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| 肝切除术后慢性疼痛的影响因素 |
| Influencing factors of chronic pain after hepatectomy |
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| DOI：10.12089/jca.2024.03.007 |
| 中文关键词: 术后慢性疼痛 肝切除术 影响因素 预测模型 |
| 英文关键词: Chronic postoperative pain Hepatectomy Risk factors Prediction model |
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| 中文摘要: |
目的：探讨肝切除术后慢性疼痛（CPSP）的影响因素。
方法：选择2019年6月至2021年5月择期行肝切除术的患者110例，男91例，女19例，年龄≥18岁，BMI 15～30 kg/m2，ASA Ⅱ或Ⅲ级。根据术后3个月是否诊断CPSP将患者分为两组：非CPSP组和CPSP组。单因素分析后将差异有统计学意义的指标纳入多因素Logistic回归，分析肝切除术CPSP的影响因素。采用回归系数以及常数项构建肝切除术CPSP的预测模型，绘制受试者工作特征（ROC）曲线并计算曲线下面积（AUC），采用Hosmer-Lemeshow进行拟合优度检验。
结果：有42例（38%）患者肝切除术后发生CPSP。多因素Logistic回归分析显示，BMI≥25 kg/m2是发生CPSP的保护因素，手术时间≥3 h、术后1 d白细胞计数≥13×109/L、术后24 h VAS疼痛评分≥4分是发生CPSP的危险因素。建立的预测模型的AUC为0.86，敏感性73.8%，特异性79.4%，Hosmer-Lemeshow拟合优度检验提示模型区分度和校准度均较好。
结论：BMI≥25 kg/m2是肝脏切除术发生CPSP的保护因素，手术时间≥3 h、术后1 d白细胞计数≥13×109/L、术后24 h VAS疼痛评分≥4分是肝脏切除术发生CPSP的危险因素。 |
| 英文摘要: |
Objective: To assess the influencing factors for chronic postoperative pain (CPSP) of hepatectomy.
Methods: A total of 110 patients undergoing elective hepatectomy from June 2019 to May 2021, 91 males and 19 females, aged ≥ 18 years, BMI 15-30 kg/m2, ASA physical status Ⅱ or Ⅲ. According to whether CPSP was diagnosed 3 months after surgery, patients were divided into two groups: no CPSP group and CPSP group. Univariate and multiple logistic regression analysis was performed to determine the independent risk factors for CPSP. Regression coefficients and constants were used to establish a scoring system for CPSP in hepatectomy. Receiver operating characteristic (ROC) curve were drawn, and area under curve (AUC) was calculated, and Hosmer-Lemeshow was used for goodness of fit testing.
Results: The incidence of CPSP after hepatectomy was 42 (38%). In this study, BMI ≥ 25 kg/m2 was a protective factor for CPSP occurrence, and the independent risk factors for CPSP were operation time ≥ 3 hours, white blood cell count ≥ 13×109/L on one day after surgery, VAS pain scores ≥ 4 points at 24 hours after surgery. The area under the curve of the model evaluated by ROC curve was 0.86, sensitivity was 73.8%, specificity was 79.4%, Hosmer-Lemeshow goodness of fit test had no statistical significance, model differentiation and calibration were good.
Conclusion: BMI ≥ 25 kg/m2 is a protective factor for CPSP occurrence, and operation time ≥ 3 hours, white blood cell count ≥ 13×109/L on one day after surgery, and VAS pain scores ≥ 4 points at 24 hours after surgery are the risk factors for CPSP after hepatectomy. |
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