A Prospective Study of Chronic Pain after Thoracic Surgery.
A Prospective Study of Chronic Pain after Thoracic Surgery.
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胸外科手术后慢性疼痛的前瞻性研究
DOI：
10.1097/aln.0000000000001576
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发表时间：
2017-05
期刊：
影响因子：
8.8
通讯作者：
Brennan TJ
中科院分区：
文献类型：
--
作者：
Bayman EO;Parekh KR;Keech J;Selte A;Brennan TJ
本研究的目的是通过对人口、社会心理和手术因素的综合评估来检测胸外科手术后 6 个月慢性疼痛的预测因素。在这项前瞻性观察性研究中，胸外科患者在术前 1 周入组，并在术后 6 个月进行随访。手术前对综合心理社会测量进行了评估。术后 3 个月和 6 个月评估疼痛的存在和严重程度。 107 名患者在术后前 3 天内接受了评估，99 名患者（30 名开胸手术和 69 名视频辅助胸腔镜手术、胸腔镜）完成了 6 个月的随访。对 6 个月时有与没有与胸外科手术相关的慢性疼痛的患者进行了比较。开胸术后 6 个月时手术相关慢性疼痛的发生率 (p = 0.37) 和严重程度 (p = 0.97) 相似（33%，95% 置信区间 [CI]：17% 至 53%，3.3 ± 2.1）和胸腔镜检查（25%，95% CI：15% 至 36%，3.3 ± 1.7）。频率论和贝叶斯多变量模型均显示，急性疼痛的严重程度（数字评分量表，0-10）是与胸外科相关慢性疼痛相关的衡量标准。心理社会因素和定量感官测试无法预测。接受开胸手术与胸腔镜检查的患者在 6 个月时慢性疼痛的发生率和严重程度没有差异。与其他术后疼痛状况不同，术前心理社会测量均与胸外科手术后的慢性疼痛无关。
The goal of this study was to detect the predictors of chronic pain at 6 months after thoracic surgery from a comprehensive evaluation of demographic, psychosocial, and surgical factors. Thoracic surgery patients were enrolled 1 week before surgery and followed-up 6 months post-surgery in this prospective, observational study. Comprehensive psychosocial measurements were assessed before surgery. The presence and severity of pain was assessed at 3 and 6 months after surgery. One-hundred seven patients were assessed during the first 3 days after surgery and 99 (30 thoracotomy and 69 video-assisted thoracoscopic surgery, thoracoscopy) patients completed the 6 months follow-up. Patients with vs without chronic pain related to thoracic surgery at 6 months were compared. Both incidence (p = 0.37) and severity (p = 0.97) of surgery-related chronic pain at 6 months were similar after thoracotomy (33%, 95% confidence interval [CI]: 17% to 53%, 3.3 ± 2.1) and thoracoscopy (25%, 95% CI: 15% to 36%, 3.3 ± 1.7). Both frequentist and Bayesian multivariate models revealed that severity of acute pain (numerical rating scale, 0–10) is the measure associated with chronic pain related to thoracic surgery. Psychosocial factors and quantitative sensory testing were not predictive. There was no difference in the incidence and severity of chronic pain at 6 months in patients undergoing thoracotomy versus thoracoscopy. Unlike other post-surgical pain conditions, none of the pre-operative psychosocial measurements were associated with chronic pain after thoracic surgery.