摘要
目的 探究良性疾病行子宫切除术后并发慢性疼痛的危险因素,分析围术期干预对策.方法 选取2021年3月至2022年9月在东南大学附属中大医院江北院区行子宫切除术的394例良性疾病患者进行前瞻性研究,收集患者的一般临床资料、临床特征、手术及心理学资料,术后4个月随访统计术后慢性疼痛(CPSP)的发生率.采用独立样本t检验、卡方检验分析上述资料与患者术后并发CPSP的关系;多因素Logistic回归分析确定患者术后并发CPSP的独立危险因素.结果 最终纳入研究386例患者中术后4个月并发CPSP 102例(26.42％),其中轻度CPSP 94例(92.16％),中度CPSP 8例(7.84％).经独立样本t检验与卡方检验可知,年龄、体质量指数(BMI)、绝经状态、高血压、糖尿病、剖宫产史、其他腹部手术史、孕次、产次、手术路径、手术时间均与患者术后并发CPSP无关(P＞0.05);术前疼痛、术后1h的NRS评分、HADS-A评分、HADS-D评分、PCS评分均可能与患者术后并发CPSP有关(P＜0.05).多因素Logistic回归分析显示,术前疼痛(OR=3.626,95％CI=1.763～7.459)、术后 1 h 的 NRS 评分(OR=1.358,95％CI=1.029～1.792)、HADS-A评分(OR=1.314,95％CI=1.060～1.628)、HADS-D评分(OR=1.270,95％CI=1.047～1.541)、PCS 评分(OR=1.138,95％CI=1.019～1.272)均为患者术后并发CPSP的独立危险因素(P＜0.05).结论 良性疾病行子宫切除术后并发CPSP主要与术前疼痛、术后1h疼痛程度、焦虑、抑郁及疼痛灾难化认知有关,可据此加强围术期干预,降低CPSP风险.
Abstract
Objective To explore the risk factors for chronic pain after benign disease hysterectomy and analyze perioperative intervention strategies.Methods A prospective study was conducted on 394 patients with benign diseases who underwent hysterectomy in the Jiangbei Hospital of Zhongda Hospital Affiliated to Southeast University from March 2021 to September 2022.General clinical data,clinical characteristics,surgical data,and psychological data were collected,and the incidence of chronic postoperative pain(CPSP)was calculated after 4 months of follow-up.The relationship between the above data and postoperative CPSP was analyzed by independent sample t test and chi-square test.Multivariate logistic regression analysis was used to determine the independent risk factors for CPSP after surgery.Results Among the 386 patients included in the study,102 patients(26.42％)had CPSP at 4 months after surgery,including 94 patients(92.16％)with mild CPSP and 8 patients(7.84％)with moderate CPSP.According to the independent sample t-test and chi-square test,age,body mass index(BMI),menopausal status,hypertension,diabetes,history of cesarean section,history of other abdominal surgery,gravidity,parity,surgical path,and operation time were not associated with postoperative CPSP(P＞0.05);Preoperative pain,NRS score at 1 hour after surgery,HADS-A score,HADS-D score,and PCS score may be related to CPSP after surgery(P＜0.05).Multivariate logistic regression analysis showed that preoperative pain(OR=3.626,95％CI=1.763-7.459),NRS score at 1 hour after surgery(OR=1.358,95％CI=1.029-1.792),HADS-A score(OR=1.314,95％CI=1.060-1.628),HADS-D score(OR=1.270,95％CI=1.047-1.541),and PCS score(OR=1.138,95％CI=1.019-1.272)were independent risk factors for CPSP after surgery(P＜0.05).Conclusions CPSP after hysterectomy for benign disease is mainly related to preoperative pain,pain level at 1 hour after surgery,anxiety,depression,and pain catastrophizing cognition.Therefore,perioperative intervention can be strengthened to reduce the risk of CPSP.
基金项目
江苏省医药卫生科技发展计划(2021WSA0201)
NETL
NSTL
维普
万方数据