胸腔镜术后慢性疼痛患者的危险因素及恢复质量

Risk factors and recovery quality of patients with chronic postsurgical pain after thoracoscopy

目的 探讨胸腔镜肺叶部分切除术后慢性疼痛(CPSP)患者的危险因素及恢复质量。方法 回顾性分析南京大学附属金陵医院2019年1月至2020年4月期间683例行胸腔镜肺叶部分切除术患者临床资料。根据是否发生CPSP将纳入研究对象分为non-CPSP组和CPSP组。CPSP组患者根据是否存在神经病理性疼痛(NP)表现进一步分为non-NP和NP者。结果 符合纳入标准的患者491例,其中167例(34%)存在CPSP。Logistic回归分析提示CPSP发生的独立危险因素包括:年龄≤63岁(OR=2.085,95%CI:1.328~3.273)、术前疼痛(OR=2.644,95%CI:1.335~5.237)、术后二次胸腔闭式引流(OR=4.242,95%CI:1.245~14.455)。与non-CPSP组相比,CPSP组患者SF-36量表评分显著降低(P<0.05)。其中,NP组SF-36评分更低,疼痛对睡眠和日常活动的影响更明显(P<0.05)。结论 年龄≤63岁、术前疼痛、术后二次胸腔闭式引流是CPSP的预警因素;CPSP显著影响患者的远期恢复,伴有NP表现则使恢复质量进一步降低。

Objective To explore the risk factors and recovery quality of patients with chronic postsurgical pain(CPSP) after thoracoscopic partial lobectomy. Methods 683 patients undergoing thoracoscopic partial lobectomy were enrolled from January 2019 to April 2020 in Jinling Hospital Affiliated to Nanjing University. According to whether CPSP occurred, patients were divided into two groups: non-CPSP and CPSP;and patients in the CPSP group were further divided into non NP and NP groups according to whether it is accompanied with neuropathic pain(NP) components. Results 491 patients met the inclusion criteria, of which 167(34%) patients had CPSP. Logistic regression analysis indicated that the independent risk factors for CPSP include: Age ≤63 years old(OR=2.085, 95%CI: 1.328-3.273), preoperative pain(OR=2.644, 95%CI: 1.335-5.237), and thoracic closed drainage for the second time(OR=4.242, 95 %CI: 1.245-14.455). Compared with the non-CPSP group, the score of SF-36 scale in CPSP group was significantly decreased(P<0.05). In addition, the SF-36 score in the NP group was lower, and the effect of pain on sleep and daily activities was more obvious(P<0.05). Conclusion Age ≤63 years, preoperative pain, and the second thoracic closed drainage after surgery are early warning factors of CPSP. CPSP significantly affects the long-term recovery of patients, and the presence of NP components further reduces the quality of recovery.