Radinovic Kristina, Milan Zoka, Markovic-Denic Ljiljana, Dubljanin-Raspopovic Emilija, Jovanovic Bojan, Bumbasirevic Vesna
Centre for Anaesthesiology, Clinical Centre of Serbia, Belgrade, Serbia.
King's College Hospital, London, United Kingdom.
Injury. 2014 Aug;45(8):1246-50. doi: 10.1016/j.injury.2014.05.024. Epub 2014 May 29.
The aim of this study was to identify risk factors for severe postoperative pain immediately after hip-fracture surgery.
Three hundred forty-four elderly patients with an acute hip fracture were admitted to the hospital during a 12-months period. All patients who entered the study answered a structured questionnaire to assess demographic characteristics, previous diseases, drug use, previous surgery, and level of education. Physical status was assessed through the American Society of Anesthesiologists' preoperative risk classification, cognitive status using the Short Portable Mental Status Questionnaire, and depression using the Geriatric Depression Scale. The presence of preoperative delirium using the Confusion Assessment Method was assessed during day and night shifts until surgery. Pain was measured using a numeric rating scale (NRS). An NRS ≥ 7 one hour after surgery indicated severe pain.
Patients with elementary-level education (8 yr in school) presented a higher risk for immediate severe postoperative pain than university-educated patients (> 12 yr in school) (P < 0.05). Higher cognitive function was associated with higher postoperative pain (P < 0.01). Patients with symptoms of depression and patients with preoperative delirium presented a higher risk for severe pain (P < 0.05, P < 0.01, respectively). Multivariate analysis showed that depression and a low level of education were independent predictors of severe pain immediately after surgery.
Depression and lower levels of education were independent predictors of immediate severe pain following hip-fracture surgery. These predictors could be clinically used to stratify analgesic risk in elderly patients for more aggressive pain treatment immediately after surgery.
本研究的目的是确定髋部骨折手术后即刻发生严重术后疼痛的风险因素。
在12个月期间，344例急性髋部骨折的老年患者入院。所有纳入研究的患者均回答了一份结构化问卷，以评估人口统计学特征、既往疾病、药物使用情况、既往手术史和教育程度。通过美国麻醉医师协会术前风险分类评估身体状况，使用简易便携式精神状态问卷评估认知状态，使用老年抑郁量表评估抑郁情况。在手术前，通过混乱评估法评估昼夜班次期间术前谵妄的存在情况。使用数字评分量表（NRS）测量疼痛程度。术后1小时NRS≥7表明存在严重疼痛。
小学教育水平（在校8年）的患者术后即刻发生严重疼痛的风险高于受过大学教育的患者（在校超过12年）（P<0.05）。较高的认知功能与较高的术后疼痛相关（P<0.01）。有抑郁症状的患者和术前有谵妄的患者发生严重疼痛的风险更高（分别为P<0.05，P<0.01）。多因素分析表明，抑郁和低教育水平是术后即刻严重疼痛的独立预测因素。
抑郁和较低的教育水平是髋部骨折手术后即刻发生严重疼痛的独立预测因素。这些预测因素可在临床上用于对老年患者的镇痛风险进行分层，以便在术后立即进行更积极的疼痛治疗。
