影响胸腔镜手术镇痛效果的危险因素分析

The risk factors affecting the analgesic effect after thoracoscopic surgery

目的探讨多因素对胸腔镜术后镇痛效果的影响。方法回顾性收集符合纳入标准的胸腔镜术后患者102例,定义疼痛视觉模拟评分(visual analogue score,VAS)≤6分为有效,否则为差效。收集术后72 h内的VAS评分,根据标准分为差效组、有效组,其中有效组55例,差效组47例,其中男50例,女52例;平均年龄为(54.62±7.89)岁,范围33~70岁,比较两组患者年龄、性别、体质指数(BMI)、手术时间、吸烟史、高血压、糖尿病、麻醉分级、镇痛方式、肿瘤性质等多种因素与镇痛效果的相关性。通过单因素及多因素logistic分析筛选出影响手术镇痛效果的独立危险因素。结果单因素分析结果显示,有效组和差效组在高血压、糖尿病、吸烟史、手术时间、ASA分级(Ⅱ)方面差异有统计学意义(P<0.05)。Logistic多因素回归分析显示手术时间、吸烟史为镇痛差效的独立危险因素。结论手术时间与吸烟会影响术后镇痛效果,可通过缩短手术时间及术前积极戒烟来提高术后镇痛效果,有助于快速康复。

Objective To investigate the effect of multiple factors on the analgesic effect after thoracoscopic surgery.Methods A retrospective study of 102 patients undergoing thoracoscopic surgery was performed.The visual analogue score(VAS)less than or equal to 6 was defined as valid,and over 6 as bad.VAS scores within 72h after surgen were collected.The effective group and the ineffective group were divided according to the criteria,and 55 cases in the effective group,and 47 cases in the bad group.There were 50 males and 52 females;and the average age was(54.62±7.89)years(33-70 years old).Age,male,body mass index(BMI),operative time,smoking history,hypertension,diabetes,anesthesia grade(ASA Ⅱ),paravertebral nerve block,and tumor nature were recorded for risk analysis for analgesic effects by single factor and multivariate logistic analysis.Results Univariate analysis showed that there were significant differrtues between the effective group and the bad group in hypertension,diabetes,smoking history,operation time,and paravertebral nerve block(P<0.05).Logistic multivariate regression analysis showed the operation time and history of smoking were independent risk factors for bad analgesia after operation.Conclusion The operation time and smoking will affect the postoperative analgesia effect.