外周静脉置管疼痛评分与腹腔镜肾切除术患者术后疼痛程度的相关性

Correlation between peripheral venous catheterization induced pain and postoperative pain intensity after laparoscopic nephrectomy

目的探讨外周静脉置管疼痛评分与腹腔镜肾切除术患者术后疼痛程度的相关性。方法选择择期行腹腔镜肾切除手术的患者106例,男57例,女49例,年龄18~65岁,BMI 18~28 kg/m^2,ASAⅠ或Ⅱ级。术前采用20 G留置针于手背浅表静脉进行置管操作并记录患者对此操作的VAS评分。所有患者于全麻下手术,术后给予舒芬太尼静脉自控镇痛。记录患者术后24 h内静息时最高VAS评分和活动时最高VAS评分,术后24 h内镇痛泵有效按压次数、术后24 h内舒芬太尼的额外消耗量。结果外周静脉置管VAS评分与术后24 h内静息时最高VAS评分(r s=0.64,P<0.001)、术后24 h内活动时最高VAS评分(r s=0.65,P<0.001)、术后24 h内镇痛泵有效按压次数(r s=0.59,P<0.001)、术后24 h内舒芬太尼额外消耗量(r s=0.58,P<0.001)呈明显正相关。外周静脉置管VAS评分≥2.0分的患者中术后静息时出现中重度疼痛的例数为14例(33.3%),VAS评分<2.0分的患者中为8例(12.5%),VAS评分≥2.0分的患者术后出现中重度疼痛的比例明显高于VAS评分<2.0分的患者(P<0.05)。结论术前外周静脉置管疼痛评分与腹腔镜肾切除术患者术后疼痛程度具有相关性,外周静脉置管VAS评分≥2.0分患者中术后24 h内静息时出现中重度疼痛比例高于VAS评分<2.0分患者。

Objective To explore the correlation between peripheral venous catheterization induced pain and postoperative pain intensity after laparoscopic nephrectomy.Methods A total of 106 patients scheduled for laparoscopic nephrectomy were selected,57 males and 49 females,aged 18-65 years,BMI 18-28 kg/m^2,falling into ASA physical statusⅠorⅡ.One experienced nurse conducted cathetering operation at superficial vein on the back of the hand with 20 G indwelling needle for all the patients before the surgery,and the VAS scores of above procedure were recorded.After general anesthesia and surgery,all the patients received the patient-controlled intravenous analgesia(PCIA)with sufentanil.The highest VAS scores in resting period and during coughing,the effective number of presses and extra consumption of sufentanil within 24 h after surgery were recorded.Results The VAS scores of external venous catheterization expressed obviously positive correlation by comparing with the highest VAS score at rest within 24 h(r s=0.64,P<0.001),during coughing(r s=0.65,P<0.001),effective number of presses(r s=0.59,P<0.001),and extra consumption of sufentanil(r s=0.58,P<0.001)within 24 h after surgery.Fourteen cases(33.3%)reported moderate or severe(≥4.0 VAS units)postoperative pain at rest among the patients with VAS scores≥2.0 of external venous catheterization,and 8 patients reported the same symptom(12.5%)with VSA scores<2.0.The proportion of patients with VAS scores≥2.0 who reported moderate or severe postoperative pain within 24 h was significant higher than those with VAS scores<2.0(P<0.05).Conclusion Peripheral venous catheterization induced pain is correlated with postoperative pain after laparoscopic nephrectomy.The proportion of patients with levels of catheterization induced pain intensity≥2.0 VAS units who reported moderate or severe postoperative pain within 24 h after surgery was higher than that of patients with levels of catheterization induced pain intensity<2.0 VAS units.