肺癌术后长期慢性疼痛的特点及危险因素研究

Long-term chronic pain after lung cancer surgery and its risk factors

目的探究影响肺癌患者术后长期慢性疼痛的特点和危险因素。方法选取2015年1月至2017年12月杭州市肿瘤医院收治且行胸外科手术治疗的肺癌患者162例,查阅所有患者的电子病历并且整理收集相关信息。采用Cox比例风险回归模型分析慢性疼痛的相关独立危险因素。结果29例患者(17.9%)在术后36个月内诊断为术后慢性疼痛。出现慢性疼痛与是否接受术后放化疗、手术操作、手术时间、麻醉方式、其他镇痛方式及术后2 d最高及术后14 d首次门诊随访NRS评分均有关(均P<0.05)。术后镇痛治疗最常采用的镇痛药为弱阿片类药物。进一步分析结果显示女性、更长的手术时间、术后首次门诊就诊的NRS评分较高、术后化疗和术后放疗是发生术后慢性疼痛的独立危险因素(均P<0.05)。结论肺癌胸外科术后的慢性疼痛较为常见,女性、手术时间长、术后14 d首次门诊随访NRS评分高及辅助放化疗等是影响术后慢性疼痛的独立危险因素。

Objective To explore the characteristics and related factors of long-term chronic pain after lung cancer surgery.Methods A total of 162 patients with lung cancer who underwent thoracic surgery in our hospital from 2015 to 2017 were enrolled.The electronic medical records of all patients were reviewed,and related information was collected.The incidence of chronic pain was evaluated at a time interval of 3 months for total of 36-month postoperative follow-up,and the factors related to the long-term chronic pain were analyzed by Cox proportional hazard regression analysis.Results 29 patients(17.9%)were diagnosed as chronic pain at 3 months and 36 months after surgery.The most frequently used analgesics for postoperative pain were weak opioids.Female sex,longer operation time,higher numeric rating scales(NRS)score for the first outpatient visit after surgery(all P<0.05),postoperative chemotherapy and postoperative radiotherapy were independent risk factors of chronic pain in the first 36 months of surgery(all P<0.05).Conclusion Chronic pain after thoracic surgery for lung cancer is quite common.Female gender,long operation time,high NRS score in postoperative follow-up,and adjuvant radiotherapy and chemotherapy are independent risk factors of postoperative chronic pain.