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预测肝胆胰手术后急性疼痛的危险因素:一项观察性病例对照研究。

Predicting risk factors for acute pain after hepatobiliary and pancreatic surgery: an observational case control study.

机构信息

Department of Anesthesiology and Perioperative Medicine, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China.

Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, Zhengzhou, Henan, China.

出版信息

BMJ Open. 2024 Aug 28;14(8):e078048. doi: 10.1136/bmjopen-2023-078048.

Abstract

BACKGROUND

Inadequate postoperative analgesia is associated with increased risks of various postoperative complications, longer hospital stay, decreased quality of life and higher costs.

OBJECTIVES

This study aimed to investigate the risk factors for moderate-to-severe postoperative pain within the first 24 hours and 24-48 hours after major hepatobiliary pancreatic surgery.

METHODS

Data of patients who underwent surgery at the Department of Hepatobiliary Surgery in Henan Provincial People's Hospital were collected from January 2018 to August 2020. Univariate and multivariate logistic regression analyses were used to identify the risk factors of postoperative pain.

RESULTS

In total, 2180 patients were included in the final analysis. 183 patients (8.4%) suffered moderate-to-severe pain within 24 hours after operation. The independent risk factors associated with moderate-to-severe pain 24 hours after procedures were younger age (OR, 0.97; 95% CI 0.95 to 0.98, p<0.001), lower body mass index (BMI) (OR, 0.94; 95% CI 0.89 to 0.98, p=0.018), open surgery (OR, 0.34; 95% CI 0.22 to 0.52, p<0.001), and postoperative analgesia protocol with sufentanil (OR, 4.38; 95% CI 3.2 to 5.99, p<0.001). Postoperative hospital stay was longer in patients with inadequate analgesia (p<0.05).

CONCLUSION

Age, BMI, laparoscopic surgery, and different analgesic drugs were significant predictors of postoperative pain after major hepatobiliary and pancreatic surgery.

TRIAL REGISTRATION

ChiCTR2100049726.

摘要

背景

术后镇痛不足与各种术后并发症风险增加、住院时间延长、生活质量下降和成本增加有关。

目的

本研究旨在探讨肝胆胰手术后 24 小时内和 24-48 小时内中重度术后疼痛的危险因素。

方法

收集 2018 年 1 月至 2020 年 8 月河南省人民医院肝胆外科手术患者的数据。采用单因素和多因素逻辑回归分析确定术后疼痛的危险因素。

结果

共纳入 2180 例患者,最终分析 2180 例患者。183 例(8.4%)患者术后 24 小时内出现中重度疼痛。与术后 24 小时中重度疼痛相关的独立危险因素为年龄较小(OR,0.97;95%CI,0.95 至 0.98,p<0.001)、体重指数(BMI)较低(OR,0.94;95%CI,0.89 至 0.98,p=0.018)、开腹手术(OR,0.34;95%CI,0.22 至 0.52,p<0.001)和舒芬太尼术后镇痛方案(OR,4.38;95%CI,3.2 至 5.99,p<0.001)。镇痛不足的患者术后住院时间较长(p<0.05)。

结论

年龄、BMI、腹腔镜手术和不同的镇痛药物是肝胆胰手术后发生术后疼痛的显著预测因素。

试验注册

ChiCTR2100049726。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9825/11367387/c63c07c38c0b/bmjopen-14-8-g001.jpg

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