腰椎融合术术前疼痛敏感性与术后疼痛程度和镇痛需求的关系  

The relationship between preoperative pain sensitivity and postoperative pain severity and pain demand in lumbar fusion surgery

作　　者：袁敏[1] YUAN Min(People′s Hospital of Wuhan University,Wuhan,Hubei 430060,China)

机构地区：[1]武汉大学人民医院,湖北武汉430060

出　　处：《颈腰痛杂志》2024年第4期705-709,共5页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨腰椎融合术术前疼痛敏感性与术后疼痛程度和镇痛需求的关系。方法选择2022年1月至2023年6月在该院接受单节段腰椎融合术的67例患者作为研究对象,评估患者术前四个场景[肘静脉抽血、头孢类药物皮试、指尖血糖、测定腰椎活动范围(ROM)]时的视觉模拟疼痛评分(VAS)、热痛阈、机械痛阈、医院焦虑抑郁量表得分(HADS)、疼痛敏感性问卷得分(PSQ)、Oswestry功能障碍指数(ODI),采用Person相关性分析评估数据之间的相关性,采用二分类多因素Logistic回归分析术前疼痛敏感性与突破性镇痛之间的关系。结果Person相关性分析显示,性别与肘静脉抽血、头孢皮试、指尖血糖、测定腰椎ROM时的VAS评分呈正相关(P<0.05),与术前机械痛阈和热痛阈呈负相关(P<0.05)。年龄、BMI、术前诊断、融合节段等与术前VAS测试及痛阈均无显著相关性(P>0.05)。Person相关性分析显示,术前肘静脉抽血、药物皮试、指尖血糖、测定腰椎ROM时VAS评分与术后2~48 h的VAS评分均呈显著正相关(P<0.05)。术前热痛阈和机械痛阈与术后2~48 h的VAS评分呈显著负相关(P<0.05)。HAD-A、HAD-D和PSQ评分与术后2~48 h的VAS评分呈显著正相关(P<0.05)。二分类Logistic分析结果显示,术前机械痛阈是术后突破性镇痛的保护因素(P<0.05),HAD-S是术后突破性镇痛的风险因素(P<0.05)。结论术前患者疼痛敏化与术后疼痛相关,机械痛阈有助于预测腰椎融合术后突破性镇痛的发生。Objective To explore the relationship between preoperative pain sensitivity and postoperative pain severity and pain demand in lumbar fusion surgery.Method 67 patients who underwent single segment lumbar fusion surgery in our hospital from January 2022 to June 2023 were selected as the study subjects.The patients′visual analog pain score(VAS)[elbow vein blood sampling,cephalosporin skin test,fingertip blood glucose,measurement of lumbar range of motion(ROM)],thermal pain threshold,mechanical pain threshold,hospital anxiety and depression scale(HADS),pain sensitivity questionnaire(PSQ),and Oswestry dysfunction index(ODI)were evaluated four times before surgery.The correlation between data was evaluated using Person correlation,and the relationship between preoperative pain sensitivity and breakthrough analgesia was analyzed using binary multivariate logistic regression.Results The Person correlation showed that gender was positively correlated with elbow vein bleeding,cephalosporin skin test,fingertip blood glucose,and VAS during lumbar ROM measurement(P<0.05),while negatively correlated with preoperative mechanical pain threshold and thermal pain threshold(P<0.05).Age,BMI,preoperative diagnosis,fusion segment,etc.were not significantly correlated with preoperative VAS testing and pain threshold(P>0.05).The Person correlation showed a significant positive correlation between preoperative elbow vein bleeding,medication skin test,fingertip blood glucose,and VAS score during lumbar ROM measurement and VAS score at 2~48 hours after surgery(P<0.05).The preoperative thermal pain threshold and mechanical pain threshold were significantly negatively correlated with VAS at 2~48 h after surgery(P<0.05).The HAD-A,HAD-D,and PSQ scores were significantly positively correlated with VAS at 2~48 hours after surgery(P<0.05).The binary logistic analysis results showed that preoperative mechanical pain threshold was a protective factor for postoperative breakthrough analgesia(P<0.05),while HAD-S was a risk factor for postoperative

关 键 词：腰椎融合术 疼痛敏感性 痛阈 疼痛 镇痛 

分 类 号：R687.3[医药卫生—骨科学]