摘要目的 采用大样本前瞻性临床研究,探讨术后慢性疼痛(CPSP)的发生率、危险因素及对生活质量的影响.方法 择期手术病人1 098例,年龄18～ 70岁,ASA分级Ⅰ或Ⅱ级.记录病人年龄、性别、BMI、文化程度、婚姻状态、居住情况、职业、术前手术部位疼痛情况、并存疾病、手术类型、手术时间、麻醉方式,记录术后3d内最高数字疼痛模拟评分.术后3、6和12月随访病人,记录CP-SP发生情况;根据是否发生CPSP,分为CPSP组和非CPSP组,采用多因素logistic回归分析筛选CPSP的危险因素,并进行生活质量评分.结果 981例病人完成了术后1年的随访,CPSP发生率35.7％,其病程分布构成比:3月≤术后病程＜6月为33.1％;6月≤术后病程＜12月为16.8％;术后病程≥12月为50.1％.女性、未并存糖尿病和术前手术部位疼痛是CPSP的独立危险因素(P＜0.05).与非CPSP组比较,CPSP组生理功能评分、生理职能评分、躯体镇痛评分、活力评分、社会功能评分、心理健康评分和总体健康评分降低(P＜0.01),情感职能评分差异无统计学意义(P＞0.05).结论 CPSP不仅发生机率较高且病程较长,病人生活质量评分降低;女性、未并存糖尿病和术前手术部位疼痛是CPSP发生的独立危险因素.

abstractsObjective To investigate the incidence and risk factors of chronic post-surgical pain (CPSP) and its effects on the quality of life in a large sample prospective study.Methods A total of 1098 patients of either sex,aged 18-70 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,undergoing elective surgery,were enrolled in the study.Data regarding patient age,gender,body mass index,educational level,marital status,living situations,occupation,pre-surgical pain in the site of surgery,complications,type of surgery,surgery time and anesthesia method were recorded.The highest numeric rating scale scores within 3 days after surgery were also recorded.The patients were followed up at 3,6 and 12 months after surgery to record the development of CPSP.The patients were divided into CPSP group and non-CPSP group according to whether or not CPSP developed.Multivariable logistic regression analysis was performed to identify the risk factors for CPSP,and the quality of life was scored.Results A total of 981 patients completed the 1 year follow-up after surgery,the incidence of CPSP was 35.7％,and the constituent ratio of the distribution of the course was as follows:3 months ≤ postsurgical course ＜ 6 months was 33.1％;6 months ≤ postsurgical course ＜ 12 months was 16.8％;postsurgical course ≥ 12 months was 50.1％.Female,no diabetes mellitus and pre-surgical pain in the site of surgery were the independent risk factors for CPSP (P＜ 0.05).Compared with non-CPSP group,the physiological function score,professional function score,body pain score,vitality score,social function score,mental health score and general health score were significantly decreased (P＜0.01),and no significant change was found in the emotional function score in CPSP group (P＞0.05).Conclusion The probability of development of CPSP is high and the course is long,and the quality of life score is decreased;female,no diabetes mellitus and pre-surgical pain in the site of surgery are the independent risk factors for CPSP.