早期非小细胞肺癌患者肺叶切除术后急慢性疼痛的危险因素分析

发布时间：2018-03-04 17:37

本文选题：非小细胞肺癌　切入点：急性疼痛　出处：《北京市结核病胸部肿瘤研究所》2017年硕士论文　论文类型：学位论文

【摘要】：研究背景:肺癌是全球范围内癌症患者死亡率最高的类型,其中非小细胞肺癌约占80%以上。手术切除是早期非小细胞肺癌主要的治疗方式之一。手术造成的组织损伤、修复导致术后急慢性疼痛的发生。术后急慢性疼痛严重影响患者的恢复,对患者术后的生存质量造成巨大的影响,开胸术后急性疼痛的发生率为80-96%,慢性疼痛的发生率为30%-80%,现存的术后镇痛模式下,患者仍然存在轻中度,甚至重度的急性疼痛,部分患者的疼痛情况长期存在演变为慢性疼痛。急慢性疼痛的发生不仅与手术损伤相关,且与患者自身,及术后镇痛模式均有关系。近年来胸腔镜的广泛使用,使患者的手术切口发生变化,可能减轻患者的术后疼痛程度,但一直存在争论,回顾性分析存在信息偏移的可能性大,且疼痛作为一个主观评价结果,受多种因素的影响,所以本研究将前瞻性的探索术后急慢性疼痛的相关危险因素,进一步结合疼痛相关细胞因子探索胸腔镜辅助手术对患者术后疼痛的影响,为个体化的治疗患者术后疼痛提供依据。研究方法:1.术前一天应用疼痛压力测试仪检测患者的压痛阈值,评价患者对疼痛的耐受情况。2.术前一天应用住院患者焦虑抑郁量表评价患者的心理情况。3.术后三天,一个月,二个月,三个月分别应用疼痛数字模拟评分量表主观的评价患者术后急慢性疼痛,4.术前,术后应用ELASE法检测患者血清中疼痛相关细胞因子的含量,较客观的评价患者术后急慢性疼痛情况。研究结果:1.112例患者中,发生急性中重度疼痛的患者51例,发生率为45.5%。发生慢性疼痛的患者46例,发生率为41.1%。2.患者术后急性中重度疼痛分析结果:单因素分析结果表明性别,年龄,ASA分级,BMI指数,吸烟史,饮酒史,高血压史,糖尿病史,文化程度,心理焦虑,手术方式等对术后急性中重度疼痛的影响差异无统计学意义(p0.05),压痛阈值,瑞芬太尼用量对术后急性中重度疼痛的影响差异有统计学意义(p0.05)。logistics回归分析结果表明急性中重度疼痛的危险因素是瑞芬太尼用量大于1mg,压痛阈值低,后外侧开胸手术(p0.05)。压痛阈值与术后急性中重度疼痛呈负相关(p0.05),瑞芬太尼用量与术后急性中重度疼痛呈正相关(p0.05)。两组患者IL-1β,IL-6,PGE2,TNF-α的浓度差异无统计学意义(p0.05)。3.患者术后慢性疼痛分析结果:单因素分析结果表明性别,年龄,ASA分级,BMI指数,吸烟史,饮酒史,高血压史,糖尿病史,压痛阈值,镇痛药物用量,手术方式对术后慢性疼痛的影响差异无统计学意义(p0.05),心理焦虑,文化程度,糖尿病对术后慢性疼痛的影响差异有统计学意义(p0.05)。logistic回归分析结果表明慢性疼痛的危险因素是心理焦虑,文化程度低,合并糖尿病(p0.05)。心理焦虑,糖尿病与慢性疼痛呈正相关(p0.05),文化程度与慢性疼痛呈负相关(p0.05)。两组患者IL-1β,IL-6,PGE2,TNF-α的浓度差异无统计学意义(p0.05)。4.电视辅助胸腔镜手术患者与后外侧开胸手术患者相比性别,年龄,ASA分级,BMI指数,吸烟史,饮酒史,高血压史,糖尿病史,压痛阈值,心理焦虑,镇痛药物用量差异无统计学意义(p0.05),手术时间差异有统计学意义(p0.05)。两组患者术后三天,一个月,二个月,三个月的NRS评分差异无统计学意义(p0.05)。两组患者IL-1β,IL-6的浓度差异无统计学意义(p0.05)。两组患者PGE2,TNF-α的浓度差异有统计学意义(p0.05)。研究结论:1.非小细胞肺癌患者术后急性中重度疼痛发生的危险因素是瑞芬太尼用量大于1mg,压痛阈值低,后外侧开胸手术。2.非小细胞肺癌患者术后慢性疼痛发生的危险因素是心理焦虑,文化程度低,糖尿病史。3.三个月内胸腔镜辅助开胸手术与后外侧开胸手术后疼痛程度类似。
[Abstract]:Background: lung cancer is a type of global cancer mortality is highest, including non small cell lung cancer accounts for more than 80%. Surgical resection for early non-small cell lung cancer is one of the main treatment. Tissue injury caused by surgery. Postoperative repair leads to acute and chronic pain occurred. Postoperative chronic pain patients the recovery, which caused a huge impact on the quality of life of patients after thoracotomy, postoperative acute pain incidence rate was 80-96%, the incidence of chronic pain is 30%-80%, the existing mode of analgesia after surgery, patients are still mild to moderate or severe acute pain, some patients pain long evolution chronic pain. Chronic pain occurred not only associated with the surgical injury, and patients, and postoperative analgesia mode have a relationship. The widespread use of thoracoscopy in recent years, with the hand hair incision Change, may reduce the patient's postoperative pain degree, but there has been controversy, a retrospective analysis of the possibility of the existence of information migration, and the pain is a subjective evaluation result is affected by many factors, so the study of risk of exploratory postoperative acute and chronic pain with pain related factors, further cytokine exploration assisted thoracoscopic surgery on the pain of the patients, provide the basis for individualized treatment of patients after pain. Methods: 1. the day before surgery by pain pressure pain threshold pressure tester were detected, the day before the evaluation of pain tolerance in patients with.2. surgery inpatients with anxiety and depression assessment of psychological condition of patients with.3. after three days, one month, two months and three months respectively using digital pain analogue scale in patients with subjective evaluation after acute and chronic pain, 4. preoperatively, The content of postoperative application of ELASE assay in the serum of patients with pain related cytokines, was evaluated objectively after acute and chronic pain. Results: in 1.112 cases, 51 cases occurred in patients with acute severe pain, the incidence of 46 patients with 45.5%. chronic pain, the incidence of acute results moderate to severe pain in 41.1%.2. patients after surgery: results of univariate analysis showed that gender, age, ASA grade, BMI index, smoking history, drinking history, history of hypertension, history of diabetes, education, psychological anxiety, surgical method had no significant effect on postoperative acute effects of moderate to severe pain, pain threshold difference (P0.05) the dosage of remifentanil, there were significant differences in the effects of acute moderate to severe postoperative pain (P0.05).Logistics regression analysis of risk factors of acute moderate to severe pain in the result, remifentanil dosage was more than 1mg, ppt The value is low, after the lateral thoracotomy (P0.05). Pain threshold and postoperative acute severe pain was negatively correlated (P0.05), the dosage of remifentanil was positively correlated with postoperative acute pain (P0.05). The two groups were IL-6, PGE2, IL-1 beta, TNF- alpha concentration difference was statistically significant (P0.05 the analysis results of.3.) chronic pain patients: results of univariate analysis showed that gender, age, ASA grade, BMI index, smoking history, drinking history, history of hypertension, history of diabetes, pain threshold, the dosage of analgesic drug, surgery had no significant effect on postoperative chronic pain effect difference (P0.05), psychological anxiety the degree of culture, there were significant differences in diabetes, chronic pain after surgery (P0.05).Logistic regression analysis of risk factors of chronic pain showed psychological anxiety, low educational level, combined with diabetes mellitus (P0.05). Positive psychological anxiety, diabetes and chronic pain Related (P0.05), education level was negatively correlated with chronic pain (P0.05). Two patients in group IL-1 beta, IL-6, PGE2, no statistically significant differences in concentration of TNF- alpha (P0.05).4. video-assisted thoracoscopic surgery patients with posterolateral thoracotomy compared with gender, age, ASA grade, BMI index, smoking history, drinking history, history of hypertension, history of diabetes, psychological anxiety, pain threshold, no statistically significant difference between the dosage of analgesic drug (P0.05), statistically significant differences in operative time (P0.05). Three days after operation in the two groups, one month, two months, there was no significant difference in NRS score of three months (P0.05). Two patients in group IL-1 beta, no statistically significant differences in the concentration of IL-6 (P0.05). Two patients in the PGE2 group, there are statistically significant differences in concentration of TNF- alpha (P0.05). Conclusion: the risk factors of 1. patients with non-small cell lung cancer after operation of acute severe pain is the dosage of remifentanil is greater than 1 Mg, the pain threshold was low, and the risk factors for postoperative chronic pain in patients with.2. non-small cell lung cancer after posterolateral thoracotomy were psychological anxiety, low education level and.3. history..3. within three months after thoracoscopic assisted thoracotomy was similar to that after posterolateral thoracotomy.

【学位授予单位】：北京市结核病胸部肿瘤研究所
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2

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