老年髋关节置换术后慢性疼痛调查及危险因素分析

Investigation and analysis of risk factors of chronic pain after hip replacement in the elderly

目的了解老年髋关节置换术患者术后慢性疼痛(chronic post-surgical pain,CPSP)的发生情况,并分析相关危险因素,为改善患者术后生活质量提供有效的建议。方法收集291例老年髋关节置换术患者的病历资料,采用疼痛数字评分法(NRS)评估患者术前疼痛程度,采用医院焦虑抑郁量表(HADS)评估患者术前焦虑及抑郁水平,采用Logistic回归分析CPSP的独立危险因素。结果291例老年髋关节置换术患者中91例发生CPSP,发生率为31.27%。单因素分析结果显示,CPSP组患者中饮酒史、吸烟史、全髋关节置换术、术前抑郁、术前焦虑、术后首次关节活动时间≥3 d、术后功能锻炼时长<2 h/d的人数高于无CPSP组,术前NRS评分及手术时间高于无CPSP组,差异均有统计学意义(P<0.05)。Logistic回归分析结果显示,术前焦虑、术前NRS评分高及术后首次关节活动时间≥3 d为老年髋关节置换术后发生CPSP的独立危险因素(OR=5.34、2.97、7.43,均P<0.05)。结论老年髋关节置换术患者CPSP发生率较高,需加强对术前焦虑、NRS评分高人群的预防性干预,把握术后首次关节活动时机。

Objective To understand the incidence of chronic post-surgical pain(CPSP)in elderly patients with hip replacement and to analyze the relevant risk factors so as to provide effective suggestions for improving the quality of life of patients after surgery.Methods The medical records of 291 elderly patients with hip replacement were collected.Numerical rating scale(NRS)was used to assess the degree of preoperative pain of patients,hospital anxiety and depression scale(HADS)was used to assess the level of preoperative anxiety and depression of patients,and Logistic regression analysis was adopted to analyze the independent risk factors of CPSP.Results Of 291 elderly patients with hip replacement,91 developed CPSP,with an incidence of 31.27%.The results of univariate analysis showed that the number of patients with drinking history,smoking history,total hip arthroplasty,preoperative depression,preoperative anxiety,first activity time of joint after surgery≥3 d and duration of postoperative functional exercise<2 h/d in the group with CPSP was significantly higher than that in the group without CPSP,the preoperative NRS score and operation time were significantly higher than those in the group without CPSP,and the differences were statistically significant(P<0.05).The results of Logistic regression analysis showed that preoperative anxiety,high preoperative NRS score and first activity time of joint after surgery≥3 d were independent risk factors associated with CPSP after hip replacement in the elderly(OR=5.34,2.97 and 7.43,all P<0.05).Conclusions The incidence of CPSP was high in elderly patients with hip replacement.It was necessary to strengthen the preventive intervention for people with preoperative anxiety and high NRS score and seize the right time of the first movement of joint after operation.