急性主动脉夹层早期疼痛控制情况及影响因素分析

Early pain control and its influencing factors in patients with acute aortic dissection

目的探讨急性主动脉夹层患者应用手术及保守治疗对疼痛症状的控制情况及早期疼痛控制的影响因素。方法回顾性分析234例急性主动脉夹层患者的临床资料,依据平均视觉模拟评分(visual analogue score,VAS)分为疼痛控制组57例(平均VAS评分≤3分)和疼痛未控制组177例(平均VAS评分>3分),比较2组一般资料、Stanford分型、疼痛部位、合并症、入院时疼痛程度,药物、介入及手术治疗情况,住院病死率,采用多因素logistic回归分析急性主动脉夹层患者早期疼痛控制的影响因素。结果疼痛未控制组Stanford分型A型比率(75.4%)、胸部疼痛比率(75.4%)、腰部疼痛比率(14.0%)、住院病死率(73.7%)均高于疼痛控制组(25.4%、49.2%、4.5%、10.2%),入院收缩压及舒张压[(133.6±31.9)、(77.7±19.0)mm Hg]、合并高血压比率(71.9%),使用硝普钠、α受体阻滞剂降压药物比率(61.4%、50.9%)及介入治疗比率(8.8%)均低于疼痛控制组[(154.8±30.4)mm Hg、(88.7±19.3)mm Hg、84.7%、75.1%、80.2%、59.3%](P<0.05);疼痛未控制组及疼痛控制组应用镇痛药物均主要为阿片类(84.2%、83.1%),苯二氮卓类、麻醉类(丙泊酚)、解热镇痛药物及其他药物应用比率均较低;疼痛未控制组应用吗啡、加罗宁、地西泮、联合应用3种及以上镇痛药物比率均低于疼痛控制组,应用氯丙嗪、单用1种镇痛药物比率高于疼痛控制组(P<0.05);多因素logistic回归分析结果显示,Stanford分型A型(OR=13.311,95%CI:5.628~31.479,P<0.001),腰部疼痛(OR=6.043,95%CI:1.187~30.768,P=0.030)是早期疼痛控制的危险因素,联合应用3种及以上镇痛药物(OR=0.260,95%CI:0.092~0.737,P=0.011)是早期疼痛控制的保护因素。结论急性主动脉夹层患者早期疼痛控制治疗应用吗啡、加罗宁等阿片类比例较高;Stanford分型A型、腰部疼痛是早期疼痛控制的危险因素,联合应用3种及以上镇痛药物是早期疼痛控制的保护因素。

Objective To observe the control of pain and its influencing factors in patients with acute aortic dissection. Methods The clinical data of 234 patients with acute aortic dissection were retrospectively analyzed and were divided into two groups according to visual analogue score （VAS）, pain controlled group （mean VAS〉3） and pain uncontrolled group （mean VAS〉 3）. The general data, Stanford type, pain site, complications, pain degree at admission, drug, interventional therapy, surgical treatment and hospital fatality were compared between two groups. Multivariate logistic regression analysis was used to study the influencing factors for early pain control. Results The proportions of Stanford type A aortic dissection （75.4%）, chest pain （75.4%）, lumbar pain （14.0%）, and hospital fatality （73.7〉/〉） in pain uncontrolled group were significantly higher than those in pain controlled group （25.4o//00, 49.2%, 4.5%, 10.2%）, and the systolic and diastolic blood pressure （（133.6 ＋- 31.9）, （77.7 ＋- 19.0） mm Hg）, proportion of hypertension （71.9 %）, proportion of using sodium nitroprusside and a-receptor blocker antihypertensive drugs （61.4 %, 50.9 %）, and proportion of the patients receiving interventiona[ therapy （8. 8%） were significantly lower than those in pain controlled group （（154.8＋--30.4） mm Hg, （88.7＋-19.3） mm Hg, 84.7%, 75.1%, 80.2%, 59.3%） （P〈0.05）. The analgesic drugs applied in pain uncontrolled group and pain controlled group were mainly opioids （84.2 %, 83.1%）. The proportions of benzodiazepine, anesthetic （propofol）, antipyretic analgesic and other drugs were low. The proportion of combined use of 3 or more analgesic drugs as morphine, garonin and diazepam was significantly lower in pain uncontrolled group than that in pain controlled group （P〈O. 05）, and the proportion of single use of analgesic drug or ehlorpromazine was significantly higher in pain uncontrolled group than that in pain controlled group （P〈0.05）. Multivariate logistic regression analysis showed that Stanford type A aortic dissection （OR=13. 311, 95%CI： 5. 628-31. 479, P〈O. 001） and lumbar pain （OR=6. 043, 95〉CI： 1. 187-30. 768, P=0.030） were the risk factors for early pain control, and the combined use of 3 or more analgesic drugs （OR= 0. 260, 95〉 CI： 0. 092-0. 737, P= 0. 011） was the protective {actor. Conclusion The proportion of morphine, galantine and other opioids is higher in early pain control in the patients with acute aortic dissection. Stanford type A aortic disection and lumbar pain are the risk factors for early pain control, and the combined use of 3 or more analgesic drugs is a protective factor for early pain control.