术后慢性疼痛患病率调查及危险因素分析

目的:探讨术后慢性疼痛(chronic postsurgical pain, CPSP)的患病率和相关危险因素。方法:纳入2019年2月在复旦大学附属中山医院接受非急诊手术治疗的376例患者,于术后3个月电话随访术后慢性疼痛情况并使用医院焦虑抑郁量表(hospital anxiety and depression scale, HADS)评估患者的心理状态。对存在术后慢性疼痛者采用数字评分法(numerical rating scale, NRS)和神经病理性疼痛量表(Douleur Neuropathique 4 questions, DN4)评估疼痛的强度、性质。采用多因素logistic回归确定术后慢性疼痛的独立危险因素。结果:20.7%(78/376)患者发生术后慢性疼痛,其中中重度疼痛占16.7%(13/376)。腹部手术(OR=3.148,95%CI 1.047～9.467)、术前非手术区域的慢性疼痛史(OR=6.852,95%CI 3.246～14.464)、手术时间大于3 h(OR=2.803,95%CI 1.089～7.217)是术后慢性疼痛的独立危险因素。结论:术后慢性疼痛的患病率为20.7%,其中1/6为中重度疼痛;腹部手术、术前非手术区域的慢性疼痛史和手术时间长是术后慢性疼痛的预警因素。

Prevalence and risk factors of chronic postsurgical pain after surgery

Objective: To explore the prevalence and risk factors of chronic postsurgical pain after surgery. Methods: 376 patients who received non-emergency surgery at Zhongshan Hospital, Fudan University in February 2019 were included. Three months after surgery, a telephone questionnaire survey was conducted to assess the occurrence of chronic postsurgical pain and the mental status using hospital anxiety and depression scale (HADS). For patients with chronic postsurgical pain, numerical rating scale (NRS) and Douleur Neuropathique 4 questions (DN4) were used to evaluate the intensity and nature of chronic postsurgical pain. The clinical data were retrospectively analyzed and multivariate logistic regression was used to analyze the perioperative risk factors of chronic postsurgical pain. Results: 20.7%(78/376) patients developed chronic postsurgical pain, among whom moderate-to-severe pain accounted for 16.7%. Abdominal surgery (OR=3.148,95% CI 1.047-9.467), preoperative chronic pain in non-surgical areas (OR=6.852, 95%CI 3.246-14.464), and operative duration over 3 hours (OR=2.803, 95%CI 1.089-7.217) were independent risk factors for chronic postsurgical pain. Conclusions: The prevalence of chronic postoperative pain after surgery is 20.7%, of which one in sixth moderate-to-severe pain. Abdominal surgery, preoperative chronic pain in non-surgical areas, and longer duration of operation are independent risk factors of chronic postsurgical pain.