10 毫升)(2)
Dosage of Lipiodol (>10ml)
(2)
Dosage of Lipiodol (>10ml) (2)| Dosage of Lipiodol (>10ml) | | :--- | | (2) |
2.001 .000 7.396 2.537 21.561
Use of analgesics (1) 使用镇痛剂 (1) -911 .034 402 .173 936
Postoperative pain (1) 术后疼痛 (1) .528 . 194 1.695 .764 3.761
Limosis before operation (1)
手术前的淋巴水肿 (1)
.558 . 159 1.748 .804 3.801
Constant 常数 607 .626 1.835
https://cdn.mathpix.com/cropped/2024_10_02_1ae20844a8432a3e2f0eg-6.jpg?height=100&width=635&top_left_y=537&top_left_x=277 B Sig. OR 95% C.I.for OR Lower Upper Step 1a Gender(1) -015 .969 985 .462 2.101 Age group( < 30 y ) 660 Age group(30-55y) (1) -677 .362 .508 .118 2.181 Age group(>55y) (2) -.593 463 553 .113 2.695 Child-Pugh Classification (1) 1.023 .084 2.783 .871 8.886 ALT .022 .172 1.022 .990 1.055 AST -004 .811 .996 .962 1.031 ALP -.042 .000 959 .939 .979 Etiology of liver cirrhosis (1) . 150 .802 1.161 361 3.732 BCLC stage(BCLC A) .001 BCLC stage (BCLC B) (1) 1.776 .007 5.906 1.641 21.252 BCLC stage (BCLC C) (2) .229 .747 1.258 .313 5.060 History of vomiting (1) .712 . 157 2.039 .760 5.470 Kinetosis (1) 1.097 .034 2.997 1.087 8.258 Smoking history (1) .114 .823 1.121 .412 3.048 Alcohol history (1) . 141 .787 1.151 414 3.201 Chemotherapeutic drugs (1) -1.029 .015 357 .156 .819 Dosage of Lipiodol ( < 5ml ) .001 "Dosage of Lipiodol(5-10ml) (1)" 1.162 .015 3.196 1.251 8.166 "Dosage of Lipiodol (>10ml) (2)" 2.001 .000 7.396 2.537 21.561 Use of analgesics (1) -911 .034 402 .173 936 Postoperative pain (1) .528 . 194 1.695 .764 3.761 Limosis before operation (1) .558 . 159 1.748 .804 3.801 Constant 607 .626 1.835 | ![](https://cdn.mathpix.com/cropped/2024_10_02_1ae20844a8432a3e2f0eg-6.jpg?height=100&width=635&top_left_y=537&top_left_x=277) | | B | Sig. | OR | 95% C.I.for OR | | | :---: | :---: | :---: | :---: | :---: | :---: | :---: | | | | Lower | | | Upper | | Step 1a | Gender(1) | | -015 | .969 | 985 | .462 | 2.101 | | | Age group( $<30 y$ ) | | 660 | | | | | | Age group(30-55y) (1) | -677 | .362 | .508 | .118 | 2.181 | | | Age group(>55y) (2) | -.593 | 463 | 553 | .113 | 2.695 | | | Child-Pugh Classification (1) | 1.023 | .084 | 2.783 | .871 | 8.886 | | | ALT | .022 | .172 | 1.022 | .990 | 1.055 | | | AST | -004 | .811 | .996 | .962 | 1.031 | | | ALP | -.042 | .000 | 959 | .939 | .979 | | | Etiology of liver cirrhosis (1) | . 150 | .802 | 1.161 | 361 | 3.732 | | | BCLC stage(BCLC A) | | .001 | | | | | | BCLC stage (BCLC B) (1) | 1.776 | .007 | 5.906 | 1.641 | 21.252 | | | BCLC stage (BCLC C) (2) | .229 | .747 | 1.258 | .313 | 5.060 | | | History of vomiting (1) | .712 | . 157 | 2.039 | .760 | 5.470 | | | Kinetosis (1) | 1.097 | .034 | 2.997 | 1.087 | 8.258 | | | Smoking history (1) | .114 | .823 | 1.121 | .412 | 3.048 | | | Alcohol history (1) | . 141 | .787 | 1.151 | 414 | 3.201 | | | Chemotherapeutic drugs (1) | -1.029 | .015 | 357 | .156 | .819 | | | Dosage of Lipiodol ( $<5 \mathrm{ml}$ ) | | .001 | | | | | | Dosage of Lipiodol(5-10ml) <br> (1) | 1.162 | .015 | 3.196 | 1.251 | 8.166 | | | Dosage of Lipiodol (>10ml) <br> (2) | 2.001 | .000 | 7.396 | 2.537 | 21.561 | | | Use of analgesics (1) | -911 | .034 | 402 | .173 | 936 | | | Postoperative pain (1) | .528 | . 194 | 1.695 | .764 | 3.761 | | | Limosis before operation (1) | .558 | . 159 | 1.748 | .804 | 3.801 | | | Constant | 607 | .626 | 1.835 | | |
a puncture site injection of local anesthetics and does not require the use of inhaled anesthetics; (2) TACE usually uses chemotherapeutic drugs; chemotherapeutic drugs are generally not used through vascular route during surgery; (3) TACE embolizes tumor feeding artery, which will lead to tumor ischemia, hypoxia, necrosis and aseptic inflammation; while surgical operation includes organ trauma and traction. Similar to chemotherapy, chemotherapeutic agents will be used during TACE. However, the dose of chemotherapeutic drugs used during surgery was significantly lower in TACE than in chemotherapy. Moreover, compared with chemotherapy, TACE performed embolization of tumor vessels, resulting in ischemia of the tissue. Because of the differences between TACE and surgery and chemotherapy, the causes of nausea and vomiting after TACE are not exactly the same as those of PONV and CINV. We believe that the causes of nausea and vomiting after TACE include: (1) trauma caused by operation, aseptic inflammation caused by ischemia and hypoxia, inducing the release of a variety of transmitters; (2) intraoperative use of chemotherapeutic drugs, through the blood circulation, stimulating the chemoreceptors of the gastrointestinal tract; especially during TACE, chemotherapeutic drugs are often injected through the celiac trunk or superior mesenteric artery branches, while the celiac trunk or superior mesenteric artery has vascular branches directly supplying the gastrointestinal tract; epirubicin and
局部麻醉药的穿刺部位注射,不需要使用吸入麻醉药;(2)TACE 通常使用化疗药物;化疗药物在手术期间通常不通过血管途径使用;(3)TACE 栓塞肿瘤供血动脉,导致肿瘤缺血、缺氧、坏死和无菌性炎症;而手术操作包括器官创伤和牵拉。与化疗类似,TACE 期间也会使用化疗药物。然而,TACE 期间使用的化疗药物剂量明显低于化疗。此外,与化疗相比,TACE 进行了肿瘤血管的栓塞,导致组织缺血。由于 TACE 与手术和化疗之间的差异,TACE 后恶心和呕吐的原因与术后恶心呕吐(PONV)和化疗引起的恶心呕吐(CINV)并不完全相同。我们认为,TACE 后恶心和呕吐的原因包括:(1)手术造成的创伤、缺血和缺氧引起的无菌炎症,诱导多种递质的释放;(2)术中使用化疗药物,通过血液循环刺激胃肠道的化学感受器;特别是在 TACE 过程中,化疗药物通常通过腹腔干或上肠系膜动脉分支注入,而腹腔干或上肠系膜动脉有直接供应胃肠道的血管分支;表阿霉素和

platinum used during TACE are chemotherapeutic drugs with moderate to high emetic risk; (3) the organs involved in TACE are the liver and gallbladder, and hepatic artery embolization will lead to hepatobiliary ischemia; similar to the causes of PONV, hepatobiliary surgery is more likely to have postoperative nausea and vomiting than other surgeries; (4) stress and pain during TACE will lead to the release of dopamine, epinephrine and other transmitters, leading to nausea and vomiting; (5) patient factors, such as young women, no history of smoking, history of PONV, and history of kinetosis [27].
在 TACE 过程中使用的铂类药物是具有中等到高呕吐风险的化疗药物;(3)TACE 涉及的器官是肝脏和胆囊,肝动脉栓塞会导致肝胆缺血;与 PONV 的原因类似,肝胆手术比其他手术更容易出现术后恶心和呕吐;(4)TACE 过程中的压力和疼痛会导致多巴胺、肾上腺素等神经递质的释放,从而引发恶心和呕吐;(5)患者因素,如年轻女性、无吸烟史、PONV 史和晕动症史[27]。

Risk factors of nausea and vomiting after TACE
经动脉化疗栓塞后恶心和呕吐的风险因素

Binary logistic regression analysis showed that ALP, BCLC stage, kinetosis, chemotherapeutic drugs, dosage of lipiodol and preoperative use of analgesics were risk factors affecting nausea and vomiting after TACE. Similar to PONV and CINV, the history of kinetosis was a risk factor for nausea and vomiting after TACE [28], and the OR for nausea and vomiting after TACE was 2.997 in patients with a history of kinetosis relative to those without a history. Compared with BCLC A stage, BCLC B stage has higher risk of postoperative nausea and vomiting, and may be multinodular liver cancer or massive liver cancer in BCLC B stage, with more dosage of embolic agent and wider embolization range. Lipiodol dose is a risk factor for nausea and vomiting after TACE. It was considered that the more lipiodol is used, the wider the embolization range, the more severe the tissue ischemia and hypoxia, aseptic inflammation and more transmitters are released. Kabuki M [29] etal shows that the multivariate logistic regression model with a predictive success of 92.4 % 92.4 % 92.4%92.4 \% for vomiting identified significant associations between female gender (odds ratio: 3.73 , p < 0.001 p < 0.001 p < 0.001p<0.001 ), the number of tumors ( 1.29 , p < 0.01 1.29 , p < 0.01 1.29,p < 0.011.29, p<0.01 ), and administration of pentazocine ( 11.70 , p < 0.05 11.70 , p < 0.05 11.70,p < 0.0511.70, p<0.05 ) with the risk of vomiting. The results of this study showed that chemotherapeutic drugs were the risk factors of postoperative nausea and vomiting after TACE. The incidence of postoperative nausea and vomiting was higher in patients who used lobaplatin during the operation. Several studies showed that the use of lobaplatin emulsion for embolization resulted in a higher tumor necrosis rate. Possibly, due to this reason, the more necrotic substances were released after TACE, the more severe the inflammatory response, and the risk of postoperative nausea and vomiting. The results showed that ALP was a risk factor for nausea and vomiting after TACE. The risk of postoperative nausea and vomiting in patients with low ALP level was consistent with the results of Wang [27], Wang etal.found out patients who developed vomiting, compared to those who did not, also had lower levels ( < 100 IU / L < 100 IU / L < 100IU//L<100 \mathrm{IU} / \mathrm{L} ) of serum ALP (112.52 ± 62.63 ± 62.63 +-62.63\pm 62.63 vs. 160.10 ± 127.80 160.10 ± 127.80 160.10+-127.80160.10 \pm 127.80, respectively, p = 0.010 p = 0.010 p=0.010p=0.010 ), and serum alanine transferase (ALT) ( 35.61 ± 22.87 35.61 ± 22.87 35.61+-22.8735.61 \pm 22.87 vs. 44.97 ± 44.97 ± 44.97+-44.97 \pm 29.62, respectively, p = 0.045 p = 0.045 p=0.045p=0.045 ). wang etal. Observed that lower levels of ALP ( < 100 IU / L < 100 IU / L < 100IU//L<100 \mathrm{IU} / \mathrm{L} ) occurred more frequently in patients with lower levels of ALT, AST and LDH ( p = 0.002 , p = 0.000 ( p = 0.002 , p = 0.000 (p=0.002,p=0.000(p=0.002, p=0.000