目的 探讨肝切除术后慢性疼痛(CPSP)的影响因素.方法 选择2019年6月至2021年5月择期行肝切除术的患者110例,男91例,女19例,年龄≥18岁,BMI 15～30 kg/m2,ASAⅡ或Ⅲ级.根据术后3个月是否诊断CPSP将患者分为两组:非CPSP组和CPSP组.单因素分析后将差异有统计学意义的指标纳入多因素Logistic回归,分析肝切除术CPSP的影响因素.采用回归系数以及常数项构建肝切除术CPSP的预测模型,绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC),采用Hosmer-Lemeshow进行拟合优度检验.结果 有42例(38％)患者肝切除术后发生CPSP.多因素Logistic回归分析显示,BMI≥25 kg/m2是发生CPSP的保护因素,手术时间≥3 h、术后1 d白细胞计数≥13×109/L、术后24 h VAS疼痛评分≥4分是发生CPSP的危险因素.建立的预测模型的AUC为0.86,敏感性73.8％,特异性79.4％,Hosmer-Lemeshow拟合优度检验提示模型区分度和校准度均较好.结论 BMI≥25 kg/m2是肝脏切除术发生CPSP的保护因素,手术时间≥3 h、术后1 d白细胞计数≥13×109/L、术后24 h VAS疼痛评分≥4分是肝脏切除术发生CPSP的危险因素.
Influencing factors of chronic pain after hepatectomy
Objective To assess the influencing factors for chronic postoperative pain(CPSP)of hepatectomy.Methods A total of 110 patients undergoing elective hepatectomy from June 2019 to May 2021,91 males and 19 females,aged≥18 years,BMI 15-30 kg/m2,ASA physical status Ⅱ or Ⅲ.Ac-cording to whether CPSP was diagnosed 3 months after surgery,patients were divided into two groups:no CPSP group and CPSP group.Univariate and multiple logistic regression analysis was performed to determine the independent risk factors for CPSP.Regression coefficients and constants were used to establish a scoring system for CPSP in hepatectomy.Receiver operating characteristic(ROC)curve were drawn,and area under curve(AUC)was calculated,and Hosmer-Lemeshow was used for goodness of fit testing.Results The incidence of CPSP after hepatectomy was 42(38％).In this study,BMI ≥ 25 kg/m2 was a protective factor for CPSP occurrence,and the independent risk factors for CPSP were operation time ≥ 3 hours,white blood cell count ≥ 13×109/L on one day after surgery,VAS pain scores≥4 points at 24 hours after surgery.The area under the curve of the model evaluated by ROC curve was 0.86,sensitivity was 73.8％,specificity was 79.4％,Hosmer-Lemeshow goodness of fit test had no statistical significance,model differ-entiation and calibration were good.Conclusion BMI ≥ 25 kg/m2 is a protective factor for CPSP occur-rence,and operation time ≥ 3 hours,white blood cell count ≥ 13x109/L on one day after surgery,and VAS pain scores ≥ 4 points at 24 hours after surgery are the risk factors for CPSP after hepatectomy.
Chronic postoperative painHepatectomyRisk factorsPrediction model
万方数据
维普
