漏斗胸患者Nuss手术后慢性疼痛的危险因素

目的探讨漏斗胸微创矫正术(Nuss手术)后慢性疼痛的危险因素。方法回顾性分析2013年1月至2019年9月择期行胸腔镜Nuss手术患者168例,男130例,女38例。收集患者联系方式、人口学资料、术前合并症、漏斗胸严重程度分级、神经阻滞情况、手术时间和术后24 h VAS疼痛评分。电话随访患者或家属完成术后慢性疼痛情况、术后并发症、对日常生活的影响、是否服用镇痛药物的问卷调查。根据问卷调查结果将患者分为两组:慢性疼痛组(P组)和非慢性疼痛组(N组)。采用多因素Logistic回归分析患者Nuss手术后慢性疼痛的独立危险因素。结果有78例(46.4%)发生了不同程度的慢性疼痛。P组年龄、体重明显大于N组,术前合并症比例、漏斗胸严重程度明显高于N组(P<0.001)。P组术后24 h VAS疼痛评分及术后并发症发生率明显高于N组(P<0.001),对日常生活的影响程度明显大于N组(P<0.001)。多因素logistic回归分析显示,漏斗胸严重程度分级(中度OR=3.043,95%CI 1.235~7.498;重度OR=15.856,95%CI 2.765~90.981)、术后有并发症(OR=3.642,95%CI 1.517~8.743)、术后24 h VAS疼痛评分(每增高1分OR=2.716,95%CI 1.600~4.612)是Nuss手术后慢性疼痛的独立危险因素。结论漏斗胸患者Nuss手术后慢性疼痛存在较高的发病率,漏斗胸严重程度、术后并发症和术后24 h VAS疼痛评分是漏斗胸患者Nuss手术后慢性疼痛的预警因素。

Risk factors of chronic pain after Nuss procedure in patients with pectus excavatum

Objective To investigate the risk factors of chronic pain after minimally invasive surgery (Nuss procedure) in patients with pectus excavatum.
Methods The clinical data of 168 patients who underwent thoracoscopic Nuss procedure in our hospital from January 2013 to September 2019 were analyzed retrospectively, including 130 males and 38 females. The contact information, demographic data, funnel chest severity grade, preoperative complications, operation time, postoperative 24 hours VAS pain score and nerve block were collected. According to the contact information, a questionnaire survey was conducted among patients or their family members about postoperative chronic pain, impact on daily life, postoperative complications and whether they took painkillers or not. According to the results of the questionnaire survey, patients were divided into chronic pain group (group P) and non-chronic pain group (group N). Multivariate Logistic regression was used to analyze the risk factors of chronic pain after Nuss operation in patients with pectus excavatum.
Results Seventy-eight patients (46.4%) with pectus excavatum experienced chronic pain of varying degrees after Nuss operation. The severity of pectus excavatum and the proportion of preoperative complications in group P were significantly higher than those in group N, and their age and weight were significantly greater than those in group N (P < 0.001). The VAS pain score and the incidence of postoperative complications in group P were significantly higher than that in group N (P < 0.001), and the impact on daily life was significantly greater than that in group N (P < 0.001). Multivariate logistic regression analysis showed that funnel chest severity (moderate OR = 3.043, 95% CI 1.235-7.498, severe OR = 15.856, 95% CI 2.765-90.981), postoperative complications (OR = 3.642, 95% CI 1.517-8.743), and postoperative 24 hours VAS pain score (added one point OR = 2.716, 95% CI 1.600-4.612) were independent risk factors for chronic pain after Nuss procedure in patients with pectus excavatum.
Conclusion There is a high incidence of chronic pain after Nuss procedure in patients with pectus excavatum. Postoperative 24 hours VAS pain score, severity of pectus excavatum and postoperative complications are the early warning factors of chronic pain after Nuss procedure in patients with pectus excavatum.