下肢骨折患者围手术期多模式镇痛效果的影响因素分析

Analysis of factors influencing the perioperative multimodal analgesic effect in patients with lower limb fractures

目的:分析下肢骨折患者围手术期多模式镇痛效果的影响因素。方法:回顾性分析2019年5月至2022年1月收治的397例下肢骨折患者的临床资料。根据患者住院期间是否出现过疼痛数字评价量表(NRS)评分>3分的情况,将其分为疼痛组(273例)与无痛组(124例)。分析两组患者住院期间多模式镇痛效果的影响因素。结果:与无痛组患者相比,疼痛组患者年龄偏低(Z=-2.919,P<0.05),麻醉时采用区域阻滞比例(χ^(2)=6.345,P<0.05)、术后应用阿片类镇痛药比例(χ^(2)=6.044,P<0.05)更高,手术时间(Z=-3.639,P<0.001)、住院时间(Z=-3.893,P<0.001)更长。多因素logistic回归分析结果显示,年龄[比值比(OR)=0.975,P=0.001]、麻醉时是否采用区域阻滞(OR=0.477,P=0.031)、术后是否应用阿片类镇痛药(OR=2.201,P=0.022)、手术时间(OR=1.795,P=0.011)、住院时间(OR=1.137,P=0.002)是下肢骨折患者住院期间出现明显疼痛的独立影响因素。结论:在下肢骨折手术治疗的患者中,围手术期多模式镇痛效果的独立影响因素有年龄、手术时间、住院时间、麻醉时采用区域阻滞及术后应用阿片类镇痛药。

Objective:To explore the factors influencing the perioperative analgesic effect of multi-modal analgesia in patients with lower limb fractures.Methods:A retrospective analysis of clinical data was conducted on 397 patients hospitalized in the Department of Orthopedics of our hospital from May 2019 to January 2022 due to lower limb fractures.The patients were divided into pain group(n=273)and painless group(n=124)according to the presence of numeric rating scale(NRS)score>3 points during hospitalization.Factors influencing the effectiveness of multi-modal analgesia were analyzed between the two groups.Results:Compared with the painless group,the patients in the pain group were younger(Z=−2.919,P<0.05),and had a higher proportion of regional block anesthesia use(χ²=6.345,P<0.05),a higher proportion of postoperative opioid analgesics use ly(χ²=6.044,P<0.05),longer operation duration(Z=−3.639,P<0.001),and longer hospitalization stay(Z=−3.893,P<0.001).Multivariate logistic regression analysis showed that age(OR=0.975,P=0.001),use of regional block anesthesia(OR=0.477,P=0.031),postoperative opioid analgesic use(OR=2.201,P=0.022),length of operation(OR=1.795,P=0.011),and length of hospital stay(OR=1.137,P=0.002)were independent influencing factors for obvious pain during hospitalization.Conclusions:Among patients undergoing surgical treatment for lower limb fractures,the independent influencing factors affecting the perioperative multi-modal analgesia effect include age,operation time,hospital stay,use of regional block anesthesia,and postoperative opioid analgesic use.