术前唾液皮质醇早/晚分泌比值预测患者术后急性疼痛的价值
Value of preoperative salivary cortisol morning/night secretion ratio in predicting acute postopera-tive pain
辜淑靖 1王存金 2高巨 2莫怀忠1
作者信息
- 1. 贵州医科大学麻醉学院,贵阳 550025
- 2. 江苏省苏北人民医院麻醉科,扬州 225001
- 折叠
摘要
目的 评价术前唾液皮质醇早/晚分泌比值预测患者术后急性疼痛的价值.方法 本研究为前瞻性队列研究.选择江苏省苏北人民医院2023年1月至10月择期行单孔腹腔镜子宫切除术患者120例,年龄18～64岁,ASA分级Ⅰ或Ⅱ级,BMI 18～28 kg/m2,术前应用医院焦虑抑郁量表(HADS)评估焦虑和抑郁状况.术前1 d早晨和晚间采集唾液样本,采用ELISA法测定皮质醇浓度,计算术前早晨皮质醇浓度与术前晚间皮质醇浓度的比值(皮质醇AM/PM比值).采用数字评分量表(NRS)评估患者术后疼痛程度,根据术后48 h内NRS最高评分将患者分为2组:无或轻度疼痛组,NRS最高评分≤3分;中重度疼痛组,NRS最高评分≥4分.采用多因素logistic回归筛选术后中重度急性疼痛的危险因素,绘制受试者工作特征曲线评价其预测价值.结果 多因素logistic回归分析显示,年龄、术前HADS焦虑评分、术前HADS抑郁评分和术前皮质醇AM/PM比值是术后中重度急性疼痛发生的独立危险因素(P＜0.05).受试者工作特征曲线结果显示,术前皮质醇AM/PM比值预测术后中重度急性疼痛的曲线下面积为0.803(95％置信区间0.708～0.898,P＜0.001),最佳截断值为3.46,灵敏度为71.1％,特异度为87.7％.结论 术前唾液皮质醇早/晚分泌比值可预测患者术后急性疼痛的发生.
Abstract
Objective To assess the value of preoperative salivary cortisol morning/night secretion ratio(AM/PM ratio)in predicting acute postoperative pain in patients.Methods This was a prospective cohort study.A total of 120 patients,aged 18-64 yr,of American Society of Anesthesiologists Physical Sta-tus classification Ⅰ or Ⅱ,with body mass index of 18-28 kg/m2,undergoing elective single-port laparo-scopic hysterectomy from January to October 2023 in Subei People's Hospital of Jiangsu Province,were se-lected,and their anxiety and depression status was evaluated by using the Hospital Anxiety and Depression Mood Measurement Scale(HADS)before surgery.Saliva samples were collected in the morning and evening 1 day before operation,and the cortisol concentration was determined by enzyme-linked immunosorbent as-say.The ratio of morning cortisol concentration to night cortisol concentration before operation was calculated(cortisol AM/PM ratio).The patients were divided into two groups according to the highest numerical rating scale(NRS)score within 48 h after surgery:no or mild pain group with the highest NRS score ≤3 and moderate to severe pain group with the highest NRS score ≥ 4.Multivariate logistic regression was used to i-dentify the risk factors of moderate to severe acute pain after surgery,and the receiver operating characteris-tic curve was plotted to evaluate the predictive value.Results Multivariate logistic regression analysis showed that age,preoperative HADS anxiety score,preoperative HADS depression score and preoperative cortisol AM/PM ratio were independent risk factors for moderate to severe acute pain after surgery(P＜0.05).The results of the receiver operating characteristic curve showed that the area under the curve of pre-operative cortisol AM/PM ratio in predicting moderate to severe acute postoperative pain was 0.803(95％confidence interval 0.708-0.898,P＜0.001),the optimal cut-off value was 3.46,the sensitivity was 71.1％,and the specificity was 87.7％.Conclusions Preoperative salivary cortisol morning/night secretion ratio can predict the occurrence of acute postoperative pain in patients.
关键词
皮质醇/预测/疼痛/手术后并发症Key words
Cortisol/Forecasting/Pain/Postoperative complications引用本文复制引用
基金项目
国家自然科学基金(82171207)
扬州市麻醉学重点实验室培育专项(YZ2021148)
江苏省科协青年科技人才支持项目(2021-008)
江苏省"333高层次人才培养工程"优秀青年人才项目(2022-3-6-146)
扬州市科技计划社发项目(YZ2021088)
出版年
2024
NETL
NSTL
万方数据