Majchrzak Maciej, Brzecka Anna, Daroszewski Cyryl, Błasiak Piotr, Rzechonek Adam, Tarasov Vadim V, Chubarev Vladimir N, Kurinnaya Anastasiya S, Melnikova Tatiana I, Makhmutova Alfiya, Klochkov Sergey G, Somasundaram Siva G, Kirkland Cecil E, Aliev Gjumrakch
Department of Thoracic Surgery, Medical University in Wroclaw, Wroclaw, Poland.
Department of Pulmonology and Lung Cancer, Medical University in Wroclaw, Wroclaw, Poland.
Front Pharmacol. 2019 Jun 14;10:626. doi: 10.3389/fphar.2019.00626. eCollection 2019.
Obesity and cancer are recognized worldwide health threats. While there is no reported causal relationship, the increasing frequency of both conditions results in a higher incidence of obese patients who are being treated for cancer. Physiological data indicate that there is a relationship between obesity and susceptibility to pain; however, currently, there are no specific pharmacological interventions. To evaluate the self-reported intensity of postoperative pain in obese and nonobese lung cancer who receive either thoracotomy or video-assisted thoracic surgery (VATS) surgical therapy. In 50 obese [mean body mass index (BMI) of 34.1 ± 3.2 kg/m] and 62 nonobese (mean BMI of 24.9 ± 3 kg/m) lung cancer patients, the intensity of pain was estimated every 4 h using a visual analog scale (VAS, 0 indicating no pain and 10 indicating "worst imaginable pain") beginning shortly after surgery (Day O) and continuing until the day of discharge (Day D). The self-reported pain was more severe in obese than in nonobese patients, both at the time of the operation [Day O (4.5 ± 1.2 3.4 ± 1.1; < 0.0001)] and at the day of discharge [Day D (3.9 ± 1.4 2.6 ± 0.9, < 0.0001)]. This finding was consistent both in the patients after thoracotomy and after video-assisted thoracic surgery (VATS, < 0.0001). The patients with severe pain shortly after surgery (VAS score >4) had significantly higher BMI (31.8 ± 5.6 kg/m 28.8 ± 5.2 kg/m, < 0.01) and were hospitalized longer than the remaining patients (13.0 ± 13.6 days 9.5 ± 3.6 days, < 0.05). The reported perception of pain in obese lung cancer patients is greater than in nonobese patients undergoing the same thoracic surgery. In obese patients, severe pain persisted longer. Pain management is an important consideration in the postoperative care of lung cancer patients, even more so with obese patients.
肥胖和癌症是全球公认的健康威胁。虽然尚无因果关系的报道，但这两种情况的发生频率不断增加，导致接受癌症治疗的肥胖患者数量增多。生理数据表明肥胖与疼痛易感性之间存在关联；然而，目前尚无具体的药物干预措施。为了评估接受开胸手术或电视辅助胸腔镜手术（VATS）治疗的肥胖和非肥胖肺癌患者术后自我报告的疼痛强度。在50名肥胖[平均体重指数（BMI）为34.1±3.2kg/m²]和62名非肥胖（平均BMI为24.9±3kg/m²）肺癌患者中，术后不久（第0天）开始每4小时使用视觉模拟量表（VAS，0表示无疼痛，10表示“难以想象的剧痛”）评估疼痛强度，持续至出院日（第D天）。无论是在手术时[第0天（4.5±1.2对3.4±1.1；P<0.0001）]还是出院日[第D天（3.9±1.4对2.6±0.9，P<0.0001）]，肥胖患者自我报告的疼痛都比非肥胖患者更严重。这一发现无论在开胸手术患者还是电视辅助胸腔镜手术（VATS）患者中均一致（P<0.0001）。术后不久疼痛严重（VAS评分>4）的患者BMI显著更高（31.8±5.6kg/m²对28.8±5.2kg/m²，P<0.01），住院时间也比其余患者更长（13.0±13.6天对9.5±3.6天，P<0.05）。据报告，肥胖肺癌患者的疼痛感知比接受相同胸外科手术的非肥胖患者更强烈。在肥胖患者中，剧痛持续时间更长。疼痛管理是肺癌患者术后护理中的一个重要考虑因素，对于肥胖患者更是如此。
