脊髓神经鞘瘤切除术患者术后慢性疼痛的危险因素

Risk factors for chronic postsurgical pain in patients undergoing spinal neurilemmoma resection

目的 探讨脊髓神经鞘瘤切除术患者术后慢性疼痛(CPSP)的危险因素。方法 选择2020年3月至2021年3月择期行脊髓神经鞘瘤切除术的患者161例,男75例,女86例,年龄≥18岁,ASAⅠ—Ⅲ级。采用数字评分量表(NRS)以及神经病理性疼痛量表(NPQ)评估患者术后3个月发生慢性疼痛及神经病理性疼痛的情况。根据NRS评分将患者分为两组:CPSP组(NRS≥1分)和无CPSP组(NRS=0分)。通过医院电子病历系统以及术后3个月电话随访收集临床资料,采用多因素Logistic回归分析脊髓神经鞘瘤切除术患者发生CPSP的独立危险因素。结果 发生CPSP的患者有63例(39%),其中中重度疼痛(NRS≥4分)40例(25%)。多因素Logistic回归分析结果显示,术前合并疼痛(OR=3.670,95%CI 1.034~13.025,P=0.044)以及术后应用阿片类药物(OR=2.357,95%CI 1.103~5.036,P=0.027)是发生CPSP的独立危险因素。结论 术前合并疼痛以及术后使用阿片类药物是脊髓神经鞘瘤切除术患者发生CPSP的危险因素。

Objective To investigate the risk factors of chronic postsurgical pain(CPSP) in the patients undergoing spinal neurilemmoma resection.Methods A total of 161 patients,75 males and 86 females,aged ≥ 18 years,ASA physical status Ⅰ-Ⅲ,who underwent elective spinal neurilemmoma resection with general anesthesia from March 2020 to March 2021 were enrolled.The spinal neurilemmoma patients were assessed by using number rank score(NRS) and neuropathic pain questionnaire(NPQ) 3 months after surgery.Patients were divided into two groups:the patients with CPSP(NRS ≥ 1) and the patients with no-CPSP(NRS = 0).According to the the electronic medical record system,the clinical data of the patients were collected and the risk factors of CPSP were analyzed.Multivariate Logistic regression model was established to find independent risk factors for CPSP in patients undergoing spinal newrilemmoma resection.Results Sixty-three(39%) patients were diagnosed with CPSP,and forty(25%) patients were considered as the moderate-to-severe CPSP(NRS ≥ 4).Multivariate Logistic analysis showed that the preoperative pain(OR = 3.670,95% CI 1.034-13.025,P = 0.044) and the using of opioids postoperatively(OR = 2.357,95% CI 1.103-5.036,P = 0.027) were independent risk factors of CPSP.ConclusionCombined with preoperative pain and using of opioids postoperatively are risk factors of the CPSP in the patients undergoing spinal neurilemmoma resection.