胸腔镜肺叶切除术后急性疼痛轨迹及其影响

目的 探讨胸腔镜肺叶切除术(video-assisted thoracoscopic surgery,VATS)患者围手术期不同类型疼痛轨迹,并分析术后疼痛对患者术后康复的影响。方法 选取2022年1月至2022年4月在温州医科大学附属第一医院择期行VATS的50例患者,采用数字疼痛量表分别记录患者术前不同类型慢性疼痛、术后1～7d内脏痛、躯体痛、最大疼痛的疼痛评分,采用组基轨迹模型分析不同类型疼痛轨迹。按照急性术后躯体痛轨迹分为轻度疼痛组(n=26)、轻中度疼痛组(n=21)、中度疼痛组(n=3),按照最大疼痛轨迹分为轻度疼痛组(n=24)、轻中度疼痛组(n=23)、中重度疼痛组(n=3),按照术后内脏痛轨迹分为存在轻度疼痛组(n=47)和轻至重度疼痛组(n=3)。比较不同轨迹各组患者术后恶心呕吐、肺部感染、睡眠障碍、术后排气时间、下床时间、胸腔引流管拔出时间、术后住院时长。结果 有28%的腹腔镜辅助下肺叶切除术患者术前存在慢性疼痛。VATS患者术后出现不同类型的急性疼痛,主要以躯体痛为主。根据最大疼痛评分建立3种疼痛轨迹组,其中,与轻度疼痛组相比,轻中度和中重度疼痛组患者术后睡眠障...

Postoperative acute pain trajectories in patients undergoing video-assisted thoracoscopic surgery and its effect on postoperative rehabilitation

Objective To investigate pain trajectories of the different types in patients undergoing video-assisted thoracoscopic surgery (VATS) during perioperative period, and analyze the impact of acute postoperative pain on postoperative rehabilitation. Methods A total of 50 patients who underwent elective VATS at the First Affiliated Hospital of Wenzhou Medical University from January 2022 to April 2022 were selected, and the pain scores of different types of chronic pain before surgery, visceral pain, somatic pain and maximal pain 1-7 days after surgery were recorded separately using a numerical pain scale, and different types of pain trajectories were analyzed using a group-based trajectory model. The trajectories were divided into mild pain group (n=26), mild to moderate pain group (n=21) and moderate pain group (n=3) according to acute postoperative somatic pain trajectory, mild pain group (n=24), mild to moderate pain group (n=23) and moderate to severe pain group (n=3) according to maximum pain trajectory, and presence of mild pain group (n=47) and mild to severe pain group according to postoperative visceral pain trajectory (n=3). Postoperative nausea and vomiting, pulmonary infection, sleep disturbance, postoperative time to exhaustion, time to bed, time to chest drain removal, and length of postoperative hospital stay were compared between the different trajectory groups. Results Chronic pain was present preoperatively in 28% of patients undergoing laparoscopic-assisted lobectomy. Patients undergoing VATS presented with different types of acute pain postoperatively, with a predominance of somatic pain. Three pain trajectory groups were established based on maximum pain scores, in which patients in the mild to moderate and moderately severe pain groups had a higher incidence of postoperative sleep disturbance, longer time to drainage tube removal and postoperative hospital stay compared to the mild pain group, all with statistically significant differences (P<0.05). Three groups of pain trajectories were established according to acute postoperative somatic pain, in which patients in the mild to moderate and moderate pain groups had a higher incidence of postoperative sleep disturbance, longer time to drainage and longer postoperative hospital stay compared to the mild pain group, all with statistically significant differences (P<0.05). When the pain trajectories of the two groups were established according to acute postoperative visceral pain, patients in the mild to severe pain group had a longer postoperative length of stay and longer time to chest drain removal than those in the mild pain group, all with statistically significant differences (P<0.05). Conclusion Acute postoperative pain in VATS patients is both somatic and visceral, and there are different pain trajectories for different types of pain. Both moderately severe and moderate pain trajectory groups increase postoperative sleep disturbance, prolong postoperative length of stay and chest drain removal time. Therefore, individualised, multimodal analgesic protocols are needed to reduce patients'' perioperative pain and thus improve their quality of life.