术后早期疼痛轨迹对于乳腺癌术后持续性疼痛的预测价值研究

Study on the value of early postoperative pain trajectory in predicting persistent pain after breast cancer operation

目的 探讨术后早期疼痛轨迹对于乳腺癌术后持续性疼痛的预测价值。方法 选取2019年1月至2021年12月在上海同济大学医学院附属东方医院治疗的乳腺癌患者临床资料进行回顾性分析。采用GBTM根据术后1~7d的疼痛强度进行组间轨迹建模分析,确定术后早期疼痛轨迹。采用Logistic回归模型分析术后早期疼痛轨迹与术后持续性疼痛的相关性。采用ROC曲线评价术后早期疼痛轨迹对乳腺癌术后持续性疼痛的预测价值。结果 3组模型(轻度、中度和重度疼痛)适用于分析术后早期疼痛轨迹。术后6个月持续性疼痛发生率为50.80%,其中有42.24%出现轻度疼痛,有8.55%出现重度疼痛。常见疼痛部位依次为胸部(39.57%)、腋窝(27.81%)、手臂(13.91%)和后背(7.49%)。术后早期疼痛中的重度疼痛轨迹与术后6个月持续性疼痛相关(P<0.001)。ROC曲线显示,重度疼痛轨迹预测乳腺癌术后持续性疼痛的AUC为0.865。结论 术后早期疼痛轨迹可用于预测乳腺癌术后持续性疼痛,临床中可根据术后早期疼痛轨迹对患者进行分类,并采取针对性干预措施。

Objective To explore the predictive value of early postoperative pain trajectory in postoperative persistent pain in breast cancer.Methods The clinical data of breast cancer patients treated in Department of Anesthesiology, Dongfang Hospital to Tongji University hospital from January 2019 to December 2021 were analyzed retrospectively.GBTM was used to model and analyze the intergroup pain intensity according to the pain intensity of 1~7 days after operation to determine the early postoperative pain trajectory.Logistic regression model was used to analyze the correlation between early postoperative pain trajectory and persistent pain 6 months after operation.ROC curve was used to evaluate the predictive value of early postoperative pain trajectory in postoperative persistent pain in patients with breast cancer.Results Three groups of models(mild, moderate and severe pain) were suitable for analyzing the early postoperative pain trajectory.Six months after operation, the incidence of pain was 50.80%,of which 42.24% had moderate pain and 8.55% had severe pain.The common sites of pain were chest(39.57%),armpit(27.81%),arm(13.91%) and back(7.49%).The track of severe pain in early postoperative pain was related to persistent pain 6 months after operation(P<0.001).ROC curve showed that the AUC of severe pain trajectory to predict the degree of persistent pain after breast cancer operation was 0.865.Conclusion The early postoperative pain trajectory can be used to predict persistent pain after breast cancer operation.patients can be classified according to the early postoperative pain trajectory and targeted intervention measures can be taken.