早期非小细胞肺癌病人肺叶切除术后慢性疼痛的影响因素

目的:探讨择期行肺叶切除术的早期非小细胞肺癌病人发生术后慢性疼痛的影响因素。方法:入组112名择期行肺叶切除术的早期非小细胞肺癌病人,记录他们的一般资料,数字疼痛量表(numeric rating scale,NRS)评分,医院焦虑抑郁量表(hospital anxiety and depression Scale,HADs)评分,压痛阈值,明确术后慢性疼痛的发生率,应用Logistic回归分析术后慢性疼痛的影响因素。结果:112例病人中,发生慢性疼痛的病人46例,未发生慢性疼痛的病人66例。术后慢性疼痛的危险因素为术前焦虑(OR=5.610,95%CI:1.811-17.377),患糖尿病(OR=3.825,95%CI:1.106-13.234)。文化程度高的病人术后慢性疼痛的发病率低(OR=0.655,95%CI:0.466-0.920)。结论:术前焦虑或合并糖尿病是术后慢性疼痛发生的危险因素,受教育程度高可降低术后慢性疼痛的发生。     

术前营养状况及衰弱与老年非心脏手术患者术后谵妄的相关性

目的 探讨术前营养状况及衰弱对行非心脏手术老年患者术后谵妄(POD)的预测价值。方法 通过电子病历系统回顾性收集2020年1月—2022年12月376例行非心脏手术的老年患者的临床资料,根据术后5 d内是否出现POD分为POD组80例和非POD组296例。采用多因素Logistic回归法分析POD的危险因素,并采用受试者工作特征(ROC)曲线对营养不良与衰弱预测POD的价值进行定量评估。结果 单因素分析显示,POD组年龄>70岁、糖尿病、初中及以下文化程度、术前衰弱、术前中重度营养不良的患者占比较非POD组升高,白蛋白水平较非POD组降低,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄>70岁(OR=1.398,95%CI:1.044～1.872)、术前衰弱(OR=1.706, 95%CI:1.238～2.349)、术前中重度营养不良(OR=1.632, 95%CI:1.282～2.079)是非心脏手术老年患者出现POD的独立危险因素。ROC曲线显示,术前衰弱联合中重度营养不良预测非心脏手术老年患者出现POD的曲线下面积(AUC)为0.80...     

腹膜透析导管植入术后早期疼痛的特点及影响因素分析

目的探讨腹膜透析导管植入术后疼痛的特点及影响因素。方法纳入2016年1～12月于中山大学附属第一医院行腹膜透析导管植入术的终末期肾病患者。用数字疼痛量表评估患者术后疼痛情况,分析相关影响因素。结果共纳入118例腹膜透析患者。90例(76.3%)患者术后发生中重度疼痛。中、重度疼痛组年龄较小(F=5.602,P=0.005)、疼痛持续时间较长(x~2=24.613,P0.001)、术后活动引起的疼痛比例高(x~2=11.080,P=0.004);重度疼痛组术中大网膜活跃比例较高(x~2=5.943,P=0.024)。多因素分析显示,较小的年龄(OR=0.96,95%CI 0.93～0.99,P=0.011)、导管出口处疼痛(OR=3.08,95%CI1.14～8.36,P=0.027)、术后活动引起疼痛(OR=3.04,95%CI1.12～8.24,P=0.029)是患者术后发生中重度疼痛的独立危险因素。结论腹膜透析导管植入术后中重度疼痛发生率为76.3%。分析患者疼痛的特点及影响因素,有助于制定相应的措施,缓解疼痛。     

基于Nomogram模型构建腹部术后并发腹腔感染的风险评分系统

目的 探讨腹部术后并发腹腔感染（intra-abdominal infection,IAI）的危险因素,并建立个体化Nomogram预测模型。方法 选择2019年1月至2021年12月于河北省秦皇岛市第一医院接受腹部开放性手术患者216例作为研究对象,根据患者术后住院期间是否发生IAI,分为IAI组58例和非IAI组158例。对两组患者相关临床资料进行单因素和多因素logistic回归分析,得出术后IAI的独立危险因素,基于此构建列线图风险模型,并对该模型进行预测效能的评价。结果 单因素和多因素logistic回归分析表明,患者年龄≥68岁（OR=9.488,95%CI 4.221～21.324）、手术时间≥5.5h(OR=2.742,95%CI 1.317～5.707)、术前白蛋白水平≤35.5g/L(OR=2.136,95%CI 1.002～4.553)、合并糖尿病（OR=3.117,95%CI 1.121～8.668）和术后合并肺部感染（OR=3.684,95%CI 1.593～8.520）是腹部手术患者术后发生IAI的独立危险因素（P<0.05）。基于以上风险因素建立No...     

结肠镜检查过程中患者疼痛相关的危险因素

目的:探讨结肠镜检查过程中患者疼痛相关的危险因素。方法:前瞻性收集2018年1至6月解放军第九〇〇医院门诊消化内镜室385例接受结肠镜检查患者的临床资料,采用视觉模拟评分法(Visual Analogue Scale,VA S)评估患者结肠镜检查过程中疼痛程度,自制调查问卷收集患者人口学特征、有无盆腹部手术史和结肠镜检查史、检查前有无腹痛主诉,采用综合医院焦虑/抑郁量表焦虑分量表(Anxiety Subscale of Hospital Anxiety and Depression Scale,HADS-A)评估检查前焦虑状况,渥太华肠道准备量表(Ottawa Bowel Preparation Scale,OBPS)评估肠道准备充分性,记录有无镇静及镇静方式,计算结肠镜进镜成功率(到达回盲部),记录内镜医师经验。通过单因素和多因素logistic回归分析各个变量与结肠镜检查过程中患者疼痛的关联。结果:本组使用镇静比例为24.7%(95/385),疼痛(VAS评分≥5)发生率为17.7%(68/385),进镜成功率为97.4%(375/385)。单因素分析显示:结肠镜检查过程中疼痛与性别(P=0.020)、体重指数(bodymassindex,BMI)(P=0.006)、盆腹部手术史(P=0.010)、结肠镜检查史(P=0.034)、检查前腹痛主诉(P=0.032)、焦虑评分(P=0.017)、有无镇静(P=0.006)、镇静方式(P=0.016)、肠道准备充分性(P=0.018)、内镜医师经验(P=0.015)存在关联(均P0.05)。多因素分析发现:低BMI(18.5 kg/m2)(OR=1.82,95%CI0.67～3.53,P=0.008)、盆腹部手术史(OR=2.35,95%CI1.48～4.76,P0.001)、高焦虑评分(HADS-A评分≥11)(OR=2.04,95%CI 1.26～4.19,P=0.005)、未使用镇静(OR=3.16,95%CI1.87～5.92,P0.001)、肠道准备不充分(OBPS评分≥6)(OR=2.15,95%CI1.54～4.06,P=0.002)、内镜医师经验少(500例)(OR=4.76,95%CI 2.28～7.85,P0.001)是疼痛的独立危险因素,丙泊酚镇静是疼痛的保护因素(OR=0.28,95%CI 0.15～0.62,P0.001)。结论:结肠镜检查过程中疼痛的发生与患者自身特征、心理因素、肠道准备质量和内镜医师经验有关,对于高危人群合理使用镇静可以有效预防疼痛的发生。     

外科重症监护病房患者术后中重度操作性疼痛发生现状及影响因素分析

目的调查外科重症监护病房(ICU)患者术后中重度操作性疼痛发生现状, 并分析其影响因素。方法本研究为横断面研究。采用便利抽样法, 选取2021年6月—2022年2月四川大学华西医院外科ICU收治的380例术后患者为研究对象, 采用自行设计的ICU患者术后操作性疼痛调查问卷、疼痛数字评价量表(NRS)对患者进行调查。采用二项Logistic回归分析探讨患者术后发生中重度操作性疼痛的影响因素。结果 380例外科ICU患者术后中重度操作性疼痛的发生率为72.63%(276/380), 其中52.17%(144/276)的患者积极报告中重度操作性疼痛, 47.83%(132/276)的患者选择隐瞒或忍耐中重度操作性疼痛。二项Logistic回归分析结果显示, 性别(OR=13.763, P<0.01)、慢性疼痛史(OR=2.363, P<0.05)、引流管数量(OR=1.297, P<0.01)、急性生理学及慢性健康状况评分(OR=4.137, P<0.01)是外科ICU患者术后发生中重度操作性疼痛的影响因素。结论外科ICU患者术后中重度操作性疼痛的发生率高, 医护人员...     

成人心脏直视术后手术部位感染危险因素分析

目的 探讨成人心脏直视术后手术部位感染(SSI)发生的危险因素,为控制SSI的发生提供依据.方法 对本院心脏外科2001年1月至2009年12月间体外循环心脏直视术后发生SSI 54例成年患者临床资料进行分析,按1:3比例配对选取对照组.对2组患者的临床资料中SSI的潜在危险因素进行单因素和多因素条件Logistic回归分析.结果 单因素条件Logistic分析:左心室射血分数(LVEF)<50%(OR=2.134,95%CI:1.095～4.159,P=0.026),心功能NYHA≥Ⅲ级(OR=2.390,95%CI:1.218～4.690,P=0.011),糖尿病(OR=3.275,95%CI:1.391-7.708,P=0.007),慢性阻塞性肺疾病(COPD)(OR=5.408,95%CI:1.248～23.445,P=0.024),体外循环时间>90 min(OR=3.045,95%CI:1.540～6.024,P=0.001),手术时间>4 h(OR=3.281,95%CI:1.610～6.685,P=0.0131),血液制品用量>2 U(OR=1.929,95%CI:1.018～3.675,P=0.044),切口连续缝合(OR=2.344,95%CI:1.221～4.498,P=0.010),二次开胸止血(OR=6.625,95%CI:1.597～27.491,P=0.009),术后高血糖(OR=3.510,95%CI:1.596～7.718,P=0.002),重症监护病房入住>72 h(OR=3.281,95%CI:1.505～7.150,P=0.003)与SSI发生相关.多因素条件Lgistic回归分析显示:手术时间>4 h(OR=3.100,95%CI:1.470～6.537,P=0.003)、切口皮下层连续缝合(OR=2.340,95%CI:1.183～4.692,P=0.015)、术后高血糖(OR=3.272,95%CI:1.427～7.505,P=0.005)是SSI的独立危险因素.结论 手术时间>4 h、切口皮下连续缝合及术后高血糖是心脏直视术后SSI发生的危险因素.     

国内经皮肾镜取石术后发生全身炎症反应综合征相关因素的Meta分析

目的探讨国内经皮肾镜取石术(PCNL)后发生全身炎症反应综合征(SIRS)的危险因素。方法计算机检索国内有关PCNL术后发生SIRS的相关研究,时间截止至2016年10月,采用Rev Man5.3进行Meta分析。结果共纳入18个研究,5 323例患者,Meta分析结果显示:(1)单因素分析结果 :肾功能不全[OR=2.78,95%CI(1.96,3.95),P=0.000]、术前尿培养细菌阳性[OR=3.41,95%CI(1.89,6.15),P=0.000]、术前尿常规白细胞异常[OR=3.78,95%CI(3.02,4.72),P=0.000]、糖尿病[OR=2.14,95%CI(1.33,3.45),P=0.002]、结石细菌培养阳性[OR=5.14,95%CI(2.46,10.73),P=0.000]和手术时间≥120 min[OR=2.31,95%CI(1.40,3.82),P=0.001]是PCNL术后发生SIRS的危险因素;(2)多因素分析显示:术前尿培养细菌阳性[OR=6.83,95%CI(2.82,16.57),P=0.000]、术前尿常规白细胞异常[OR=5.43,95%CI(3.51,8.41),P=0.000]、糖尿病[OR=2.85,95%CI(1.45,5.58),P=0.002]、结石细菌培养阳性[OR=4.30,95%CI(1.30,14.21),P=0.020]和手术时间≥120 min[OR=2.72,95%CI(1.62,4.59),P=0.000]是PCNL术后发生SIRS的独立危险因素。结论糖尿病、术前尿培养细菌阳性、术前尿常规白细胞异常、结石细菌培养阳性和手术时间是PCNL术后发生SIRS的独立危险因素,受纳入研究数量和质量影响,需开展更多高质量研究证实上述结论。     

胃肠道手术术前风险度列线图评价模型的建立

目的通过分析胃肠道手术术后并发症的危险因素,建立术前列线图评价模型,并评价预测术后并发症的准确性,为分级护理提供依据。方法选择2015年1月至2018年1月本院普外科收治的胃肠道手术患者323例作为研究对象,其中发生术后并发症的患者78例作为并发症组,无发生并发症的患者245例作为对照组。建立胃肠道手术患者评分系统,并进行并发症单因素分析,将有统计学意义的指标纳入多因素Logistic回归模型,分析胃肠道手术术后并发症的危险因素。根据回归分析结果,建立列线图术前评价模型。利用ROC曲线及Hosmer-Lemeshow检验评价模型预测效能。结果多因素分析显示,心血管系统评分(OR=4.983, 95%CI:2.123～11.750)、呼吸系统评分(OR=2.132, 95%CI:1.081～4.204)、高血压评分(OR=2.154, 95%CI:1.030～4.502)、肝储备功能评分(OR=4.505, 95%CI:2.232～9.092)、营养状态评分(OR=3.150, 95%CI:1.057～9.388)、肾脏功能评分(OR=3.496, 95%CI:1.856～6.586)、昏迷评分(OR=1.842, 95%CI:1.004～3.377)是发生术后并发症的危险因素(均P0.05)。ROC曲线显示列线图模型预测胃肠道手术术后并发症曲线下面积(area under the ROC curve,AUC)为0.982(95%CI:0.971～0.992),特异性为89.80%,敏感性为96.15%。结论基于心血管系统评分、呼吸系统评分、高血压评分、肝储备功能评分、营养状态评分、肾脏功能评分、昏迷评分建立预测胃肠道手术术后并发症发生风险的列线图模型,具有良好的特异性和敏感性,临床价值较高。     

多模式疼痛管理下日间手术患者术后疼痛的影响因素分析

目的 了解日间手术患者术后急性疼痛发生率及疼痛程度，探讨术后中重度疼痛的影响因素，为日间手术疼痛管理提供参考。方法 采用便利抽样法，选取2020年4月-8月四川大学华西医院多模式疼痛管理下的日间手术患者，调查患者的一般情况、手术情况及术后疼痛情况等。按患者术后疼痛程度分为轻微疼痛组和中重度疼痛组，采用logistic回归分析探讨两组患者术后疼痛的影响因素。结果 最终纳入509例患者，其中69例患者出现中重度疼痛。Logistic回归分析显示，患者年龄[比值比（odds ratio,OR）=0.970,95%置信区间（confidence interval,CI）(0.946,0.993),P=0.012]、疼痛阈值[OR=1.348,95%CI(1.048,1.734),P=0.020]和术后有无引流管[OR=2.752,95%CI(1.090,6.938),P=0.017]是术后中重度疼痛的影响因素。结论 在多模式疼痛管理下，日间手术患者的中重度疼痛发生率较低，医护人员应从疼痛影响因素着手进一步加强疼痛管理，减少患者术后中重度疼痛的发生率。     

Psychosocial Predictors of Acute and Chronic Pain in Adolescents Undergoing Major Musculoskeletal Surgery

Acute and chronic pain delay recovery and impair outcomes after major pediatric surgery. Understanding unique risk factors for acute and chronic pain is critical to developing effective treatments for youth at risk. We aimed to identify adolescent and family psychosocial predictors of acute and chronic postsurgical pain after major surgery in adolescents. Participants included 119 youth age 10 to 18 years (M_age = 14.9; 78.2% white) undergoing major musculoskeletal surgery and their parents. Participants completed presurgery baseline questionnaires, with youth reporting on baseline pain, anxiety, depression, insomnia and sleep quality, and parents reporting on parental catastrophizing and family functioning. At baseline, 2-week, and 4-month postsurgery, youth completed 7 days of daily pain diaries and reported on health-related quality of life. Sequential logistic regression models examined presurgery predictors of acute and chronic postsurgical pain, defined as significant pain with impairment in health-related quality of life. Acute pain was experienced by 27.2% of youth at 2 weeks, while 19.8% of youth met criteria for chronic pain at 4 months. Baseline pain predicted acute pain (odds ratio [OR] = 1.96; 95% confidence interval [CI] = 1.32–2.90), while depressive symptoms (OR = 1.22; 95%CI = 1.01–1.47), and sleep quality (OR = 0.26; 95%CI = 0.08–0.83) predicted chronic pain. Tailored interventions need to be developed and incorporated into perioperative care to address risk factors for acute and chronic pain.PerspectiveLongitudinal results demonstrate adolescents’ presurgery pain severity predicts acute postsurgical pain, while depressive symptoms and poor sleep quality predict chronic postsurgical pain. Tailored interventions should address separate risk factors for acute and chronic pain after adolescent surgery.     

Facteurs de risque de la douleur chronique postchirurgicale

Chronic postsurgical pain is a major health issue since it is common and can compromise patient autonomy. The definition of risk factors for chronic postsurgical pain is important if we are to act quickly, particularly in specific situations, and take steps to prevent it if possible. Risk factors can be related to both surgery and patient. Certain types of surgery are identified as presenting a high risk of chronic postsurgical pain (for example, amputation, thoracic surgery, breast surgery), but more generally there is a connection between perioperative nerve lesion and the risk of chronic postsurgical pain. The patient sees preoperative pain and intense postoperative pain as the most significant risk factors in various types of surgery. Psychological risk factors are still in the process of identification. A postoperative mechanical allodynia around the wound seems to be predictive of chronic postsurgical pain.We still need to improve our understanding of the risk factors related to chronic postsurgical pain and try to develop the clinical tools for predicting it.     

Are Psychological Predictors of Chronic Postsurgical Pain Dependent on the Surgical Model? A Comparison of Total Knee Arthroplasty and Breast Surgery for Cancer

Anxiety, depression, and catastrophizing are generally considered to be predictive of chronic postoperative pain, but this may not be the case after all types of surgery, raising the possibility that the results depend on the surgical model. We assessed the predictive value of these factors for chronic postsurgical pain in 2 different surgical models: total knee arthroplasty for osteoarthritis (89 patients, 65% women, age = 69 ± 9 years, baseline pain intensity = 4.7 ± 2.1) and breast surgery for cancer (100 patients, 100% women, age = 55 ± 12 years, no preoperative pain). Data were collected before surgery, then 2 days and 3 months after surgery. Anxiety, depression, and catastrophizing were measured with the Spielberger State-Trait Anxiety Inventory, Beck Depression Inventory, and Pain Catastrophizing Scale, respectively. Pain was assessed with the Brief Pain Inventory. Neuropathic pain was detected with the DN4 questionnaire. Multivariate logistic regression analyses for the total knee arthroplasty and breast surgery models considered together indicated that the presence of clinically meaningful chronic pain at 3 months (pain intensity ≥3/10) was predicted independently by age (P = .04), pain intensity on day 2 (P = .009), and state anxiety (P = .001). Linear regression models also showed that pain magnification, one of the dimensions of catastrophizing, independently predicted chronic pain intensity (P = .04). These results were not affected by the surgical model or by the neuropathic characteristics of the pain. Thus, state anxiety and pain magnification seem to constitute psychological risk factors for chronic postsurgical pain relevant in all surgical models.PerspectiveThis prospective study performed in patients with total knee arthroplasty or breast surgery for cancer shows that state anxiety, amplification of pain, and acute postoperative pain independently predict postsurgical pain at 3 months and that this does not depend on the surgical model.     

Risk of Pain and Gastrointestinal Complaints at 6Months After Elective Abdominal Surgery

The incidence of chronic postoperative abdominal pain (CPAP) after abdominal surgery is substantial and decreases overall quality of life. One in 3 patients report pain-related interference with mood, sleep, and enjoyment of life and 12% visit the emergency department for pain-related symptoms. Previous studies lack data on preoperative health and pain status or are limited by small patient samples. The aim of this study was to assess risk factors for CPAP and gastrointestinal complaints 6 months after surgery. A prospective cohort study was performed including patients undergoing an elective laparotomy or laparoscopy at a tertiary referral center. Relevant patient, pain, surgical, and medical data as well as the Gastrointestinal Symptom Rating Scale (GSRS) were assessed before, during, and after hospital stay and at the outpatient clinic until 6 months after discharge. Linear and logistic regression analysis were used to assess risk factors. Of 518 included patients, 184 (36%) had CPAP. The median GSRS score was 5 (interquartile range?=?3–10). The presence of preoperative pain for <3 months (odds ratio [OR]?=?2.69, P = .016) or >3 months (OR?=?3.99, P = .000), use of opioid analgesia preoperatively (OR?=?3.54, P = .001), severe adhesions underneath the incision (OR?=?1.63, P = .040), and the numeric rating scale pain score on postoperative day 2 (OR?=?1.23, P = .004) independently increased the risk for chronic abdominal pain. Chronic pancreatitis as indication for surgery (B?=?4.20, P = .03), ≥3 previous abdominal operations (B?=?1.03, P = .03), presence of pain >3 months before surgery (B?=?1.61, P < .01), upper gastrointestinal tract as the anatomic location of surgery (B?=?1.43, P = .03), and a higher preoperative GSRS score (B?=?.36, P < .01) independently increased the GSRS score 6 months after surgery. The duration and severity of preoperative pain and more severe acute postoperative pain were the most relevant risk factors for CPAP. The number of operations and the anatomic location of the operation showed to be important risk factors for increasing the number of gastrointestinal complaints.Perspective: This prospective observational study shows the incidence and risk factors for CPAP after major abdominal surgery. Preoperative pain-related factors were associated with the occurrence of CPAP.     

The ability of preoperative factors to predict patient-reported disability following surgery for rotator cuff pathology

Purpose: Minimal research has examined the prognostic ability of shoulder examination data or psychosocial factors in predicting patient-reported disability following surgery for rotator cuff pathology. The purpose of this study was to examine these factors for prognostic value in order to help clinicians and patients understand preoperative factors that impact disability following surgery.

Methods: Sixty-two patients scheduled for subacromial decompression with or without supraspinatus repair were recruited. Six-month follow-up data were available for 46 patients. Patient characteristics, history of the condition, shoulder impairments, psychosocial factors, and patient-reported disability questionnaires were collected preoperatively. Six months following surgery, the Western Ontario Rotator Cuff Index (WORC) and global rating of change dichotomized subjects into responders versus nonresponders. Logistic regression quantified prognostic ability and created the most parsimonious model to predict outcome.

Results: Being on modified job duty (OR?=?.17, 95%CI: 0.03–0.94), and having a worker’s compensation claim (OR?=?0.08, 95%CI: 0.01–0.74) decreased probability of a positive outcome, while surgery on the dominant shoulder (OR?=?11.96, 95%CI: 2.91–49.18) increased probability. From the examination, only impaired internal rotation strength was a significant univariate predictor. The Fear-avoidance Beliefs Questionnaire (FABQ) score (OR?=?0.95, 95%CI: 0.91–0.98) and the FABQ_work subscale (OR?=?0.92, 95%CI: 0.87–0.97) were univariate predictors. In the final model, surgery on the dominant shoulder (OR?=?8.9, 95%CI 1.75–45.7) and FABQ_work subscale score?≤25 (OR?=?15.3, 95%CI 2.3–101.9) remained significant.

Discussion: Surgery on the dominant arm resulted in greater improvement in patient-reported disability, thereby increasing the odds of a successful surgery. The predictive ability of the FABQ_work subscale highlights the potential impact of psychosocial factors on patient-reported disability.

• Implications for Rehabilitation

• Impairment-based shoulder measurements were not strong predictors of patient-reported outcome.

• Having high fear-avoidance behavior scores on the FABQ, especially the work subscale, resulted in a much lower chance of responding well to rotator cuff surgery as measured by self-reported disability.

• Having surgery on the dominant shoulder, as compared to the nondominant side, resulted in larger improvements in disability levels.

     

老年冠心病患者PCI相关造影剂肾病的危险因素分析

目的：分析老年冠心病患者行经皮冠状动脉介入术（Percutaneous Coronary Intervention，PCI）发生造影剂肾病（contrast induced nephropathy, CIN）的危险因素。方法：选择2015.01-2017.12于复旦大学附属中山医院心内科住院行PCI术的378例老年患者的临床资料，包括基本信息、合并症、实验室指标以及药物治疗，应用单因素和多因素分析发生造影剂肾病的危险因素，应用Kaplan-Meier曲线分析CIN对再住院的影响。结果：378例老年冠心病患者中有58例（15.3%）发生CIN。多因素分析结果显示术前肌酐（P=0.010, OR=0.721, 95%CI: 0.622-0.834），术后肌酐（P=0.023, OR=1.207, 95%CI: 1.094-1.332），肾小球滤过率（P=0.024, OR=0.755, 95%CI: 0.630-0.905）以及应用利尿剂（P=0.032, OR=1.206, 95%CI: 0.904-1.364）是导致老年冠心病患者行PCI发生CIN的重要危险因素。生存曲线显示CIN的发生将显著增加老年冠心病患者PCI术后再住院率（P=0.0009, HR=2.359, 95%CI: 1.192-4.668）。结论：术前肌酐、术后肌酐、肾小球滤过率以及应用利尿剂是导致老年冠心病患者行PCI发生CIN的重要危险因素。     

Predictive risk factors for recollapse of cemented vertebrae after percutaneous vertebroplasty: A meta-analysis

BACKGROUNDAs one of the most common complications of osteoporosis, osteoporotic vertebral compression fracture (OVCF) increases the risk of disability and mortality in elderly patients. Percutaneous vertebroplasty (PVP) is considered to be an effective, safe, and minimally invasive treatment for OVCFs. The recollapse of cemented vertebrae is one of the serious complications of PVP. However, the risk factors associated with recollapse after PVP remain controversial. AIMTo identify risk factors for the recollapse of cemented vertebrae after PVP in patients with OVCFs.METHODSA systematic search in EMBASE, MEDLINE, the Cochrane Library, and PubMed was conducted for relevant studies from inception until March 2020. Studies investigating risk factors for the recollapse of cemented vertebrae after PVP without additional trauma were selected for analysis. Odds ratios (ORs) or standardized mean differences with 95% confidence interval (CI) were calculated and heterogeneity was assessed by both the chi-squared test and the I-squared test. The methodological quality of the included studies was assessed according to the Newcastle-Ottawa Scale. RESULTSA total of nine case-control studies were included in our meta-analysis comprising 300 cases and 2674 controls. The significant risk factors for the recollapse of cemented vertebrae after PVP in OVCF patients were fractures located at the thoracolumbar junction (OR = 2.09; 95%CI: 1.30 to 3.38; P = 0.002), preoperative intravertebral cleft (OR = 2.97; 95%CI: 1.93 to 4.57; P < 0.00001), and solid lump distribution pattern of the cement (OR = 3.11; 95%CI: 1.91 to 5.07; P < 0.00001). The analysis did not support that age, gender, lumbar bone mineral density, preoperative visual analogue scale score, injected cement volume, intradiscal cement leakage, or vertebral height restoration could increase the risk for cemented vertebra recollapse after PVP in OVCFs.CONCLUSIONThis meta-analysis suggests that thoracolumbar junction fractures, preoperative intravertebral cleft, and solid lump cement distribution pattern are associated with the recollapse of cemented vertebrae after PVP in OVCF patients.     

Applying the Rapid OPPERA Algorithm to Predict Persistent Pain Outcomes Among a Cohort of Women Undergoing Breast Cancer Surgery

Persistent postmastectomy pain after breast surgery is variable in duration and severity across patients, due in part to interindividual variability in pain processing. The Rapid OPPERA Algorithm (ROPA) empirically identified 3 clusters of patients with different risk of chronic pain based on 4 key psychophysical and psychosocial characteristics. We aimed to test this type of group-based clustering within in a perioperative cohort undergoing breast surgery to investigate differences in postsurgical pain outcomes. Women (N = 228) scheduled for breast cancer surgery were prospectively enrolled in a longitudinal observational study. Pressure pain threshold (PPT), anxiety, depression, and somatization were assessed preoperatively. At 2-weeks, 3, 6, and 12-months after surgery, patients reported surgical area pain severity, impact of pain on cognitive/emotional and physical functioning, and pain catastrophizing. The ROPA clustering, which used patients’ preoperative anxiety, depression, somatization, and PPT scores, assigned patients to 3 groups: Adaptive (low psychosocial scores, high PPT), Pain Sensitive (moderate psychosocial scores, low PPT), and Global Symptoms (high psychosocial scores, moderate PPT). The Global Symptoms cluster, compared to other clusters, reported significantly worse persistent pain outcomes following surgery. Findings suggest that patient characteristic-based clustering algorithms, like ROPA, may generalize across diverse diagnoses and clinical settings, indicating the importance of “person type” in understanding pain variability.PerspectiveThis article presents the practical translation of a previously developed patient clustering solution, based within a chronic pain cohort, to a perioperative cohort of women undergoing breast cancer surgery. Such preoperative characterization could potentially help clinicians apply personalized interventions based on predictions concerning postsurgical pain.     

Factors associated with acute respiratory distress syndrome in brain-injured patients: A systematic review and meta-analysis

PurposeAcute respiratory distress syndrome (ARDS) is common in patients with acute brain injury admitted to the ICU. We aimed to identify factors associated with ARDS in this population.MethodsWe searched MEDLINE, Embase, Cochrane Central, Scopus, and Web of Science from inception to January 14, 2022. Three reviewers independently screened articles and selected English-language studies reporting risk factors for ARDS in brain-injured adult patients. Data were extracted on ARDS incidence, adjusted and unadjusted risk factors, and clinical outcomes. Risk of bias was reported using the Quality in Prognostic Studies tool. Certainty of evidence was assessed using GRADE.ResultsWe selected 23 studies involving 6,961,284 patients with acute brain injury. The pooled cumulative incidence of ARDS after brain injury was 17.0% (95%CI 10.7–25.8). In adjusted analysis, factors associated with ARDS included sepsis (odds ratio (OR) 4.38, 95%CI 2.37–8.10; high certainty), history of hypertension (OR 3.11, 95%CI 2.31–4.19; high certainty), pneumonia (OR 2.69, 95%CI 2.35–3.10; high certainty), acute kidney injury (OR 1.44, 95%CI 1.30–1.59; moderate certainty), admission hypoxemia (OR 1.67, 95%CI 1.29–2.17; moderate certainty), male sex (OR 1.30, 95%CI 1.06–1.58; moderate certainty), and chronic obstructive pulmonary disease (OR 1.27, 95%CI 1.13–1.44; moderate certainty). Development of ARDS was independently associated with increased odds of in-hospital mortality (OR 3.12, 95% CI 1.39–7.00).ConclusionsMultiple risk factors are associated with ARDS in brain-injured patients. These findings could be used to develop prognostic models for ARDS or as prognostic enrichment strategies for patient enrolment in future clinical trials.