肝癌开腹术后急性疼痛特点及镇痛效果影响因素分析

Analysis of the characteristics of acute pain and the influencing factors of analgesic effect af⁃ter laparotomy for hepatocellular carcinoma

目的:探讨开腹肝癌术后急性疼痛发生的特点及镇痛效果的影响因素。方法:选取广西医科大学第一附属医院肝胆外科2019年1~6月择期行开腹肝癌切除术手术的患者131例作为研究对象,患者术后1周内疼痛的发生情况及特点,依据患者术后镇痛效果分为良好和欠佳,运用二分类Logistic回归分析影响术后镇痛效果的因素。结果:开腹肝癌术后1周内约81.40%的疼痛发生于术后4 d内,60.60%的疼痛发生在夜间。131例患者中,68例(51.91%)镇痛效果良好,63例(48.09%)镇痛效果欠佳,二分类Logistic回归分析结果显示,手术时长、年龄、预防性镇痛的种类数目、既往有腹部手术史是影响术后镇痛效果的因素。手术时长与术后镇痛效果呈负相关关系(P<0.05),年龄、预防性镇痛的种类数目、既往有腹部手术史的镇痛效与术后镇痛效果呈正相关关系(P<0.05)。结论:开腹肝癌手术患者术后疼痛多发生于术后4 d内,且具有一定的时辰规律,以夜间多发。对于肝癌开腹患者术后需要多模式预防性镇痛,尤其是对于手术时间长且首次手术的年轻患者。

Objective:To explore the characteristics of acute pain after laparotomy for liver cancer and the influencing factors of analgesic effect.Methods:A total of 131 patients who underwent open hepatectomy in our hospital from January 2019 to June 2019 were selected as the study subjects.The occurrence and characteristics of pain,and postoperative analgesic effect within one week after operation were divided into good and poor.Binary Logistic regression was used to analyze the factors affecting the effect of postoperative analgesia.Results:About 81.40%of the pain within 1 week after laparotomy for liver cancer occurred within 4 days after operation,and 60.60%of the pain occurred at night.Among the 131 patients,68 cases(51.91%)had good analgesic effect and 63 cases(48.09%)had poor analgesic effect.Binary Logistic regression analysis showed that the length of operation,ages,the types of prophylactic analgesia and previous abdominal surgery were the factors affecting the effect of postoperative analgesia.The length of operation was negatively correlated with the effect of postoperative analgesia(P<0.05),while the ages,the types of prophylactic analgesia and previous abdominal surgery were positively correlated with the postoperative analgesia effect(P<0.05).Conclusion:Postoperative pain in patients with liver cancer after laparotomy mostly occurs within 4 days after operation,and has a certain time rule,which occurs frequently at night.Multimode prophylactic analgesia is needed for patients with liver cancer after laparotomy,especially for young patients with long operation time in the first operation.