Department of Cardiothoracic Anesthesia double daggerDivision of Lung Transplantation, Heart Center Section for Surgical Pathophysiology, Rigshospitalet, University of Copenhagen, Denmark.
Clin J Pain. 2010 Mar-Apr;26(3):217-22. doi: 10.1097/AJP.0b013e3181b705e4.
Little is known about persistent postsurgical pain after lung transplantation with the associated intensive and continuous immunosuppressive treatment. Therefore, we investigated the nationwide incidence of chronic pain after lung transplantations.
Detailed questionnaires were sent to all 110 Danish surviving recipients of lung transplantation from September 2002 to September 2007.
Seventy-nine patients fulfilled the inclusion criteria with a mean follow-up time of 39 months. Excluded patients were 1 death during survey, 14 with previous thoracic surgery, and 16 patients who did not respond to an initial mailed questionnaire or a reminder. Fourteen patients (18%) reported persistent pain, whereas only 8 patients (10%) reported pain score >3 (numeric rating scale 0 to 10) and 4 patients (5%) >5 (numeric rating scale 0 to 10). Seventy-one percent of the patients with postsurgical pain also had pain from another part of the body. In patients with persistent postsurgical pain, this was a limiting factor for daily social activities in 29% to 92% dependent on the activity and 54% in pain felt quality of life was compromised due to the pain. Seventy-three percent of persistent postsurgical pain patients (lateral thoracotomy) experienced sensory disturbances compared with 46% of nonpain patients.
Moderate-to-severe persistent postsurgical pain occurred in 5% to 10% of patients after lung transplantation, which is lower than reported after nontransplant thoracotomy. The specific role of the peritransplant immunosuppression on persistent post-thoracotomy pain should be explored further.
肺移植术后持续性疼痛较为少见，且与术后密集、持续的免疫抑制治疗有关，因此我们对肺移植术后慢性疼痛的全国发病率进行了研究。
2002 年 9 月至 2007 年 9 月，我们向所有 110 名丹麦健在的肺移植受者发送了详细的调查问卷。
79 名患者符合纳入标准，平均随访时间为 39 个月。排除标准为：调查期间 1 例死亡；14 例既往有开胸手术史；16 例患者初始邮寄问卷或提醒未予回复。14 例（18%）患者报告有持续性疼痛，而仅有 8 例（10%）患者报告疼痛评分>3（数字评分量表 0 至 10），4 例（5%）患者报告疼痛评分>5（数字评分量表 0 至 10）。术后疼痛的 71%患者还伴有身体其他部位的疼痛。在持续性术后疼痛患者中，疼痛对日常社交活动的限制程度因活动而异，29%至 92%的患者受到影响，54%的患者认为疼痛影响了生活质量。与非疼痛患者（46%）相比，持续性术后疼痛患者（侧开胸）中有 73%经历感觉障碍。
肺移植术后 5%至 10%的患者发生中重度持续性术后疼痛，低于非移植开胸手术后的报道。围手术期免疫抑制对开胸术后持续性疼痛的具体作用有待进一步研究。
