吸烟对肝脏肿瘤切除患者术后疼痛的影响

目的 观察吸烟对肝脏肿瘤切除患者术后切口疼痛的影响,评估吗啡对吸烟患者术后疼痛的治疗效果.方法 纳入上海东方肝胆外科医院择期全身麻醉下行肝脏肿瘤切除手术的肝癌患者120例,其中吸烟组42例,戒烟组38例,对照组40例,检测各组患者术前基础痛阈值,评估各组患者术后苏醒期、24 h、48 h疼痛数字等级评分(NRS)以及恶心呕吐视觉模拟评分(VAS),记录各组患者术后48 h内吗啡消耗量.结果 吸烟组术前基础痛阈值[(1.0±0.2)mA]低于戒烟组[(3.2±0.5)mA]以及对照组[(3.2±0.5)mA],差异有统计学意义(P<0.05),术后48 h吗啡需要量[(45.8±2.6)mg]较戒烟组[(35.4±3.2)mg]以及对照组[(35.2±1.9)mg]增加,差异有统计学意义(P<0.05),戒烟组与对照组的基础痛阈值和术后吗啡需要量差异无统计学意义(P>0.05).吸烟组术后疼痛NRS分值和恶心呕吐VAS分值高于对照组及戒烟组,差异有统计学意义(P<0.05).结论 术前长期慢性吸烟会导致患者手术后急性疼痛加重,单纯增加吗啡用量并不能显著缓解患者疼痛,提示阿片肽类药物可能不是吸烟患者术后首选的镇痛药物.

Impact of cigarette smoking on postoperative pain after liver tumor resection

Objective To observe the impact of cigarette smoking on postoperative pain after liver tumor resection , and also to evaluate the therapeutic effect of morphine on postoperative pain management in smokers .Methods A total of 120 patients, who under-went liver tumor resection with general anesthesia in the Eastern Hepatobiliary Surgery Hospital , were recruited as research subjects .Of all the patients, 42 were current-smokers (the smoker group), 38 were ex-smokers (the ex-smoker group) and 40 were non-smokers (the control group).Before surgery, basal pain thresholds were detected in each group .Conscious recovery time , scores of pain numerical rat-ing scale (NRS) at hours 24 and 48, and scores of nausea and vomiting visual analogue scale (VAS) were also evaluated for each group . Meanwhile, the amount of morphine consumption 48 hours after surgery was recorded as well for each group .Results Basal pain thresh-olds in the patients of the smoker group [(1.0 ±0.2)mA] was significant lower than those of the patients of the ex-smoker group [(3.2 ±0.5)mA] and the control group [(3.2 ±0.5)mA] (P<0.05).The amount of morphine consumption 48 hours after surgery in the pa-tients of the smoker group [(45.8 ±2.6)mg] was much higher than that of the patients of the ex-smoker group [(35.4 ±3.2)mg] and the control group [(35.2 ±1.9)mg] (P<0.05).There was no statistical significance in the baseline pain thresholds and postoperative morphine consumption, when comparisons were made between the 2 groups.The scores of NRS after surgery and the scores of VAS of the smoker group were significantly higher than those of the ex-smoker and control groups (P<0.05).Conclusion Prolonged chronic smoking before surgery could bring about worsening of acute pain after surgery in the smoker patients .Simple increased consumption of morphine would not help much to alleviate pain, suggesting that opioid peptides might not be the drugs of first choice for anesthesia in smoker patients .