术后并发症与术后持续疼痛的关系：观察性队列研究
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Association between postoperative complications and lingering post-surgical pain: an observational cohort study
背景与目的
术后疼痛持续超过最初几周的组织愈合期，是疼痛慢性化的一个主要预测因子，可导致严重残疾和阿片类镇痛药物持续使用。本研究旨在探讨术后并发症是否增加了术后持续疼痛的发生风险。
方 法
本研究纳入2013年9月至2017年5月期间，在美国学术转诊中心接受各种择期手术的患者。从患者自述报告中获得的结果，采用多变量逻辑回归对混杂变量和患者特有的危险因素进行校正，验证任何主要术后并发症与术后1~3个月功能限制性持续疼痛之间的独立相关性。
结 果
本队列研究共纳入11986例成年患者；其中，10562例资料完整。13.3%（95%CI 12.7~14.0）的患者报告至少有一种并发症（心血管、呼吸、肾脏/胃肠道、创伤、血栓形成或神经）出现，19.7% （19.0~20.5%）的患者报告了功能限制性术后持续疼痛。排除已知危险因素后，如果患者同时报有术后并发症，那他们自述报告术后持续疼痛的可能性是无并发症患者的两倍（OR 2.04;1.78~2.35）。当并发症数据从国家外科质量改进计划登记处提取，而不是从患者自述报告中获得时，发生并发症也可独立预测术后持续疼痛（OR 1.95;1.26~3.04）。
结 论
术后1~3个月的功能限制性疼痛呈2倍增加与发生医疗并发症有关。了解并发症与病理性持续疼痛之间的联系机制，有助于进一步研究预防术后持续疼痛的处理方法。
原始文献摘要
Willingham M, Rangrass G, Curcuru C,et al. Association between postoperative complications and lingering post-surgical pain: an observational cohort study.[J]. Br J Anaesth 2020 Feb;124(2):214-221.
Background: Post-surgical pain that lingers beyond the initial few-week period of tissue healing is a major predictor of pain chronification, which leads to substantial disability and new persistent opioid analgesic use. We investigated whether postoperative medical complications increase the risk of lingering post-surgical pain.
Methods: The study population consisted of patients undergoing diverse elective surgical procedures in an academic referral centre in the USA, between September 2013 and May 2017. Multivariable logistic regression, adjusting for confounding variables and patient-specific risk factors, was used to test for an independent association between any major postoperative complication and functionally limiting lingering pain 1~3 months after surgery, as obtained from patient self-reports.
Results: The cohort included 11 986 adult surgical patients; 10 562 with complete data. At least one complication (cardiovascular, respiratory, renal/gastrointestinal, wound, thrombotic, or neural) was reported by 13.3% (95% confidence interval: 12.7~14.0) of patients, and 19.7% (19.0~20.5%) reported functionally limiting lingering post-surgical pain. After adjusting for known risk factors, the patients were twice as likely (odds ratio: 2.04; 1.78~2.35) to report lingering post-surgical pain if they also self-reported a postoperative complication. Experiencing a complication was also independently predictive of lingering post-surgical pain (odds ratio: 1.95; 1.26~3.04) when complication data were extracted from the National Surgical Quality Improvement Program registry, instead of being obtained from patient self-report.
Conclusions: Medical complications were associated with a two-fold increase in functionally limiting pain 1~3 months after surgery. Understanding the mechanisms that link complications to pathological persistence of pain could help develop future approaches to prevent persistent post-surgical pain.
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贵州医科大学高鸿教授课题组
翻译：冯玉蓉 编辑：冯玉蓉 审校：王贵龙