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| 胸部微创手术患者术后慢性疼痛的危险因素 |
| Risk factors for postoperative chronic pain after minimally invasive thoracic surgery |
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| DOI：10.12089/jca.2025.09.008 |
| 中文关键词: 胸部微创手术 术后慢性疼痛 围术期急性疼痛 独立危险因素 Shapley加性解释分析 |
| 英文关键词: Minimally invasive thoracic surgery Postoperative chronic pain Perioperative acute pain Independent risk factors Shapley additive explanations analysis |
| 基金项目: |
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| 摘要点击次数: 1243 |
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| 中文摘要: |
目的：分析胸部微创手术患者术后慢性疼痛发生的独立危险因素。
方法：本研究为巢式病例-对照研究，纳入胸部微创手术患者158例，男77例，女81例，年龄50～74岁，BMI 18.5～30.0 kg/m2，ASA Ⅰ—Ⅲ级。收集患者一般资料以及围术期可能对术后疼痛产生影响的资料，尤其是围术期急性疼痛相关资料。采用Boruta算法进行变量筛选，采用多因素Logistic回归分析相关独立危险因素，采用受试者工作特征曲线下面积（AUROC）分析围术期急性疼痛指标预测术后慢性疼痛的效能，采用XGboost+Shapley加性解释（SHAP）分析方法结合限制性立方样条回归具体描述术后动肩疼痛与术后慢性疼痛的相关性。
结果：Boruta法筛选出与术后慢性疼痛相关的指标为术后动肩疼痛、术后疼痛轨迹、术后咳嗽疼痛、经肋缝合、手术入路、背阔肌保留和瘢痕长度。多因素Logistic回归分析显示，术后动肩疼痛（OR=1.69，95%CI 1.32～2.17）和经肋缝合（OR=0.28，95%CI 0.09～0.91）与术后慢性疼痛相关。术后动肩疼痛与术后慢性疼痛相关且在各种围术期急性疼痛指标中具有最大的AUROC为0.714（95%CI 0.678～0.749）。SHAP分析显示术后动肩疼痛评分3分以上才会导致术后慢性疼痛的发生，且术后动肩疼痛评分3分以上对术后慢性疼痛贡献的线性回归拟合显示β值为0.291（95%CI 0.242～0.341），同时，SHAP交互作用分析显示在导致术后慢性疼痛方面，术后动肩疼痛与瘢痕长度和手术入路之间可能有弱协同作用（0.1<交互值<0.5）。
结论：各种围术期急性疼痛指标中，动肩疼痛评分3分以上是胸部微创手术后慢性疼痛的良好预测指标。 |
| 英文摘要: |
Objective: To analyze the independent risk factors for the development of postoperative chronic pain in patients undergoing minimally invasive thoracic surgery.
Methods: This study was a nested case-control investigation involving 158 patients who underwent minimally invasive thoracic surgery, including 77 males and 81 females, aged 50-74 years, BMI 18.5-30.0 kg/m2, ASA physical status Ⅰ—Ⅲ. We collected patient general data and perioperative information that could potentially affect postoperative pain, particularly perioperative acute pain-related data. The Boruta algorithm was employed for variable screening, and multivariate logistic regression was used to identify independent risk factors. The area under the receiver operating characteristic curve (AUROC) from univariate analysis was utilized to compare the correlation between various perioperative acute pain characteristics and postoperative chronic pain. Additionally, the XGboost+Shapley additive explanations (SHAP) analysis method, combined with restricted cubic spline regression, was applied to specifically describe the relationship between postoperative shoulder pain during movement and postoperative chronic pain.
Results: The Boruta algorithm identified characteristics associated with postoperative chronic pain, including postoperative moving shoulder pain, postoperative pain trajectory, postoperative cough pain, intercostal suture, surgical approach, latissimus dorsi muscle preservation, and scar length. Multivariate logistic regression revealed that postoperative moving shoulder pain (OR = 1.69, 95% CI 1.32-2.17) and intercostal suture (OR = 0.28, 95% CI 0.09-0.91) were linked to postoperative chronic pain. Postoperative moving shoulder pain was correlated with postoperative chronic pain and presented the highest AUROC (0.714, 95% CI 0.678-0.749) among various perioperative acute pain factors. SHAP analysis indicated that a postoperative moving shoulder pain score of over 3 points would increase the likelihood of developing postoperative chronic pain, and linear regression fitting of the contribution of postoperative moving shoulder pain score (exceeding 3 points) to postoperative chronic pain showed a β value of 0.291 (95% CI 0.242-0.341). Additionally, SHAP interaction analysis suggested that postoperative moving shoulder pain may have a mild synergistic effect with scar length and surgical approach in contributing to postoperative chronic pain (0.1 < interactive value < 0.5).
Conclusion: Among various perioperative acute pain characteristics, the intensity of shoulder pain during movement (exceeding 3 points) is a solid indicator of the likelihood of developing chronic pain following minimally invasive thoracic surgery. |
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