摘要目的 筛选经皮肾镜取石术患者术后中重度疼痛的危险因素.方法 选择择期全身麻醉下行经皮肾镜取石术患者81例,ASA分级Ⅰ或Ⅱ级,年龄18～70岁,性别不限,BMI 19～42kg/m2.术后发生中重度疼痛(VAS评分≥4分)时,静脉注射地佐辛5 mg,给药间隔大于4h.根据术后24 h内中重度疼痛的发生情况,分为中重度疼痛组和非中重度疼痛组.收集患者年龄、性别、ASA分级、BMI、术前肌酐异常情况、尿白细胞水平、尿细菌水平、手术部位、肾积水情况、受累肾盏数、结石CT值、术中穿刺通道长度、手术时间、术后引流管数量和结石残留情况.将组间比较差异有统计学意义的因素进行多因素logistic回归分析,筛选术后中重度疼痛的危险因素.结果 本研究共纳入79例患者,其中有47例患者发生了中重度疼痛,发生率为59％.多因素logistic回归分析结果显示:术前受累肾盏＞3个、结石CT值＞1000和术后结石残留是经皮肾镜取石术患者术后中重度疼痛的独立危险因素(P＜0.05).结论 术前受累肾盏＞3个、结石CT值＞1000和术后结石残留是经皮肾镜取石术患者术后中重度疼痛的独立危险因素.

abstractsObjective To determine the risk factors for moderate and severe postoperative pain in patients undergoing percutaneous nephrolithotomy.Methods Eighty-one patients of both sexes,aged 18-70 yr,with body mass index of 19-42 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients,undergoing elective percutaneous nephrolithotomy under general anesthesia,were selected.When moderate and severe postoperative pain developed (visual analog scale score ≥ 4),dezocine 5 mg was intravenously injected with the dosing interval greater than 4 h.According to the occurrence of moderate and severe pain within 24 h after operation,the patients were divided into moderate and severe pain group and non-moderate and severe pain group.The age,sex,American Society of Anesthesiologists physical status,body mass index,preoperative abnormality of creatinine,urinary leukocyte,urinary bacteria,surgical site,severity of hydronephrosis,the number of affected renal calyx,CT value of stones,length of puncture channel,operation time,the number of postoperative drainage tube and residual stones were collected.Multivariate logistic regression analysis was performed to stratify the risk factors for moderate and severe postoperative pain.Results A total of 79 patients were included in this study.Among the 79 patients,47 patients developed moderate or severe pain,and the incidence was 59％.The results of multivariate logistic regression analysis showed that the number of preoperative affected renal calyx＞3,CT value of stones ＞ 1 000 and postoperative residual stones were independent risk factors for moderate and severe pain after percutaneous nephrolithotomy (P＜0.05).Conclusion The number of preoperative affected renal calyx＞3,CT value of stones ＞ 1 000 and postoperative residual stones are independent risk factors for moderate and severe postoperative pain in the patients undergoing percutaneous nephrolithotomy.