摘要
目的 筛选青少年特发性脊柱侧凸(AIS)患儿行后路脊柱融合术后疼痛的危险因素,并评价其预测价值.方法 回顾性收集2015年1月1日至2019年12月31日接受后路脊柱融合术的AIS患儿的病例资料,年龄10～18岁,ASA分级I～Ⅲ级.记录患儿的性别、年龄、体质量指数(BMI)、术前Cobb角度、融合节段数目、手术时间、术中用药情况、失血量及静脉自控镇痛(PCIA)的使用情况,记录患儿术后第24小时疼痛数字等级评分(NRS)以及术后使用镇痛药物的种类与次数.根据第24小时NRS评分,将患儿分为轻度疼痛组(＜4分)和中重度疼痛组(≥4分),认为中重度疼痛组的患者发生了急性术后疼痛.采用多因素logistic回归分析确定急性术后疼痛的危险因素.结果 最终纳入患儿2 249例,有392例患儿发生了急性术后疼痛,发生率为17.4％.多因素logistic回归分析结果表明,融合节段数目(OR=1.377,95％CI:1.292～1.468,P＜0.001)、手术时间(OR=1.007,95％CI:1.004～1.009,P＜0.001)为AIS患儿急性术后疼痛的危险因素,术中应用右美托咪定和PCIA为保护因素(P均＜0.05).术中融合节段数目预测急性术后疼痛发生的AUC为0.771(95％CI:0.746～0.797,P＜0.001),其预测的截断值为9.5,灵敏度和特异度分别为86％和59％.手术时间预测急性疼痛发生的AUC为0.659(95％CI:0.629～0.689,P＜0.001),其预测的截断值为291.5,灵敏度和特异度分别为45％和84％.结论 融合节段数目、手术时间为AIS患儿后路脊柱融合术后疼痛的危险因素,具有一定的预测价值;术中应用右美托咪定和PCIA为保护因素.
Abstract
Objective To identify the risk factors for acute postoperative pain(APP)in adolescents underwent posterior spinal fusion surgery,and evaluate the predictive value.Methods The medical records of children,aged 10-18 years old,American Society of Anesthesiologists(ASA)physical status Ⅰ-Ⅲ,underwent posterior spinal fusion surgery from January 1st 2015 to December 31st 2019,were retrospectively collected.The childrens'gender,age,body mass index(BMI),Cobb angle,the number of vertebral fusion,duration of operation,intraoperative medication,the volume of intraoperative blood loss,administration of patient-controlled intravenous analgesia(PCIA)were all collected.The numerical rating scale(NRS)at 24 h after the surgery,the times and types of postoperative analgesic drugs were recorded.According to the NRS at 24 h after the surgery,children were divided into mild pain group(＜4)and moderate to severe pain group(≥4).Children were considered to have experienced APP in the moderate to severe pain group.The risk factors for APP were determined by multivariate logistic regression.Results A total of 2 249 children were finally enrolled in this study,392 children developed to APP,and the incidence was 17.4％.The multivariate logistic regression showed that the number of vertebral fusion(OR=1.377,95％CI:1.292-1.468,P＜0.001),duration of operation(0R=1.007,95％CI:1.004-1.009,P＜0.001)were risk factors;use of dexmedetomidine and PCIA were protective factors for APP.The area under curve(AUC)of the number of vertebral fusion in predicting APP was 0.771(95％CI:0.746-0.797,P＜0.001),the cut-off value was set at 9.5,and the sensitivity and specificity were 86％and 59％,respectively.The AUC of operation duration in predicting APP was 0.659(95％CI:0.629-0.689,P＜0.001),the cut-off value was set at 291.5,and the sensitivity and specificity were 45％and 84％,respectively.Conclusion The number of vertebral fusion,duration of operation are risk factors,and use of dexmedetomidine and PCIA were protective factors for APP in adolescents with posterior spinal fusion surgery.
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