乳腺癌患者术前超声引导下胸椎旁神经阻滞与术后慢性疼痛的相关性

目的 采用倾向性评分匹配法(PSM)评估术前超声引导下胸椎旁神经阻滞(TPVB)与术后1年以上乳腺癌患者术后慢性疼痛(CPSP)的相关性.方法 回顾性收集2018年1月至2019年3月全麻下择期乳腺癌手术女性患者的临床资料,ASAⅠ—Ⅲ级.根据是否接受术前超声引导下TPVB将患者分为两组:TPVB联合全麻组(TG组)和...     

Levels of preoperative cerebrospinal fluid pro-inflammatory mediators and chronic pain after total knee arthroplasty surgery

Background

Patients undergoing total knee arthroplasty (TKA) surgery are at high risk of chronic postsurgical pain (CPSP). Accumulating evidence suggests an active role of neuroinflammation in chronic pain. However, its role in the progression to CPSP following TKA surgery remains unanswered. Here, we examined the associations between preoperative neuroinflammatory states and pre- and postsurgical chronic pain in TKA surgery.

Methods

The data of 42 patients undergoing elective TKA surgery for chronic knee arthralgia at our hospital were analyzed in this prospective study. Patients completed the following questionnaires: brief pain inventory (BPI), hospital anxiety and depression scale, painDETECT, and pain catastrophizing scale (PCS). Cerebrospinal fluid (CSF) samples were collected preoperatively and concentrations of IL-6, IL-8, TNF, fractalkine, and CSF-1 were measured by electrochemiluminescence multiplex immunoassay. CPSP severity was ascertained, using the BPI, 6 months postsurgery.

Results

While no significant correlation was observed between the preoperative CSF mediator levels and preoperative pain profiles, the preoperative fractalkine level in the CSF showed a significant correlation with CPSP severity (Spearman's rho = −0.525; p = .002). Furthermore, multivariate linear regression analysis revealed that the preoperative PCS score (standardized β coefficient [β]: .11; 95% confidence interval [CI]: 0.06–0.16; p < .001) and CSF fractalkine level (β: −.62; 95% CI: −1.10 to −0.15; p = .012) were independent predictors of CPSP severity 6 months after TKA surgery.

Conclusions

We identified the CSF fractalkine level as a potential predictor for CPSP severity following TKA surgery. In addition, our study provided novel insights into the potential role of neuroinflammatory mediators in the pathogenesis of CPSP.     

Risk factors for persistent pain after breast cancer surgery: a multicentre prospective cohort study

Identifying factors associated with persistent pain after breast cancer surgery may facilitate risk stratification and individualised management. Single-population studies have limited generalisability as socio-economic and genetic factors contribute to persistent pain development. Therefore, this prospective multicentre cohort study aimed to develop a predictive model from a sample of Asian and American women. We enrolled women undergoing elective breast cancer surgery at KK Women's and Children's Hospital and Duke University Medical Center. Pre-operative patient and clinical characteristics and EQ-5D-3L health status were recorded. Pain catastrophising scale; central sensitisation inventory; coping strategies questionnaire-revised; brief symptom inventory-18; perceived stress scale; mechanical temporal summation; and pressure-pain threshold assessments were performed. Persistent pain was defined as pain score ≥ 3 or pain affecting activities of daily living 4 months after surgery. Univariate associations were generated using generalised estimating equations. Enrolment site was forced into the multivariable model, and risk factors with p < 0.2 in univariate analyses were considered for backwards selection. Of 210 patients, 135 (64.3%) developed persistent pain. The multivariable model attained AUC = 0.807, with five independent associations: age (OR 0.85 95%CI 0.74–0.98 per 5 years); diabetes (OR 4.68, 95%CI 1.03–21.22); pre-operative pain score at sites other than the breast (OR 1.48, 95%CI 1.11–1.96); previous mastitis (OR 4.90, 95%CI 1.31–18.34); and perceived stress scale (OR 1.35, 95%CI 1.01–1.80 per 5 points), after adjusting for: enrolment site; pre-operative pain score at the breast; pre-operative overall pain score at rest; postoperative non-steroidal anti-inflammatory drug use; and pain catastrophising scale. Future research should validate this model and evaluate pre-emptive interventions to reduce persistent pain risk.     

Paravertebral block and persistent postoperative pain after breast surgery: meta‐analysis and trial sequential analysis

We examined whether paravertebral block has an effect on the prevalence of persistent postsurgical pain after breast surgery. Seven randomised, controlled trials (559 patients) which had the outcome assessor blinded were included, comparing patients who received paravertebral blocks after breast surgery with patients who did not. The risk ratio (95% CI) was 0.75 (0.48–1.15) for the incidence of postoperative pain at 3 months (four studies, 317 patients); the risk ratio (95% CI) obtained from three studies including 301 patients reporting on pain after 6 months was 0.57 (0.29–1.72), and the risk ratio (95% CI) for pain after 12 months (three trials, 237 patients) was 0.42 (0.15–1.23). Conventional meta‐analysis using the random effects model thus showed no statistically significant risk reduction for persistent postoperative pain at 3 months, 6 months or 12 months. Trial sequential analysis, used to consider the risk of type 1 and type 2 random error, showed that at 3 months, 6 months and 12 months, the number of subjects in the analyses were only 18.3%, 6.8% and 4.2% of the required information sizes at those time points, respectively. Our study is the first to evaluate data on pain 12 months postoperatively. Trial sequential analysis revealed that the current evidence is not sufficient to reach a conclusion. These findings stand in contrast to previous meta‐analyses with fewer studies that had concluded that paravertebral block effectively reduces chronic pain.     

老年慢性疼痛患者疼痛接受度对生活质量的影响

目的探讨老年患者慢性疼痛接受度对其生活质量的影响。方法采用McGill疼痛问卷、中文版简易慢性疼痛接受问卷及简明生活质量量表,对太原市3所三甲医院就诊的235例老年慢性疼痛患者进行调查。结果老年慢性疼痛患者McGill疼痛得分(61.89±22.55)分,慢性疼痛接受得分为(23.79±5.23)分,活动参与得分高于疼痛意愿;生活质量得分为(57.01±15.41)分;疼痛接受与生活质量呈正相关(P0.01),且是生活质量的预测因素。结论疼痛接受程度越高,老年慢性疼痛患者的生活质量越好。医护人员应根据疼痛接受中活动参与的益处,制定促进老年慢性疼痛患者参与活动的诊疗计划,以促进老年患者生活质量的提高。     

A prospective observational study to investigate the relationship between local anesthetic infiltration pain before spinal anesthesia and acute and chronic postsurgical pain in women undergoing elective cesarean delivery

BackgroundCesarean delivery is one of the most common procedures performed worldwide. We conducted this prospective cohort study to evaluate the association between local anesthetic infiltration (LAI) pain prior to spinal anesthesia and pain and morphine consumption within 24 h after cesarean delivery (primary outcomes). A secondary objective was to assess the association between LAI pain and pain at one month postoperatively.MethodsRecruitment of 216 eligible women scheduled for elective cesarean delivery. Local infiltration before spinal anesthesia was performed using a 24-gauge needle and 3 mL 2% plain lidocaine. All subjects received 2.2 mL 0.5% hyperbaric bupivacaine with 200 µg morphine for spinal anesthesia. A 0–10 verbal numerical rating scale was used to assess LAI pain severity, and subsequent pain at 24 h, 1, 3 and 12 months.ResultsWe found a moderate correlation between LAI pain intensity and severity of acute pain at rest (rho=0.56, P <0.001) and with movement (rho=0.58, P <0.001) and a weak correlation with morphine consumption (rho=0.17, P=0.01) within 24 h postoperatively. We also found a positive correlation between LAI pain and the severity of persistent wound pain at rest (rho=0.30, P <0.001) and with movement (rho=0.52, P <0.001) at 1 month. The incidence of wound pain at 1, 3 and 12 months postoperatively was 37.1%, 7.0% and 1.4%, respectively.ConclusionsPain from LAI prior to spinal anesthesia is significantly associated with subsequent postoperative pain both acutely and at one month in women scheduled for elective cesarean delivery under spinal anesthesia.     

乳腺癌保留皮肤全乳切除一期乳房重建129例临床分析

目的 探讨乳腺癌保留皮肤全乳切除(SSM)联合一期乳房重建(IBR)的安全性、适应证、美容效果及其对辅助治疗的影响.方法 对1999年10月至2007年5月共129例接受SSM+IBR手术的乳腺癌患者进行回顾性分析.采用背阔肌或背阔肌联合假体、带蒂横行腹直肌肌皮瓣等方法行乳房重建.结果 平均住院18.6 d,术后首次化疗开始时间平均为术后第5.2天.假体包囊挛缩11例(11/63,17.5%),背部供区血清肿24例(24/99,24.2%),腹直肌肌皮瓣或腹壁下动脉穿支皮瓣部分坏死或硬结9例(9/28,32.1%).未接受放疗患者对重建乳房外观的可接受度为89.7%,高于接受放疗患者的68.2%(P<0.01).随访2-73个月,中位随访11个月.局部复发5例,远处转移7例.结论 SSM+IBR对于0～Ⅱa期乳腺癌患者是安全的,能同时满足肿瘤治疗及形体美容的要求.放疗对于重建乳房的外观有一定的负面影响,对于需要术后放疗的患者,可以考虑延期或者延期-即时乳房重建.     

肛肠手术后慢性疼痛的危险因素分析

目的 探讨肛肠手术后慢性疼痛（CPSP）的危险因素。
方法 收集2018年8月至2019年10月择期行肛肠手术746例患者资料,并记录人口学特征、合并症、术前疼痛情况、围术期情况等。通过电话随访术后1、3个月时的疼痛情况,根据术后是否发生CPSP将患者分为两组：CPSP组和非CPSP组。采用多因素Logistic回归分析CPSP的危险因素。
结果 有37例（4.96％）患者发生CPSP。与非CPSP组比较,CPSP组术前合并疼痛、高血压、贫血、术后7 d VAS疼痛评分>3分、术后发生出血、睡眠障碍和便秘的比例明显升高（P<0.05）。多因素Logistic回归分析显示,术前疼痛（OR=3.022,P=0.013）、术前贫血（OR=2.235,P=0.017）、术后出血（OR=3.511,P=0.034）、术后睡眠障碍（OR=2.345,P=0.003）以及术后7 d VAS疼痛评分>3分（OR=4.323,P=0.006）是发生肛肠手术后CPSP的危险因素。
结论 肛肠手术CPSP发生率较低,术前疼痛、术前贫血、术后出血、术后睡眠障碍以及术后7 d VAS疼痛评分>3分是发生肛肠手术CPSP的危险因素。     

The association between bariatric surgery and cataract: a propensity score-matched cohort study

BackgroundObesity is considered a risk factor for cataracts. The association between weight loss and a cataract among patients with obesity has not been assessed to date.ObjectivesTo assess the association between weight loss following bariatric surgery and cataracts.SettingNationwide Swedish healthcare registries between 2006 and 2019.MethodsWe performed a population-based cohort study. Patients aged 40–79 years who underwent bariatric surgery were matched on their propensity score (PS) to up to 2 patients with obesity (“unexposed patients”). Cox proportional hazard regression analyses calculated hazard ratios (HRs) and 95% confidence intervals (CIs) of developing cataracts following bariatric surgery, compared with unexposed patients. Subgroup analyses by age, sex, bariatric surgery type, and duration of follow-up were conducted.ResultsIn total, 22,560 bariatric surgery patients were PS-matched to 35,523 unexposed patients. The risk of cataracts was decreased in bariatric surgery patients compared with unexposed patients (HR .71, 95% CI .66–.76). We observed the lowest risk of cataracts among bariatric surgery patients aged 40–49 years (HR .52, 95% CI .44–.75) but a null result for patients aged ≥60 years. Gastric bypass or duodenal switch were associated with decreased risks of cataracts, whereas sleeve gastrectomy yielded a null result. Subgroups of sex and duration of follow-up showed no evidence of effect modification (hazards were proportional throughout follow-up).ConclusionOur results suggest that substantial weight loss following bariatric surgery is associated with a decreased risk of cataracts, especially if bariatric surgery was performed before age 60.     

保乳手术和改良根治术治疗早期乳腺癌的临床疗效分析

目的探讨和比较保乳手术和改良根治术治疗早期乳腺癌的临床疗效和安全性。方法回顾性分析2013年1月至2015年9月期间接受外科手术治疗的100例早期乳腺癌手术患者的临床资料,根据患者的手术方式进行分组,其中保乳手术组(保乳组)50例,改良根治术组(改良组)50例,采用SPSS 19.0统计分析,两组患者的手术时间、术中出血量、住院天数等用"均数±标准差"表示,组间比较采用t检验;术后并发症发生情况、乳房美容效果、术后肿瘤局部复发率、远处转移率、1年生存率等用"%"形式表示,组间比较采用χ2检验。P0.05差异有统计学意义。结果保乳组手术时间、术中出血量、住院时间及术后并发症发生率均少于改良组(P0.05),美容效果优良率高于改良组(P0.05)。两组患者术后肿瘤局部复发率、远处转移率、1年生存率差异均无统计学意义(P0.05)。结论保乳手术与改良根治术治疗早期乳腺癌疗效确切,但保乳手术对患者损伤小、出血量少、并发症少、美容效果好,值得推广应用。