吸烟及尼古丁依赖对腹腔镜手术后疼痛的影响

The effects of smoking and nicotine dependence on postoperative pain after laparoscopic surgery

目的 比较吸烟与非吸烟对腹腔镜胆囊切除术后疼痛的影响.方法 将60例择期全身麻醉行腹腔镜胆囊切除术的男性患者按随机数字表法分为吸烟组和非吸烟组,每组30例.吸烟组患者中,14例术前1周内戒烟.术前对吸烟组患者行尼古丁依赖Fagerstrom测试（FTND）,其中FTND≥6分11例.入麻醉后恢复室（PACU）即刻、入PACU 15 min、入PACU 30 min、离开PACU时评估疼痛视觉模拟评分（VAS）、布氏舒适评分（BCS）、镇静躁动评分（SAS）,记录手术时间、麻醉时间、苏醒时间、拔管时间、PACU时间、补救措施使用率和不良反应等.结果 两组手术时间、麻醉时间、苏醒时间、拔管时间、各时间点SAS和不良反应发生率比较差异无统计学意义（P〉0.05）.吸烟组PACU时间、补救措施使用率明显高于非吸烟组[（39.7±5.1）min比（31.3±6.1）min和30.0%（9/30）比0],差异有统计学意义（P〈0.05）.吸烟组入PACU即刻、入PACU 15 min、入PACU 30 min、离开PACU时VAS明显高于非吸烟组[（2.90±0.85）分比（1.00±0.83）分、（2.70±0.47）分比（0.73±0.69）分、（2.60±0.56）分比（1.13±0.73）分、（2.23±0.57）分比（1.13±0.73）分],BCS明显低于非吸烟组[（1.80±0.61）分比（2.90±0.99）分、（1.90±0.31）分比（2.87±1.00）分、（2.10±0.31）分比（2.47±0.82）分、（2.17±0.38）分比（2.47±0.82）分],差异有统计学意义（P〈0.05）.FTND≥6分患者入PACU即刻VAS明显高于FTND〈6分患者[（3.6±0.7）分比（2.5±0.7）分],BCS明显低于FTND〈6分患者[（1.5±0.5）分比（2.0±0.6）分],差异有统计学意义（P〈0.05）.未戒烟患者入PACU即刻VAS明显高于戒烟患者[（3.4±0.7）分比（2.4±0.6）分],差异有统计学意义（P〈0.05）.结论 吸烟可增加腹腔镜胆囊切除术后疼痛,术前戒烟可减轻疼痛及并发症,适当增加镇痛药物可预防吸烟患者术后疼痛.

Objective To compare the effects of smoking and non smoking on postoperative pain of laparoscopic cholecystectomy. Methods Sixty patients having underwent selective laparoscopic cholecystectom were divided into smoking group and non smoking group by random digits table with 30 cases each. In smoking group, 14 cases quitted smoking within 1 week before operation. The Fagerstrom test of nicotine dependence （FTND） was evaluated before operation in smoking group, and FTND ≥ 6 scores was in 11 cases. The visual analog score （VAS）, Bruggrmarm comfort score （BCS）, sedation-agitation score （SAS）, immediately, 15 min, and 30 min after entering postanesthesia care unit （PACU） and leaving PACU was evaluated. The operation time, anesthesia time, wake up time, extubation time, PACU time, using rate of remedial measures and untoward reaction were recorded. Results There were no statistical differences in operation time, anesthesia time, wake up time, extubation time, SAS and incidence of untoward reaction between 2 groups （P〉0.05）. The PACU time and using rate of remedial measures in smoking group were significantly higher than those in non smoking group：（39.7 ± 5.1） min vs. （31.3 ± 6.1） min and 30.0% （9/30） vs. 0, and there were statistical differences （P〈0.05）. The VAS immediately, 15 min and 30 min after entering PACU and leaving PACU in smoking group was significantly higher than that in non smoking group： （2.90 ± 0.85） scores vs. （1.00 ± 0.83） scores, （2.70 ± 0.47） scores vs. （0.73 ± 0.69） scores, （2.60 ± 0.56） scores vs. （1.13 ± 0.73） scores, （2.23 ± 0.57） scores vs. （1.13 ± 0.73） scores; and the BCS was significantly lower than that in non smoking group：（1.80 ± 0.61） scores vs. （2.90 ± 0.99） scores, （1.90 ± 0.31） scores vs. （2.87 ± 1.00） scores, （2.10 ± 0.31） scores vs. （2.47 ± 0.82） scores, （2.17 ± 0.38） scores vs. （2.47 ± 0.82） scores, and there were statistical differences （P〈0.05）. The VAS immediately after entering PACU in patients of FTND ≥ 6 scores was significantly higher than that in patients of FTND〈6 scores：（3.6 ± 0.7） scores vs. （2.5 ± 0.7） scores, the BCS was significantly lower than that in patients of FTND 〈6 scores：（1.5 ± 0.5） scores vs. （2.0 ± 0.6） scores, and there were statistical differences （P〈0.05）. The VAS immediately after entering PACU in patients of non- quit smoking was significantly higher than that in patients of quit smoking： （3.4 ± 0.7） scores vs. （2.4 ± 0.6） scores, and there were statistical differences （P〈0.05）. Conclusions Smokers have more severe postoperative pain in laparoscopic cholecystectomy and higher postoperative opioid requirement than nonsmokers. Quit smoking before surgery will reduce postoperative pain and related complications. Appropriate increase of analgesic drugs can prevent postoperative pain in patients with smoking.