Shi C X, Zhang Y Y, Zhou R, Sun Y E, Bo J H
Department of Anesthesiology, Nanjing Drum Tower Hospital, Affiliated to Nanjing University Medical School, Nanjing 210008, China.
Zhonghua Yi Xue Za Zhi. 2022 Oct 11;102(37):2939-2943. doi: 10.3760/cma.j.cn112137-20220318-00579.
To identify the risk factors of pain after CT-guided preoperative localization of pulmonary nodules with 4-hook needle. The clinical data of 212 patients, who underwent CT-guided preoperative localization of single pulmonary nodule with 4-hook needle in Nanjing Drum Tower Hospital affiliated to Nanjing University Medical School from September 2021 to February 2022 were retrospectively analyzed. All patients, including 83 males and 129 females with an age of (54±12) years, were divided into mild pain group (=163) and moderate-severe pain group (=49) according to numeric rating scale (NRS) for assessment of pain intensity. The gender, age, body mass index, smoking history, American Society of Anesthesiologists physical status (ASA), nodule location, nodule size, nodule distance from pleura, needle tip distance from pleura, localization-related complications (pneumothorax, pulmonary hemorrhage) and NRS for assessment of pain intensity after pulmonary nodules localization were collected and compared between the two groups. Univariate analysis and multivariate binary logistic regression analysis were performed to identify the risk factors of moderate-severe pain after CT-guided preoperative localization of pulmonary nodules with 4-hook needle. The success rate of preoperative localization was 100%. The rates of pneumothorax and pulmonary hemorrhage were 22.6% and 17.0%, respectively. Univariate analysis showed that there was no significant difference in gender, age, body mass index, smoking history, ASA physical status, nodule location, nodule size, nodule distance from pleura and localization-related complications (pneumothorax, pulmonary hemorrhage) between the two groups (>0.05), while needle tip distance from pleura of moderate-severe pain group was significantly less than that of mild pain group [7(6, 11) mm vs 15(12, 19) mm, <0.001]. Multivariate binary logistic regression analysis showed that needle tip distance from pleura was the only risk factor for moderate-severe pain (=0.645, 95%: 0.562-0.739, <0.001). According to receiver operating characteristic (ROC) curve analysis, when the cut-off value of needle tip distance from pleura was 9.5 mm, the sensitivity was 69.4%(34/49), the specificity was 90.2%(147/163), and the area under the curve (AUC) was 0.878 (95%: 0.820-0.935, <0.001). Needle tip distance from pleura was the independent risk factor of moderate-severe pain after CT-guided preoperative localization of pulmonary nodules with 4-hook needle. The less needle tip distance from pleura is, the higher risk of moderate-severe pain occurs.
探讨CT引导下四爪针术前定位肺结节后疼痛的危险因素。回顾性分析2021年9月至2022年2月在南京大学医学院附属南京鼓楼医院行CT引导下四爪针单肺结节术前定位的212例患者的临床资料。所有患者，包括83例男性和129例女性，年龄为(54±12)岁，根据数字评分量表(NRS)评估疼痛强度，分为轻度疼痛组(=163)和中重度疼痛组(=49)。收集两组患者的性别、年龄、体重指数、吸烟史、美国麻醉医师协会身体状况(ASA)、结节位置、结节大小、结节距胸膜距离、针尖距胸膜距离、定位相关并发症(气胸、肺出血)及肺结节定位后疼痛强度的NRS评分，并进行比较。采用单因素分析和多因素二元logistic回归分析，确定CT引导下四爪针术前定位肺结节后中重度疼痛的危险因素。术前定位成功率为100%。气胸和肺出血发生率分别为22.6%和17.0%。单因素分析显示，两组患者在性别、年龄、体重指数、吸烟史、ASA身体状况、结节位置、结节大小、结节距胸膜距离及定位相关并发症(气胸、肺出血)方面差异无统计学意义(>0.05)，而中重度疼痛组针尖距胸膜距离明显小于轻度疼痛组[7(6,11)mm vs 15(12,19)mm，<0.001]。多因素二元logistic回归分析显示，针尖距胸膜距离是中重度疼痛的唯一危险因素(=0.645，95%可信区间:0.562 - 0.739，<0.001)。根据受试者工作特征(ROC)曲线分析，当针尖距胸膜距离的截断值为9.5 mm时，灵敏度为69.4%(34/49)，特异度为90.2%(147/163)，曲线下面积(AUC)为0.878(95%可信区间:0.820 - 0.935，<0.001)。针尖距胸膜距离是CT引导下四爪针术前定位肺结节后中重度疼痛的独立危险因素。针尖距胸膜距离越小，发生中重度疼痛的风险越高。
