The relationship between movement-evoked versus spontaneous pain and peak expiratory flow after abdominal hysterectomy
The relationship between movement-evoked versus spontaneous pain and peak expiratory flow after abdominal hysterectomy
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DOI：
10.1097/00000539-200212000-00043
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发表时间：
2002-12-01
影响因子：
5.7
通讯作者：
Orr, E
中科院分区：
文献类型：
--
作者：
Gilron, I;Tod, D;Orr, E
术后肺功能障碍的发病机制暗示了运动诱发疼痛的作用（例如，夹板固定/由于避免疼痛而导致的换气不足）。然而，诱发疼痛和呼吸生理之间的相互作用知之甚少。因此，我们研究了诱发性疼痛与自发性疼痛之间的关系和肺功能的一个指标。在25例接受子宫切除术的患者中，在术后第1天和第2天的8个时间点测量自发性疼痛（REST）和坐位疼痛（SIT）、用力呼气（BLOW）和咳嗽（COUGH）的视觉模拟量表评分（100 mm）以及呼气峰流速（PEF）。次要结局指标包括血氧饱和度和需氧量。在八个研究时间点中的八个、七个、四个和两个时间点，疼痛与咳嗽、SIT、吹气和休息的PEF显着相关。COUGH（26.1 mm [1.7]）和SIT（21.5 mm [1.5]）的平均视觉模拟量表评分[SE]大于（P < 0.05）REST（10.5 mm [0.8]），COUGH大于（P < 0.05）BLOW（16.8 mm [1.3]）。在整个研究期间，所有疼痛指标均降低（P < 0.05），PEF降低改善（P < 0.05）。我们推测，咳嗽诱发的疼痛与PEF的一致负相关性部分是由避免咳嗽引起的，这最终限制了深吸气、肺再扩张和分泌物的清除。
The pathogenesis of postoperative lung dysfunction implies a role for movement-evoked pain (e.g., splinting/hypoventilation because of pain avoidance). However, interactions between evoked pain and respiratory physiology are poorly understood. Thus, we examined the relationship between evoked versus spontaneous pain and one index of pulmonary function. In 25 patients having undergone a hysterectomy, visual analog scale ratings (100 mm) for spontaneous pain (REST) and pain during sitting (SIT), forced expiration (BLOW), and coughing (COUGH) were measured together with peak expiratory flow (PEF) at eight time points during postoperative Days 1 and 2. Secondary outcome measures included oxygen saturation and oxygen requirements. Pain was significantly correlated with PEF for COUGH, SIT, BLOW, and REST at eight, seven, four, and two of the eight studied time points, respectively. Mean visual analog scale scores [SE] for COUGH (26.1 mm [1.7]) and SIT (21.5 mm [1.5]) were greater (P < 0.05) than REST (10.5 mm [0.8]), and COUGH was greater (P < 0.05) than BLOW (16.8 mm [1.3]). All pain measures diminished (P < 0.05), and PEF reductions improved (P < 0.05) across the study period. We hypothesize that the consistent negative correlation of COUGH-evoked pain with PEF is, in part, caused by avoidance of coughing, which ultimately limits deep inspiration, lung reexpansion, and clearance of secretions.