乳腺癌术后疼痛综合征的发生情况及其危险因素分析

The investigation of the incidence of postoperative pain syndrome in breast cancer and analysis of its risk factors

目的调查乳腺癌患者术后疼痛综合征的发生情况并分析其发病的危险因素。方法回顾性分析接受乳腺癌手术治疗的156例患者的临床资料。根据术后是否发生疼痛综合征,分为A组(发生疼痛综合征)33例和B组(未发生疼痛综合征)123例。统计乳腺癌患者术后疼痛综合征的发生率以及疼痛部位、疼痛性质、疼痛程度、疼痛出现时间、疼痛发作频率,对比两组患者的临床特征,并通过Logistic逐步回归法分析乳腺癌患者术后疼痛综合征发生的危险因素。结果乳腺癌患者术后疼痛综合征的发生率为21.15%。疼痛部位以患侧腋窝最常见,占42.42%;疼痛性质以麻木为主,占39.39%;87.88%的患者的疼痛数字评分法(NRS)评分﹤4分;45.45%的患者疼痛出现时间为术后即刻;39.39%的患者疼痛发作频率为每日发作。A组患者的平均年龄为(45.95±10.89)岁,明显低于B组的(55.37±9.92)岁(P﹤0.01);术前A组患者焦虑抑郁的发生率为18.18%,清扫腋窝淋巴结的比例为93.94%,均高于B组的4.07%、76.42%(P﹤0.05);多因素Logistic逐步回归分析结果显示,年龄(﹤50岁)(OR=2.04,95%CI:1.43～2.68)、有术前焦虑抑郁(OR=4.14,95%CI:2.16～6.33)以及有清扫腋窝淋巴结(OR=1.57,95%CI:1.14～2.21)是乳腺癌患者术后疼痛综合征发生的危险因素(P﹤0.05)。结论乳腺癌术后疼痛综合征的发生率较高,年龄(﹤50岁)、术前焦虑抑郁、腋窝淋巴结清扫是乳腺癌患者术后疼痛综合征发生的独立危险因素。

Objective To investigate the incidence of postoperative pain syndrome in breast cancer and analyze its risk factors. Method One hundred and fifty-six patients undergoing breast cancer surgery were included in the study and their clinical data were retrospectively analyzed. According to the occurrence of postoperative pain syndrome, 33 patients with pain syndrome were assigned as group A, and another 123 without postoperative pain syndrome were included as group B. The incidence of postoperative pain syndrome in breast cancer and the pain site, nature of pain, degree of pain, time of first pain attack, and frequency of pain attack were recorded for these patients. The clinical data of the two groups were compared and the risk factors for the postoperative pain syndrome of breast cancer were analyzed by Logistic stepwise regression. Result The incidence of postoperative pain syndrome in these breast cancer patients was 21.15%. The most common pain location was axillary fossa on the affected side, accounting for 42.42%. The nature of pain was mainly numbness, representing 39.39% of all patients. Besides, 87.88% of patients had numerical rating scale (NRS) score <4, and 45.45% of patients had immediate pain. Those who had daily pain attack constituted 39.39% of all patients. The mean age of group A was (45.95±10.89) years old, which was significantly lower than that in group B at (55.37±9.92) years old (P<0.01);while in group A, the incidence of anxiety and depression was 18.18%, and the rate of axillary lymph node dissection was 93.94%, which were significantly higher than those in group B at 4.07% and 76.42%, respectively (P<0.05);multivariate Logistic stepwise regression analysis showed that, age (<50 years old)(OR=2.04, 95%CI: 1.43- 2.68), presence of preoperative anxiety and depression (OR=4.14, 95%CI: 2.16-6.33) and axillary lymph node dissection (OR=1.57, 95%CI: 1.14-2.21) were risk factors for postoperative pain syndrome in breast cancer patients (P<0.05). Conclusion The incidence of postoperative pain syndrome is rather high in breast cancer, age (<50 years old), preoperative anxiety and depression, and axillary lymph node dissection are independent risk factors of postoperative pain syndrome.