文章摘要
老年髋关节置换术患者术后慢性疼痛的相关因素及其预测模型
Related factors analysis and development of prognostic model in elderly patients undergoing hip replacement
  
DOI：10.12089/jca.2019.12.013
中文关键词: 术后慢性疼痛  老年患者  髋关节置换术  预测模型
英文关键词: Chronic post-surgical pain  Elderly patients  Hip replacement  Prognostic model
基金项目:广东省中医药局科研项目(20191247)
作者单位E-mail
鲁义 510130,广州市中医医院麻醉科  
姚嘉茵 中山大学附属第六医院(姚嘉茵)  
龚楚链 中山大学附属第三医院(龚楚链)  
王保 510130,广州市中医医院麻醉科  
卿朝晖 510130,广州市中医医院麻醉科  
劳俊铭 510130,广州市中医医院麻醉科  
刘栋 510130,广州市中医医院麻醉科  
尧新华 510130,广州市中医医院麻醉科 yxh200210@126.com 
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中文摘要:
      
目的 探讨老年患者髋关节置换术后6个月发生慢性疼痛(CPSP)的相关因素,并进一步建立风险预测模型。
方法 选择在腰-硬联合麻醉下行髋关节置换术患者177例,男85例，女92例,年龄65～80岁,ASA Ⅰ-Ⅲ级。应用NRS量表评价术后24 h以及术后6个月的疼痛情况。依据国际疼痛学会的标准诊断CPSP。根据患者术后6个月是否诊断为CPSP分为两组,采用单因素及多因素Logistic回归分析CPSP的相关因素并建立风险预测模型。
结果 单因素分析提示术后6个月CPSP相关因素包括饮酒史、术中出血量、术中输血量、手术时间、手术类型、术后24 h NRS评分以及术后镇痛方式(P<0.05)。多因素Logistic回归分析提示CPSP危险因素包括术中出血量大、手术时间长以及术后24 h NRS评分>3分(P<0.05)。CPSP风险预测模型具有较高的敏感性(78.05％)和特异性(97.04％)。
结论 本研究建立CPSP的风险预测模型,能够较为准确地预测老年患者髋关节置换术后6个月CPSP发生的风险。
英文摘要:
      
Ojective To confirm the associated factors for CPSP occurred six months postoperatively on elderly patients undergoing hip replacement and further establish a prognostic model in order to guide the clinical daily practice.
Methods A total of 177 patients, 85 males and 92 females, aged 65-80 years, ASA physical status Ⅰ-Ⅲ, who had undergone hip replacement under combined spinal-epidural anesthesia were enrolled. As for retrospective case-control study, number rating scale (NRS) was used to evaluate the patient′s pain degree 24 h and 6 months after surgery. CPSP was diagnosed according to the criteria of the International Society of Pain. All possible CPSP-associated factors were analyzed, and a prognostic model was established by univariate analysis and multivariate logistic regression.
Results Univariate analysis of CPSP associated factors 6 months after operation included drinking history, intraoperative bleeding, intraoperative infusion, operating time, operating type, NRS score at 24 h after operation and postoperative analgesic methods (P < 0.05). Multivariate logistic regression analysis of CPSP showed that the risk factors included intraoperative bleeding volume, operation time and 24 h NRS score > 3 (P < 0.05). This prognostic model had an ideal sensitivity (78.05％) and specificity (97.04％).
Conclusion This prognostic model established in our study could accurately predict the risk of CPSP six months postoperatively on elder patients undergoing hip replacement.
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