小儿腹腔镜阑尾切除术后疼痛的危险因素分析

The risk factors analysis of pediatric substantial pain after laparoscopic appendectomy

目的：探讨小儿腹腔镜术后发生明显术后疼痛的影响因素,为患儿的适时镇痛治疗提供线索。方法：收集2012年1月-12月收治、确诊并行腹腔镜阑尾切除术（laparoscopic appendectomy,LA）的阑尾炎患儿57例,对发生明显术后疼痛的病例分布情况进行描述并对各时间点疼痛评估分数进行对比,同时对8个可能与LA术后明显疼痛的有关因素进行多因素logistic回归分析。结果：术后12 h明显术后疼痛人数最多,且其疼痛评估分数最高;术后12 h除与术后6 h相比P值为0.179,与其他时间点相比P值均〈0.05。多因素logistic回归分析显示,影响LA明显术后疼痛的独立危险因素为CO2气腹特殊情况[即腹内压（intra-abdominal pressure,IAP）〉16 mmHg和/或时间持续〉1 h]（OR为1.34,P〈0.001）。结论：儿童LA术后发生明显术后疼痛与气腹条件异常有关,建议术中将气腹条件控制在适宜范围,术中经历气腹特殊情况的患儿应注重适宜的镇痛治疗。

Objective： To investigate the influence factors which lead to substantial postoperative pain after pediatric laparoscopic appendectomy,and search clues in order to provide timely pain treatment for the children. Methods： The clinical data of 57 children with appendicitis who underwent laparoscopic appendectomy from Jan. 2012 to Dec. 2012 were retrospectively analyzed,the distribution of the substantial postoperative pain was described and the pain scores between different time points were compared. A total of 8potential factors which would cause substantial postoperative pain were evaluated by multivariate logistic regression analysis. Results： At the time points of postoperative 12 h,the cases who suffered substantial postoperative pain were max,and the pain assessment scores was highest. Comparing with other time points,the difference of the pain assessment scores of postoperative 12 h was statistically significant,P value was 0. 05,except the time point of postoperative 6 h,P value was 0. 179. Multivariate logistic regression analysis showed that independent risk factors for substantial postoperative pain of pediatric laparoscopic appendectomy was special CO2 artificial pneumoperitoneum circumstances（ intra-abdominal pressure,IAP 16 mmHg and /or lasted 1 h）（ OR was 1. 34,P〈 0. 001）. Conclusions： The substantial postoperative pain of pediatric laparoscopic appendectomy relates to pneumoperitoneum abnormal conditions,and the study proposed that the surgeon should control pneumoperitoneum conditions at an appropriate range during operation,the children experienced special pneumoperitoneum circumstances should be paid attention to appropriate analgesic therapy.