试验性疼痛测试与术后疼痛的关系

Predictors of experimental pain sensitivity and their relationship with postoperative analgesia

目的探讨术后疼痛状态的相关影响因素及试验性疼痛测试对术后疼痛状态的预测效力。方法选取开腹胃癌根治术的患者78例,收集临床资料,术前行试验性冷、热疼痛测试及冷耐受实验,术后观察并记录患者清醒后5min疼痛NRS评分、首次使用羟考酮的时间及自控止痛装置(PCAD)使用情况,统计学分析患者一般临床资料及试验性疼痛测试结果与术后疼痛状态之间的相关性。结果患者清醒后5min疼痛NRS评分、首次使用羟考酮的时间与年龄、BMI等临床一般资料无明显的相关性(P>0.05)。清醒后5min疼痛的NRS评分与术前冷、热疼痛测试的NRS评分呈显著正相关性(P<0.05),与冷刺激耐受时间呈显著负相关(P<0.05);首次使用羟考酮的时间与冷刺激疼痛NRS评分呈负相关,与冷刺激耐受时间呈正相关,但与热刺激疼痛无显著相关性。PCAD使用受到性别、术前有无疼痛及术前热疼痛测试的影响。结论术前的试验性疼痛敏感测试是术后疼痛状态的重要预测因子。

Objective To explore factors affecting postoperative pain status and effectiveness of experimental pain test in predicting postoperative pain status.Methods We recruited 78 consenting patients who would undergo radical operation for stomach carcinoma.Before surgery,the patients＇ clinical data were collected; they were also exposed to experimental tests measuring heat （48 ℃,5 s） and cold （2-4 ℃） pain intensity and tolerance.Postoperative NRS scores of patients were recorded 5 minutes after waking.Time from first oxycodone injection to waking and use of PCAD were also evaluated.Correlations between clinical characteristics,results of experimental pain tests,and status of postoperative pain were statistically analyzed.Results The patients＇ pain NRS scores at 5 min after waking and time for the first oxycodone injection were not obviously correlated with their clinical data such as age or BMI （P＞0.05）.However,the patients＇ pain NRS score at 5 min after waking had a significantly positive correlation with their preoperative heat and cold pain sensitivity scores （P＜0.05） and a negative correlation with their cold pain tolerance duration （P ＜ 0.05）.The time for the first oxycodone injection was correlated negatively with cold pain sensitivity NRS score,but positively with cold pain tolerance duration; it had no significant correlation with cold pain sensitivity score.Usage of PCAD was affected by gender,preoperative pain and heat pain test score.Conclusion Preoperative pain sensitivity test is an important factor predicting postoperative pain status.