冠状动脉旁路移植术后镇痛效果的影响因素

Influence factors of analgesic effect after coronary artery bypass grafting

目的探讨影响冠状动脉旁路移植术后镇痛效果的相关因素。方法回顾性分析2017年5月至2018年6月在首都医科大学附属北京安贞医院行冠状动脉旁路移植术1 291例患者的临床资料,根据其术后镇痛表收集术后8、24、48 h的疼痛视觉模拟量表(VAS)评分(分别定义为VAS-8、VAS-24、VAS-48)以评估术后镇痛方案的效果。纳入可能影响VAS评分的相关变量包括年龄、性别、体重指数、吸烟史、长期饮酒史、高血压病史、糖尿病史、是否使用乳内动脉、手术时间、是否体外循环、术中是否输血。通过单因素分析及多因素Logistic回归分析,得出对VAS-48产生影响的危险因素。结果在1 291例患者中,单因素分析结果提示,VAS-8的影响因素有糖尿病史、吸烟史和使用乳内动脉(均P <0. 05); VAS-24的影响因素在VAS-8相关因素的基础上增加了年龄、性别和饮酒史(均P <0. 05);而VAS-48的影响因素则包括所有影响VAS-8和VAS-24的因素(均P <0. 01)。多因素Logistic回归模型分析结果提示,对VAS-48有正相关影响的因素包括VAS-8(相关系数=0. 081,P <0. 001)、VAS-24(相关系数=0. 995,P <0. 001)、年龄<55岁(相关系数=0. 161,P=0. 015)、男性(相关系数=0. 139,P=0. 045)和吸烟史(相关系数=0. 647,P <0. 001);对VAS-48有负相关影响的包括年龄> 70岁(相关系数=-0. 411,P <0. 001)、糖尿病史(相关系数=-0. 308,P <0. 001)、手术时间> 6 h(相关系数=-0. 157,P=0. 013)。结论预测冠状动脉旁路移植术后镇痛效果不佳的因素包括年龄(<55岁)、男性、有吸烟史;高龄(> 70岁)、糖尿病史、手术时间(> 6 h)与术后48 h VAS评分呈负相关。术后8 h和24 h时的VAS评分能很好地预测术后48 h的VAS评分,提示若早期发现镇痛效果不佳,宜尽早启动多模式镇痛,避免慢性疼痛的发生。

Objective To analyze the factors affecting analgesic effect after coronary artery bypass grafting.Methods A total of 1 291 patients who underwent coronary artery bypass grafting in Beijing Anzhen Hospital,Capital Medical University from May 2017 to June 2018 were retrospectively analyzed.Postoperative 8,24,48 h Visual Analogue Scale(VAS)scores(VAS-8,VAS-24,VAS-48)were recorded.Relevant variables of analgesic effect included age,gender,body mass index,smoking history,drinking history,history of hypertension,history of diabetes,use of internal mammary artery,operative time,extracorporeal circulation and blood transfusion.Risk factors of VAS-48 were analyzed through single-factor analysis and multi-factor logistic regression.Results Among the 1 291 patients,influence factors associated with VAS-8 were history of diabetes,smoking and use of internal mammary artery(all P<0.05);influence factors associated with VAS-24 were age,gender and drinking history in addition(all P<0.05);influence factors of VAS-48 included all the significant factors of VAS-8 and VAS-24(all P<0.01).Multivariate logistic regression showed that VAS-48 was positively related with VAS-8(coefficient of correlation=0.081,P<0.001),VAS-24(coefficient of correlation=0.995,P<0.001),age<55 years(coefficient of correlation=0.161,P=0.015),male(coefficient of correlation=0.139,P=0.045),smoking history(coefficient of correlation=0.647,P<0.001)and negatively related with age>70 years(coefficient of correlation=-0.411,P<0.001),diabetes history(coefficient of correlation=-0.308,P<0.001)and operative time>6 h(coefficient of correlation=-0.157,P=0.013).Conclusions Risk factors of insufficient postoperative analgesia include age(<55 years),male and smoking history.Advanced age(>70 years),diabetes history and operative time(>6 h)are negatively correlated with VAS-48.VAS-8 and VAS-24 are good predictors of VAS-48,suggesting that if early analgesia is not effective,multimodal analgesia should be initiated as early as possible to avoid chronic pain.