胸科手术患者PACU中重度疼痛的危险因素

Risk factors for moderate-to-severe pain in PACU in patients undergoing thoracic surgery

目的筛选胸科手术患者PACU中重度疼痛的危险因素。方法回顾性收集2019年1月至2020年1月择期行胸科手术后带气管插管转入PACU患者的病历资料,性别不限,年龄18~80岁,ASA分级Ⅰ~Ⅲ级。采用静吸复合麻醉。收集患者年龄、性别、ASA分级、吸烟史、饮酒史、非胸外科手术史、高血压病史、糖尿病病史、免疫系统疾病病史;手术方式、手术类型、手术时间、术中神经阻滞、阿片类药物和右美托咪定使用情况;收集PACU期间补救镇痛药物用量、恶心呕吐发生情况和PACU停留时间。根据PACU气管拔管后10 min时的静态和动态VAS评分将患者分为中重度疼痛组(VAS评分>3分)和非中重度疼痛组(VAS评分≤3分)。采用logistic回归分析筛选PACU中重度疼痛的危险因素。结果共纳入1698例患者,静态中重度疼痛发生率为46.70%,动态中重度疼痛发生率为54.12%。logistic回归分析结果显示,女性、食管癌根治术、纵膈手术、肋骨/胸骨手术是胸科手术患者PACU中重度疼痛的危险因素,年龄增加、腔镜手术、术中使用神经阻滞和右美托咪定是胸科手术患者PACU中重度疼痛的保护因素(P<0.05)。结论女性、食管癌根治术、纵膈手术和肋骨/胸骨手术是胸科手术患者PACU中重度疼痛的危险因素;年龄增加、腔镜手术、术中使用神经阻滞和右美托咪定是胸科手术患者PACU中重度疼痛的保护因素。

Objective To identify the risk factors for moderate-to-severe pain in postanesthesia care unit(PACU)in the patients undergoing thoracic surgery.Methods The medical records of patients of both sexes,aged 18-80 yr,of American Society of Anesthesiologists(ASA)physical statusⅠ-Ⅲ,transferred to PACU with tracheal intubation from January 2019 to January 2020,were retrospectively collected.Combined intravenous-inhalational anesthesia was used during surgery.The patient′s age,gender,ASA physical status,smoking history,drinking history,history of non-thoracic surgery,history of hypertension,history of diabetes mellitus,and history of immune system disease were collected.The operation method,type of operation,operation time,intraoperative nerve block and use of opioids and dexmedetomidine were also collected.The consumption of rescue analgesics during PACU,occurrence of nausea and vomiting,and length of stay in PACU were also collected.Patients were divided into moderate-to-severe pain group(VAS score>3 points)and non-moderate-to-severe pain group(VAS score≤3 points)according to the VAS scores at rest and during activity at 10 min after extubation in PACU.Logistic regression analysis was used to identity the risk factors for moderate-to-severe pain in PACU.Results A total of 1698 patients were included in this study,the incidence of moderate-to-severe pain at rest was 46.70%,and the incidence of moderate-to-severe pain during activity was 54.12%.The results of logistic regression analysis showed that female,radical resection of esophageal cancer,mediastinal surgery,internal fixation for rib/sternal surgery were risk factors for moderate-to-severe pain in PACU,and increasing age,endoscopic surgery,intraoperative use of nerve block and dexmedetomidine were protective factors for moderate-to-severe pain in PACU in the patients undergoing thoracic surgery(P<0.05).Conclusion Female,radical resection of esophageal cancer,mediastinal surgery,and rib/sternal surgery are risk factors for moderate-to-severe pain in PACU in the patients undergoing thoracic surgery;increasing age,endoscopic surgery,intraoperative use of nerve block and dexmedetomidine are protective factors for moderate-to-severe pain in PACU in the patients undergoing thoracic surgery.