定量感觉温度测试在预测胸腔镜术后慢性疼痛中的作用  

EFFECT OF QUANTITATIVE SENSORY THERMAL TESTING NO THE PREDICTING THE MORBIDITY OF CHRONIC PAIN AFTER VIDEO-ASSISTED THORACOSCOPIC SURGERY

作　　者：吉晓琳[1] 冯艺[1] 何苗[1] 王广[1] 

机构地区：[1]北京大学人民医院麻醉与疼痛医学科,北京100044

出　　处：《中国疼痛医学杂志》2014年第7期472-475,共4页Chinese Journal of Pain Medicine

摘　　要：目的:评价定量感觉测试(quantitative sensory testing,QST)对预测胸腔镜手术(video-assisted thoracoscopic surgery,VATS)术后慢性疼痛的价值。方法:针对100名胸腔镜肺叶切除术患者于术前和拔除胸腔引流管后在手术切口肋间前缘皮肤进行QST,于术后3个月以疼痛调查问卷形式随访。根据随访结果将患者分为P组(慢性疼痛组)和N组(无慢性疼痛组)。结果:33.3%(32/96)的患者存在慢性疼痛,其中81.25%(26/32)的慢性疼痛患者倾向于神经病理性疼痛。P组冷痛阈值差异显著高于N组(P=0.021),冷感、温感及热痛阈值改变两组比较,差异无统计学意义。冷痛阈值差异是VATS后3个月慢性疼痛的独立预测因素(OR 1.046,P=0.024)。结论:大多数VATS后慢性疼痛可能是神经病理性疼痛,QST冷痛阈值差异是VATS后3个月慢性疼痛的独立预测因素。Objective： To evaluate the value of predicting morbidity of chronic pain after video-assisted thoracoscopic surgery（VATS） by perioperative quantitative sensory testing（QST）. Methods： A total of 100 patients who were scheduled to undergo video-assisted thoracoscopic lobectomy were enrolled. In all patients, the proximal intercostal skin adjacent to incision was tested by QST before surgery and after extraction of the chest drainage tube. At 3 months after surgery the patients were followed-up and received questionnaires about the details of pain. According to the follow-up results, the patients were divided into two groups： chronic pain group（Group P） and non-chronic pain group（Group N）. Results： The incidence of chronic pain was 33.3%（32/96）, and 81.25%（26/32） of the chronic pain showed neuropathic tendency. The change in cold pain threshold in Group P was significantly higher than that of Group N（P = 0.021）. The differences for changes in cold, warm detection thresholds, and hot pain thresholds between the two groups were not statistically significant. The change in cold pain threshold was the predictive factor of chronic pain after VATS（OR=1.046, P = 0.024）. Conclusion： Most chronic pain after VATS is possibly neuropathic. The change in perioperative cold pain threshold for the proximal intercostal skin adjacent to incision is a predictive factor of chronic pain at 3 months after VATS.

关 键 词：胸腔镜术后慢性疼痛 神经病理性疼痛 定量感觉测试 

分 类 号：R655[医药卫生—外科学]