成人肝移植术后疼痛变化轨迹及影响因素分析

Analysis of pain trajectory and influencing factors after adult liver transplantation

目的分析成人肝移植术后疼痛变化轨迹及影响因素,为制订针对性的护理措施缓解成人肝移植术后疼痛提供参考。方法采用目的抽样法选择在某三甲医院麻醉科行肝移植的138例成人患者,采用疼痛数字评定量表(NRS)于患者手术当天、术后第1天上午、术后第1天下午、术后第2天上午、术后第2天下午、术后第3天上午、术后第3天下午进行调查,评估患者的疼痛程度。采用潜分类增长模型(LCGM)识别疼痛变化轨迹的潜在类别;运用时间不变协变量的潜增长曲线模型(LGCM)分析其影响因素;纳入协变量运用混合回归模型(MRM)分析各潜在类别的影响因素。结果疼痛变化轨迹可分为疼痛低组(64.5%)、疼痛快速上升组(22.5%)、疼痛缓慢上升组(13.0%)。纳入协变量的分析结果显示,年龄、诊断、术中低体温是影响术后疼痛的轨迹类别(均P<0.05或0.001)。结论成人肝移植患者术后疼痛分为3种不同的变化轨迹,其术后疼痛存在群体异质性,应基于患者术后疼痛变化轨迹的同质群体,有针对性地进行评估和干预。

Objective To analyze the trajectory and influencing factors of pain changes after adult liver transplantation,so as to provide reference for developing targeted nursing measures to alleviate pain after adult liver transplantation.Methods A purposive sampling method was used to select 138 adult patients who underwent liver transplantation in the anesthesia department of a tertiary hospital.The pain number rating scale(NRS)was used to assess the degree of pain in patients on the day of surgery,the morning of the first day after surgery,the afternoon of the first day after surgery,the morning of the second day after surgery,the afternoon of the second day after surgery,the morning of the third day after surgery,and the afternoon of the third day after surgery.Latent category growth model(LCGM)was used to identify potential categories of pain trajectory changes;the latent growth curve model(LGCM)with time invariant covariates was used to analyze its influencing factors;Covariates were included and a mixed regression model(MRM)was used to analyze the influencing factors of each potential category.Results The trajectory of pain changes can be divided into low pain group(64.5%),rapid increase pain group(22.5%),and slow increase pain group(13.0%).The analysis results incorporating covariates showed that age,diagnosis,and intraoperative hypothermia affected the trajectory categories of postoperative pain(all P<0.05 or 0.001).Conclusion Postoperative pain in adult liver transplant patients can be divided into three different trajectories,and there is group heterogeneity in postoperative pain.Targeted evaluation and intervention should be based on the homogeneous population of postoperative pain trajectories in patients.