胸部手术后慢性疼痛危险因素及预防

Risk factors and prevention and control of chronic pain after thoracic surgery

从术前、术中和术后三方面对胸部手术患者发生慢性术后疼痛(chronic post-surgical pain, CPSP)的风险因素进行了综述,主要包括术前疼痛、社会心理因素、基因变异,术中肋间神经损伤及严重的急性术后疼痛等。其中,肋间神经损伤及严重的术后急性疼痛是CPTP发生的重要因素。此外,还就降低术后急性疼痛和减少术中肋间神经损伤对CPTP的预防作用进行了综述,硬膜外镇痛可能会降低CPTP的发生率,而胸椎旁神经阻滞对CPTP的影响尚无定论。

This article reviews the risk factors of chronic post-surgical pain (CPSP) in preoperative, intraoperative and postperative aspects, including preoperative pain, psychosocial factors, genetic variation, intlaoperative intercostal nerve injury and severe postoperative acute pain. Intercostal nerve injury and severe postoperative acute pain are important factors in the occurrence of CPTP. In addition, this paper also reviews the preventive effects of reducing acute pain after operation and intercostal nerve injury during operation on CPTP. Epidural analgesia may reduce the incidence of CPTP, while the effect of thoracic paravertebral nerve blook on CPTP is still uncertain.