胸腹部肿瘤手术患者术后中重度疼痛的危险因素  

Risk factors for moderate and severe postoperative pain in patients undergoing thoracic or abdominal tumor surgery

作　　者：王迪 缪长虹 陈万坤 张建锋[1] 陈小红[1] 郁燕[1] 陈烨 尹倩 刁怀悦 曹汉忠[1] Wang Di;Miao Changhong;Chen Wankun;Zhang Jianfeng;Chen Xiaohong;Yu Yan;Chen Ye;Yin Qian;Diao Huaiyue;Cao Hanzhong(Department of Anesthesiology,Affiliated Cancer Hospital of Nantong University,Nantong 226361,China;Department of Anesthesiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]南通大学附属肿瘤医院麻醉科,226361 [2]复旦大学附属中山医院麻醉科,200032

出　　处：《中华麻醉学杂志》2020年第9期1071-1074,共4页Chinese Journal of Anesthesiology

基　　金：国家重点研发计划重点专项(2020YFC2008400)。

摘　　要：目的筛选胸腹部肿瘤手术患者术后中重度疼痛的危险因素。方法收集本院无线镇痛管理系统数据库内2016年1月1日至2018年10月22日行胸腹部肿瘤手术患者资料,均采用术后智能化PCA管理,年龄≥18岁,性别不限,ASA分级Ⅰ~Ⅳ级。麻醉方法为静吸复合麻醉。根据术后72 h内静态或动态疼痛数字评分(NRS)分为中重度疼痛(中度疼痛:静态或动态NRS评分4~6分,重度疼痛:静态或动态NRS评分≥7分)组和非中重度疼痛组。收集患者一般情况指标、镇痛方式、手术方式及手术类型等情况。采用多因素logistic回归分析筛选术后中重度疼痛的危险因素。结果本研究共纳入4394例患者,中重度疼痛组1194例,非中重度疼痛组3200例,中重度疼痛发生率27.17%。多因素logistic回归分析结果显示:男性、年龄46~69岁、饮酒史、开放手术、胸部及胸腹部联合手术是肿瘤手术患者术后中重度疼痛的危险因素(P<0.05)。结论男性、年龄46~69岁、饮酒史、开放手术、胸部及胸腹部联合手术是胸腹部肿瘤手术患者术后中重度疼痛的危险因素。Objective To determine the risk factors for moderate and severe postoperative pain in the patients undergoing thoracic or abdominal tumor surgery.Methods Data of thoracic or abdominal tumor patients of both sexes,aged≥18 yr,of American Society of Anesthesiologists physical statusⅠ-Ⅳ,underwent postoperative Ai-PCA management from January 1,2016 to October 22,2018 searched from the wireless analgesia management system database in our hospital,were collected.Combined intravenous-inhalational anesthesia was used during surgery.According to the numerical rating scale(NRS)scores at rest or during activity within 72 h after surgery,the patients were divided into moderate-to-severe pain group(moderate pain:NRS scores at rest or during activity 4-6,severe pain:NRS score at rest or during activity≥7)and non-moderate-to-severe pain group.The patients′baseline characteristics,methods of analgesia,surgical methods,and types of surgery were collected.Multivariate logistic regression analysis was used to identity the risk factors for postoperative moderate and severe pain.Results A total of 4394 patients were included in this study,including 1194 patients in moderate-to-severe pain group,and 3200 patients in non-moderate-to-severe pain group,and the incidence of moderate to severe pain was 27.17%.The results of multivariate logistic regression analysis showed that male,age 46-69 yr,history of drinking,open surgery and thoracic and abdominal surgery were the risk factors for postoperative moderate and severe pain(P<0.05).Conclusion Male,age 46-69 yr,history of drinking,open surgery,thoracic surgery and thoracic and abdominal surgery are the risk factors for postoperative moderate and severe pain in the patients undergoing thoracic or abdominal tumor surgery.

关 键 词：疼痛 手术后 肿瘤 危险因素 

分 类 号：R614[医药卫生—麻醉学] R730.56[医药卫生—外科学]