术前衰弱对胸外科老年患者术后慢性疼痛的预测价值  

Predictive value of preoperative frailty for chronic post-surgical pain in elderly patients in department of thoracic surgery

作　　者：孟振昂 陈丽莉 樊金燕 张传武 王光磊 MENG Zhen-ang;CHEN Li-li;FAN Jin-yan;ZHANG Chuan-wu;WANG Guang-lei(Department of Anesthesiology,the Affiliated Hospital of Xuzhou Medical University,Jiangsu Province,Xuzhou 221000,China)

机构地区：[1]徐州医科大学附属医院麻醉科,江苏徐州221000

出　　处：《河北医科大学学报》2025年第2期195-201,共7页Journal of Hebei Medical University

基　　金：江苏省自然科学基金(BK20220474)。

摘　　要：目的评价术前衰弱对胸外科老年患者术后慢性疼痛(chronic postsugrical pain,CPSP)的预测价值。方法择期全麻下行胸科手术患者318例,年龄≥65岁,性别不限,美国麻醉医师协会(American society of anesthesiologists,ASA)分级Ⅱ~Ⅳ级。术前1 d采用衰弱筛查量表(Fatigue,Resistance,Ambulation,Illness,Loss of weight,FRAIL)评估衰弱情况。术后24 h及48 h使用数字评分量表(numerical rating scale,NRS)记录患者静息与运动时疼痛评分,并于术后3个月电话随访,记录患者疼痛评分,NRS评分>0即为发生术后慢性疼痛。根据术后3个月是否发生术后慢性疼痛,将患者分为CPSP组和非CPSP组。采用多因素Logistics回归分析筛选胸科手术老年患者术后慢性疼痛的独立危险因素,通过受试者工作特征(receiver operativing characteristic,ROC)曲线分析术前衰弱对术后慢性疼痛的预测价值。结果最终纳入273例患者,术前衰弱64例,发生率为23.4%;术后慢性疼痛患者75例,发生率为27.5%。单因素Logistic回归分结果显示,2组患者在性别、年龄、ASA分级、糖尿病、胸腔引流时间、术后48 h平均静息NRS评分、切口个数及衰弱评分上差异有统计学意义。多因素Logistics回归分析结果显示:女性(OR值2.545,95%CI:1.365~4.746,P=0.003)、术前衰弱(OR值3.227,95%CI:2.146~4.853,P<0.001)、胸腔引流时间(OR值1.250,95%CI:1.079~1.449,P=0.003)和术后48 h平均静息NRS评分(OR值1.457,95%CI:1.081~1.963,P=0.014)是接受胸科手术的老年患者发生术后慢性疼痛的影响因素。术前衰弱预测CPSP的曲线下面积(area under curve,AUC)为0.705,95%CI:0.634~0.776,敏感度为0.493,特异度为0.843。结论女性、术前衰弱、胸腔引流时间延长和术后48 h平均静息NRS评分升高是胸科手术老年患者CPSP的独立危险因素,常规行术前衰弱筛查可以一定程度上预测CPSP的发生。Objective To evaluate the predictive value of preoperative frailty for chronic post-sugrical pain(CPSP)in elderly patients in department of thoracic surgery.Methods In total,318 patients underwent elective thoracic surgery under general anesthesia,who were aged 65 years or older,with American society of anesthesiologists(ASA)Ⅱ-Ⅳand regardless of gender.Frailty was assessed using FRAIL Scale at 1 d before surgery.At 24 h and 48 h after surgery,the numerical rating scale(NRS)was used to record patient pain scores at rest and on movement,and telephone follow-up was performed at 3 months after surgery,to record the patient's pain scores.NRS score>0 represented the occurrence of CPSP.Patients were divided into CPSP and non-CPSP groups based on whether CPSP occurred at 3 months after surgery.Multivariate Logistics regression analysis was used to screen risk factors for CPSP in elderly patients undergoing thoracic surgery and receiver operating characteristic(ROC)curve was used to analyze the predictive value of preoperative frailty on CPSP.Results Of 273 patients enrolled,64 patients had preoperative frailty,with an incidence of 23.4%,and 75 patients developed CPSP,with an incidence of 27.5%.Univariate Logistic regression results showed that there were significant differences in both groups with respect to gender,age,ASA grade,diabetes,duration of thoracic drainage,mean NRS score at rest at 48 h after surgery,number of incisions and frailty grade.The results of multivariate Logistics regression analysis showed that female(OR 2.545,95%CI:1.365-4.746,P=0.003),preoperative frailty(OR 3.272,95%CI:2.146-4.853,P<0.001),duration of thoracic drainage(OR 1.250,95%CI:1.079-1.449,P=0.003)and the mean NRS score at rest at 48 h after surgery(OR value 1.457,95%CI:1.081-1.963,P=0.014)were closely related with occurrence of CPSP in elderly patients undergoing thoracic surgery.The area under the ROC curve(AUC)of preoperative frailty in predicting CPSP was 0.705,with 95%CI:0.634-0.776,sensitivity of 0.493,specificity of 0.843.Conclu

关 键 词：衰弱 疼痛 手术后 老年人 

分 类 号：R619.9[医药卫生—外科学]