腰椎融合术后患者急性疼痛发展轨迹及影响因素

Potential trajectory categories of acute postsurgical pain in patients undergoing lumbar fusion surgery:the influencing factors

目的探讨开放性腰椎融合术患者急性术后疼痛轨迹的潜在类别,分析不同潜在类别的影响因素,为不同类别患者制定针对性镇痛措施提供依据。方法使用便利抽样法,选取择期开放性腰椎融合术患者251例,在术前1 d收集患者一般资料、疼痛评分及睡眠质量资料。术后分别于全麻清醒并拔除气管导管的0 h、6 h、12 h、1 d、2 d、3 d、4 d、5 d、6 d 9个时间点评估患者疼痛程度。采用潜类别增长模型识别急性术后疼痛轨迹的潜在类别,采用无序多分类logistic回归分析急性术后疼痛轨迹潜在类别的影响因素。结果识别出3种急性术后疼痛轨迹,分别为疼痛加剧后缓解组(83例,33.0%),疼痛加剧稳定后反弹组(30例,12.0%),轻度疼痛组(138例,55.0%)。回归分析显示,相对于轻度疼痛组,病程≥10年、高中以下文化程度、手术时间>240 min的患者更容易进入疼痛加剧稳定后反弹组;年龄≤50岁、存在睡眠障碍、术后未使用镇痛泵的患者更容易进入疼痛加剧后缓解组(均P<0.05)。结论开放性腰椎融合手术患者急性术后疼痛呈现不同的发展轨迹,医护人员应根据不同发展轨迹重视年龄≤50岁、病程≥10年、高中以下文化程度、术前有睡眠障碍、手术时间>240 min、术后未使用镇痛泵的患者,给予及时的疼痛评估及针对性干预措施,改善患者术后疼痛程度。

Objective To explore the potential trajectory categories and influencing factors of acute postsurgical pain(APSP)in patients undergoing open lumbar fusion surgery,to analyze the influencing factors of different potential categories,and to provide theoretical basis for developing targeted analgesic measures for patients of different categories in the future.Methods A convenience sampling method was utilized to select 251 patients undergoing open lumbar fusion surgery.Social-demographic data,pain scores,and sleep quality assessments were collected one day before surgery,with pain levels assessed at nine time point spost-surgery(0 h,6 h,12 h,1 d,2 d,3 d,4 d,5 d,and 6 d of extubation).Latent class growth modeling was employed to identify distinct APSP trajectories,and logistic regression was used to analyze predictive factors of these trajectories.Results Three distinct APSP trajectories were identified:the pain-aggravation-then-relief group(33.0%),the pain-aggravation-stabilization-then-rebound group(12.0%),and the mild pain group(55.0%).Logistic regression analysis indicated that,compared with the mild pain group,those aged≤50 years,with sleep disorders,without using postsurgical patient-controlled intravenous analgesia,were more likely to join membership of the pain-aggravation-then-relief group;those with disease duration≥10 years,education level below high school,operation duration>240 minutes were more likely to join membership of the pain-aggravation-stabilization-then-rebound group(all P<0.05).Conclusion Patients undergoing open lumbar fusion surgery exhibit diverse APSP trajectories.Medical professionals should be attentive to patients who are aged≤50,who have disease duration≥10 years,education level below high school,preoperative sleep disorder,operation duration>240 min,and who don’t use postoperative analgesia,and provide timely pain management and intervention.