| 程少毅,陈 召,陈 静,卢 强,周勇安,杨三虎.胸外科手术术后神经病理性疼痛的发生情况及相关因素分析[J].,2020,(2):281-284 |
| 胸外科手术术后神经病理性疼痛的发生情况及相关因素分析 |
| Analysis of the Occurrence and Related Factors of Neuropathic Pain after Thoracic Surgery |
| 投稿时间：2019-08-08 修订日期：2019-08-31 |
| DOI：10.13241/j.cnki.pmb.2020.02.016 |
| 中文关键词: 神经病理性疼痛 胸外科手术 危险因素 |
| 英文关键词: Neuropathic pain Thoracic surgery Risk factors |
| 基金项目:国家自然科学基金项目(81572252) |
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| 中文摘要: |
| 摘要 目的：探讨胸外科手术术后神经病理性疼痛的发生情况及相关危险因素。方法：回顾性分析2015年至2016年就诊于我院行胸外科手术的患者的临床资料，包括患者的年龄、性别、吸烟史、BMI、术前是否使用催眠药物、术前诊断、手术侧别、手术方式、是否为微创、硬膜外自控镇痛泵使用情况、术中失血量、手术持续时间、引流管引流时间及是否发生神经病理性疼痛，对比分析是否发生神经病理性疼痛患者的临床资料，对有差异的临床资料进行多因素Logistic回归分析探讨发生神经病理性疼痛的危险因素。结果：共有123例患者纳入研究，33例(26.8%)患者的患者术后出现神经病理性疼痛，6例(4.9%)患者在术后一年仍有持续性神经性病理疼痛，术后出现神经病理性疼痛的平均时间为术后第7天，平均持续时间为75天，发生神经病理性疼痛的患者吸烟比例(81.8%)、术前使用催眠药比例(57.6%)、开胸手术比例(81.8%)、术中失血量(185 mL)、手术时间(196 分钟)、术后引流时间(2.5 天)均高于没有发生神经病理性疼痛的患者。多因素分析显示术前使用催眠药(OR=2.322, P＜0.001)、手术时间延长(OR=3.703, P＜0.001)和术后引流时间延长(OR=2.675, P=0.002)均是神经病理性疼痛发生的危险因素，电视辅助胸腔镜手术方式是保护性因素(OR=0.453, P=0.002)。结论：术前使用催眠药物、延长的手术时间及术后引流时间增加了神经病理性疼痛发生的风险，电视辅助胸腔镜技术可减少其发生率。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the occurrence of neuropathic pain and related risk factors after thoracic surgery. Methods: The clinical data of patients who underwent thoracic surgery in our hospital from 2015 to 2016, including patients' age, gender, smoking history, BMI, preoperative use of hypnotics, preoperative diagnosis, surgical side, surgical approach, whether it was minimally invasive, the use of epidural analgesia pump, intraoperative blood loss, duration of surgery, tube drainage time and whether neuropathic pain occurred were retrospectively collected. The clinical data of patients with neuropathic pain and without were comparably analyzed. Multivariate logistic regression analysis was performed on the differential clinical data to explore the risk factors of neuropathic pain. Results: A total of 123 patients were enrolled in the study. 33 patients (26.8%) had postoperative neuropathic pain. 6 patients (4.9%) had persistent neuropathic pain for one year after surgery. The time for postoperative neuropathic pain was on the 7th day after surgery and the duration was 75 days. The smoking proportion (81.8%), the proportion of hypnotics before surgery (57.6%), the proportion of thoracotomy (81.8%), and the amount of intraoperative blood loss ( 185 mL), operative time (196 minutes), and postoperative drainage time (2.5 days) of patients with neuropathic pain were higher than those without neuropathic pain. Multivariate analysis showed that preoperative use of hypnotics (OR=2.322, P<0.001), prolonged operative time (OR=3.703, P<0.001), and prolonged postoperative drainage time (OR=2.675, P=0.002) were the risk factors of neuropathic pain. Conversely, Video-assisted thoracoscopic surgery is a protective factor (OR=0.453, P=0.002). Conclusion: Preoperative use of hypnotics, and prolonged operative time and postoperative drainage time increase the risk of neuropathic pain. Video-assisted thoracoscopic techniques can reduce the incidence. |
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