胸腔镜下肺癌根治术患者术后慢性疼痛发生的影响因素分析及其预测模型构建

Analysis of the influencing factors of postoperative chronic pain in patients with lung cancer undergoing thoracoscopic radical surgery and construction of the predictive model

目的:分析胸腔镜下肺癌根治术患者术后慢性疼痛发生的影响因素并构建其预测模型。方法:选择2021年3月—2022年3月行胸腔镜肺癌根治术的非小细胞肺癌(NSCLC)患者148例。采用数字分级评分(NRS)对患者术后切口疼痛进行评估,术后3个月以上NRS评分超过3分为慢性疼痛。其中56例术后慢性疼痛患者为疼痛组,其余92例患者为无痛组。对可能影响患者术后慢性疼痛发生的各因素进行单因素及多因素回归分析,并构建术后慢性疼痛预测模型。结果:148例患者中,56例患者术后3个月仍存在手术切口处疼痛,术后慢性疼痛发生率为37.84%。单因素比较结果显示,两组术后放疗、术后化疗、手术时间、术后2 d最高NRS评分以及术后14 d首次门诊随访NRS评分比较差异有统计学意义(P<0.05)。将上述单因素分析具有统计学意义的各因素作为自变量,组别作为因变量进行逐步回归分析,结果显示,术后14 d首次门诊随访NRS评分、手术时间、术后2 d最高NRS评分以及术后放疗进入回归模型(P<0.05)。预测模型公式:Logit(P)=-0.913+0.140×术后放疗+0.006×手术时间+0.054×术后2 d最高NRS评分+0.267×术后14 d首次门诊随访NRS评分。随着Logit(P)值的升高,患者术后发生慢性疼痛的风险增加。结论:术后14 d首次门诊随访NRS评分、手术时间、术后2 d最高NRS评分以及术后放疗是影响胸腔镜下肺癌根治术患者术后慢性疼痛发生的独立危险因素,构建术后慢性疼痛预测模型可为慢性疼痛的临床护理工作提供依据。

Objective:To investigate and analyze the influencing factors of chronic pain after thoracoscopic radical resection of lung cancer and build a predictive model.Methods:All 148 patients with non-small cell lung cancer(NSCLC)who underwent thoracoscopic radical resection of lung cancer in our hospital from March 2021 to March 2022 were selected.The patients'postoperative incision pain was scored with numerical grading score(NRS),and the NRS score of more than 3 months after surgery was more than 3 points as chronic pain.56 patients with postoperative chronic pain were treated as pain group,and the remaining 92 patients were treated as pain free group.Single factor and multi factor regression analysis was conducted on the factors that may affect the occurrence of postoperative chronic pain,and a prediction model of postoperative chronic pain was established.Results:Among 148 patients,56 patients still had pain at the incision 3 months after operation,and the incidence of chronic pain was 37.84%.The results of single factor comparison showed that there were significant differences between the pain group and the pain free group in terms of postoperative radiotherapy,postoperative chemotherapy,operation time,the highest NRS score 2 days after operation,and the NRS score of the first outpatient follow-up 14 days after operation(P>0.05).The factors with statistical significance in the above univariate analysis were used as independent variables,and the groups were used as dependent variables for stepwise regression analysis.The results showed that the NRS score of the first outpatient follow-up 14 days after surgery,the operation time,the highest NRS score 2 days after surgery,and postoperative radiotherapy entered the regression model(P<0.05).Prediction model formula:Logit(P)=-0.913+0.140×postoperative radiotherapy+0.006×operation time+0.054×highest NRS score 2 days after operation+0.267×NRS score of the first outpatient follow-up 14 days after operation.With the increase of Logit(P)value,the risk of chronic pain after operation increases.Conclusion:The NRS score of the first outpatient follow-up 14 days after operation,the operation time,the highest NRS score 2 days after operation,and postoperative radiotherapy are independent risk factors that affect the occurrence of postoperative chronic pain in patients undergoing thoracoscopic radical resection of lung cancer.A predictive model of postoperative chronic pain is established to provide basis for clinical nursing of chronic pain.