肺癌根治术后慢性疼痛的发生率和危险因素及对患者生活质量的影响  

Occurrence,risk factors,and impact on quality of life of chronic post-surgical pain following radical lung cancer surgery

作　　者：吴光玲[1] 马红霞[1] 钟巍[1] 周俊辉[1] WU Guang-ling;MA Hong-xia;ZHONG Wei;ZHOU Jun-hui(Department of Anesthesiology,Henan Provincial Chest Hospital,the Affiliated Chest Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]河南省胸科医院,郑州大学附属胸科医院麻醉科,郑州450000

出　　处：《医药论坛杂志》2024年第15期1595-1600,共6页Journal of Medical Forum

基　　金：河南省科技研发计划联合基金(应用攻关类)(232103810054);河南省医学科技攻关计划联合共建项目(LHGJ20200220)。

摘　　要：目的本研究旨在通过前瞻性队列研究的方式,深入分析肺癌根治术后慢性疼痛(chronic post-surgical pain syndrome,CPSP)的发生率、相关危险因素及对患者生活质量(quality of life,QoL)的具体影响。方法本研究选择从2022年3月至2023年3月在河南省胸科医院接受肺癌根治术治疗的2118例患者作为研究对象,年龄18~65岁,且美国麻醉医师协会(ASA)分级为Ⅰ至Ⅲ级。详细记录患者的年龄、性别、体重指数(body mass index,BMI)、文化程度、婚姻状况、居住情况、职业状态、术前手术部位的疼痛情况、并存疾病、手术类型、手术时间以及麻醉方式等信息,并在术后2天内记录患者的最高数字评价量表(numerical Rating Scale,NRS)评分。在术后3个月、6个月和12个月对患者进行随访,以了解CPSP的发生情况。根据是否发生CPSP,将患者分为CPSP组和非CPSP组,并运用多因素logistic回归分析来识别CPSP的危险因素,同时评估两组患者的QoL。结果在2118例患者中,所有人均完成了住院期间的调查。有248例患者在术后12个月的随访中失访,失访率为11.7%。最终,1870例患者成功完成了术后12个月的随访,随访成功率为88.3%。结果显示,CPSP的总发生率为33.3%,其中术后病程在3至6个月内的患者占32.5%,6至12个月的占20.7%,而病程超过12个月的占46.8%。进一步分析发现,女性、术前焦虑及抑郁评分高、术前手术部位疼痛、未合并糖尿病、开胸手术、未联合使用经静脉患者自控镇痛(patient controlled intravenousanalgesia,PCIA)+胸椎旁神经阻滞(thoracic paravertebral block,TPVB)镇痛方案以及术后14天内最高NRS评分高是CPSP的独立危险因素(P<0.05)。与非CPSP组相比,CPSP组在生理功能、生理职能、躯体镇痛、活力、社会功能、情感职能、心理健康和总体健康等方面的QoL评分均显著降低(P<0.05)。结论肺癌根治术患者CPSP不仅发生率较高,且病程较长,严重影响患者�Objective This study aimed to investigate the occurrence,risk factors,and impact on quality of life(QoL)of chronic post-surgical pain(CPSP)after radical lung cancer surgery through a prospective cohort study.Methods A total of 2118 patients aged 18 to 65 years,with American Society of Anesthesiologists(ASA)classification Ⅰ to Ⅲ,who underwent radical lung cancer surgery at Henan Provincial Chest Hospital from March 2022 to March 2023 were enrolled in this study.Demographic information such as age,gender,body mass index(BMI),educational level,marital status,living situation,occupational status,preoperative pain at the surgical site,comorbidities,surgical type,duration of surgery,and anesthesia method were recorded.The highest numerical rating scale(NRS)score within 2 days after surgery was also recorded.Follow-up assessments were performed at 3,6,and 12 months post-surgery to evaluate the occurrence of CPSP.Patients were divided into CPSP and non-CPSP groups based on the occurrence of CPSP.Multivariate logistic regression analysis was used to identify risk factors for CPSP,and QoL scores were assessed in both groups.Results All 2118 patients completed the in-hospital survey.However,248 patients were lost to follow-up at 12 months,resulting in a loss to follow-up rate of 11.7%.Ultimately,1870 patients successfully completed the 12-month follow-up,with a follow-up success rate of 88.3%.The overall occurrence rate of CPSP was 33.3%,with 32.5% of patients experiencing CPSP between 3 and 6 months,20.7% between 6 and 12 months,and 46.8% with a duration of more than 12 months.Further analysis revealed that female gender,high preoperative anxiety and depression scores,preoperative pain at the surgical site,non-diabetes comorbidity,open-chest surgery,non-combined use of PCIA and TPVB analgesia protocol,and high NRS scores within 14 days after surgery were independent risk factors for CPSP(P<0.05).Compared with the non-CPSP group,the CPSP group had significantly lower QoL scores in terms of physical function,role-physica

关 键 词：疼痛 胸外科手术 危险因素 生活质量 

分 类 号：R734[医药卫生—肿瘤]