Stienen Martin N, Smoll Nicolas R, Hildebrandt Gerhard, Schaller Karl, Gautschi Oliver P
Department of Neurosurgery, Kantonsspital St. Gallen, St. Gallen, Switzerland.
Department of Neurosurgery and Faculty of Medicine, University Hospital of Geneva, Geneva, Switzerland.
Clin Neurol Neurosurg. 2014 Jul;122:12-9. doi: 10.1016/j.clineuro.2014.04.015. Epub 2014 Apr 22.
It is well established that smoking has a myriad of negative effects on varies aspects of bodily health. The aim of this study was to examine the effects of the smoking status at time of surgery on the postoperative subjective pain course and health related quality of life (HRQoL) until 1 year after surgery for lumbar disc herniation (LDH).
This prospective cohort study included patients ≥18 and ≤90 years of age with a symptomatic and radiological verified LDH. The current smoking patient collective (smoking 1 or more cigarettes a day) was compared with the nonsmoking collective (previous smokers without cigarette consumption for >2 months and never smokers) in respect of subjective pain sensation (measured with the visual analogue scale (VAS)) and HRQoL using the short-form (SF-12) questionnaire preoperatively, before discharge, as well as after 4 weeks and 1 year postoperatively. The primary outcome measures were the 1-year SF-12 scores (MCS and PCS) categorized into responders and non-responders.
A total of 102 patients were enrolled in the study. Thirty-eight patients were current smokers (37.2%), whereas 43 (42.2%) and 21 (20.6%) patients were never-smokers and previous smokers, respectively. Four weeks and one year after surgery, both smokers and nonsmokers reported increase in the HRQoL as compared to preoperative values - the MCS increased more than the PCS. From a univariate and multivariate perspective, smoking status at time of surgery did not predict responder status.
The present study results could not confirm the hypothesis that smoking at time of surgery was associated with worse outcome after surgery for LDH.
吸烟对身体健康的各个方面具有众多负面影响，这一点已得到充分证实。本研究的目的是探讨腰椎间盘突出症（LDH）手术时的吸烟状态对术后主观疼痛进程及术后1年健康相关生活质量（HRQoL）的影响。
这项前瞻性队列研究纳入了年龄在18至90岁之间、有症状且经影像学证实为LDH的患者。将当前吸烟患者群体（每天吸烟1支或更多）与非吸烟群体（既往吸烟者且已戒烟超过2个月及从不吸烟者）在术前、出院前、术后4周及术后1年时的主观疼痛感觉（采用视觉模拟量表（VAS）测量）及使用简短健康调查问卷（SF - 12）评估的HRQoL方面进行比较。主要结局指标是将1年时的SF - 12评分（MCS和PCS）分为反应者和非反应者。
共有102例患者纳入本研究。38例患者为当前吸烟者（37.2%），而从不吸烟者和既往吸烟者分别为43例（42.2%）和21例（20.6%）。与术前值相比，术后4周和1年时，吸烟者和非吸烟者的HRQoL均有所提高——MCS的提高幅度大于PCS。从单变量和多变量角度来看，手术时的吸烟状态并不能预测反应者状态。
本研究结果无法证实手术时吸烟与LDH手术后预后较差相关这一假设。
