文章摘要
术前疼痛灾难化和全膝关节置换术后慢性疼痛的相关性
Correlation between preoperative pain catastrophizing and chronic post-surgical pain after total knee arthroplasty
  
DOI：10.12089/jca.2022.07.010
中文关键词: 疼痛灾难化  术后慢性疼痛  全膝关节置换术
英文关键词: Pain catastrophizing  Chronic post-surgical pain  Total knee arthroplasty
基金项目:
作者单位E-mail
陈洁茹 230001,合肥市,安徽医科大学附属省立医院麻醉科  
胡继成 230001,合肥市,安徽医科大学附属省立医院麻醉科  
陈家琪 230001,合肥市,安徽医科大学附属省立医院麻醉科  
龙丹丹 230001,合肥市,安徽医科大学附属省立医院麻醉科  
高玮 230001,合肥市,安徽医科大学附属省立医院麻醉科  
谷海 230001,合肥市,安徽医科大学附属省立医院麻醉科  
王迪 230001,合肥市,安徽医科大学附属省立医院麻醉科  
柴小青 230001,合肥市,安徽医科大学附属省立医院麻醉科 xiaoqingchai@163.com 
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中文摘要:
      
目的 探讨膝骨关节炎（KOA）患者术前疼痛灾难化与全膝关节置换术（TKA）术后慢性疼痛（CPSP）的相关性。
方法 选择2020年8月至2021年1月行首次单侧TKA患者240例，男105例，女135例，年龄45～64岁，BMI 18～30 kg/m 2，ASA Ⅰ—Ⅲ级。根据是否发生术前疼痛灾难化将患者分为两组：灾难化组（n=78）和非灾难化组（n=162）。所有患者麻醉方法和手术方式一致。记录性别、年龄、BMI、ASA分级、K-L分级、KOA病程、术前合并心血管疾病、术前镇痛药物使用例数和术前1 d C-反应蛋白（CRP）浓度。术前1 d记录医院焦虑抑郁量表（HAD）、中枢敏化问卷（CSQ）和疼痛灾难化量表（PCS），若PCS评分≥30分认为发生疼痛灾难化。记录术中丙泊酚、瑞芬太尼、舒芬太尼用量、出血量、止血带使用时间、手术时间、补救镇痛例数、术后住院时间和术后6个月内使用非甾体抗炎药（NSAIDs）例数。记录术后6个月静息和活动时VAS疼痛评分，若术后6个月静息或（和）活动时VAS疼痛评分＞3分记为发生CPSP。采用Poisson回归分析评估发生术前疼痛灾难化对发生CPSP的风险性。
结果 灾难化组女性比例、HAD评分、CSQ评分、术后6个月内NSAIDs使用率、术后6个月静息和活动时VAS疼痛评分和CPSP发生率明显高于非灾难化组（P<0.05），KOA病程明显长于非灾难化组（P<0.05），CRP浓度明显低于非灾难化组（P<0.05）。Poisson回归分析显示，发生术前疼痛灾难化（RR=1.811，95%CI 1.191～2.754，P=0.005）和术后6个月内使用NSAIDs（RR=1.414，95%CI 1.062～3.673，P=0.032）是TKA患者发生CPSP的风险因素。
结论 发生术前疼痛灾难化和术后6个月内使用NSAIDs的TKA患者发生CPSP的风险更大。
英文摘要:
      
Objective To explore the correlation between preoperative pain catastrophizing in patients with knee osteoarthritis (KOA) and chronic post-surgical pain (CPSP) after total knee arthroplasty (TKA).
Methods A total of 240 patients,firstly undergoing unilateral TKA from August 2020 to January 2021 were selected,105 males and 135 females,aged 45-64 years,BMI 18-30 kg/m 2,ASA physical status Ⅰ-Ⅲ. Patients were divided into two groups according to whether preoperative pain catastrophizing occurred: the catastrophizing group (n = 78) and the non-catastrophizing group (n = 162). Anesthesia and surgical methods were consistent in all patients. Gender,age,BMI,ASA physical status,K-L grade,duration of KOA,the number of patients complicating with cardiovascular disease preoperatively,the number of patients using analgesic drugs preoperatively and concentration of C-reactive protein (CRP) 1 day before operation were recorded. The hospital anxiety and depression scale (HAD), central sensitization questionnaire (CSQ) and pain catastrophizing scale (PCS) were recorded 1 day before operation. If PCS ≥30 points,pain catastrophizing was occurred. The amount of propofol, remifentanil, sufentanil, blood volume loss, tourniquet use time, operation time, rescue analgesic cases, postoperative hospital stay and number of patients using nonsteroidal anti-inflammatory drugs (NSAIDs) within 6 months postoperatively were recorded. VAS scores at rest and during exercise were recorded 6 months after operation, CPSP was considered if VAS score > 3 at rest or (and) during exercise 6 months after operation. Poisson regression analysis was used to analyze the risk of preoperatively catastrophizing pain on CPSP.
Results Compared with the non-catastrophizing group, the proportion of female patients, HAD score, CSQ score, NSAIDs utilization rate within 6 months after surgery, VAS scores at rest and during exercise and CPSP incidence 6 months after surgery were significantly increased (P < 0.05),the duration of KOA was significantly prolonged (P < 0.05),the concentration of CRP was significantly lower in the catastrophizing group (P < 0.05). Poisson regression analysis showed that the occurrence of preoperative pain catastrophizing (RR = 1.811, 95% CI 1.191-2.754, P = 0.005) and the use of NSAIDs 6 months after surgery (RR = 1.414, 95% CI 1.062-3.673, P = 0.032) were risk factors for the occurrence of CPSP in patients with TKA.
Conclusion The risk for CPSP was higher in the patients with TKA who underwent pain catastrophizing and were on NSAIDs for 6 months postoperatively.
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