分析支气管肺癌患者胸腔镜肺段切除术后中重度急性疼痛的风险因素。

选择2022年8月至2024年8月我院收治的支气管肺癌经胸腔镜肺段切除术后急性疼痛，疼痛持续时间超过20 min患者72例为对象，采用视觉模拟评分(visual analogue scale, VAS)判断急性疼痛严重程度，18例评分4~10分为中重度组，54例评分1~3分为轻度组。比较两组年龄、性别、吸烟史、饮酒史、文化程度、糖尿病、高血压、术前焦虑、术前抑郁、术前恐惧评分(疼痛恐惧问卷-Ⅲ-FPQ-Ⅲ)、胸背部疼痛史、TNM分期(Ⅰ、Ⅱ、Ⅲ A期)、手术及术后情况(美国麻醉医师协会分级、手术时间、手术部位、术后镇痛天数、胸腔闭式引流管根数、胸腔闭式引流管天数、术后住院时间、麻醉时间、术后7 d内镇痛药物消耗量、有无并发症)，采用Logistic回归分析术后中重度急性疼痛的因素。

多因素分析结果表明，饮酒史(OR＝2.038，95%CI：1.345~3.088)、术前焦虑(OR＝2.375，95%CI：1.314~4.293)、术前恐惧评分(OR＝1.923，95%CI：1.414~2.616)、直径(OR＝2.625，95%CI：1.595~4.318)、手术时间(OR＝2.421，95%CI：1.184~4.950)、术后住院时间(OR＝2.237，95%CI：1.660~3.013)、麻醉时间(OR＝2.136，95%CI：1.139~4.007)、术毕镇痛方法(肋间神经阻滞)(OR＝0.521，95%CI：0.312~0.871)、切口肋间隙宽度(≥1.5 cm)(OR＝0.470，95%CI：0.285~0.772)是支气管肺癌术后患者中重度急性疼痛的影响因素(P<0.05)。

饮酒史、术前焦虑、术前恐惧评分、直径、手术时间等因素是胸腔镜支气管肺癌肺段切除术后发生中重度急性疼痛的危险因素。早期识别和治疗，有助于降低术后中重度急性疼痛发生率，改善术后生活质量。

To analyze the risk factors of moderate to severe acute pain after thoracoscopic segmental resection of the lung in patients with bronchogenic lung cancer.

Seventy-two patients with acute pain after thoracoscopic segmental resection of bronchogenic lung cancer and a pain duration of more than 20 minutes who were admitted to our hospital from August 2022 to August 2024 were selected as the subjects. The severity of acute pain was determined by the visual analogue scale (VAS). Eighteen cases with a score of 4 to 10 were classified as the moderate to severe group, and 54 cases with a score of 1 to 3 were classified as the mild group. The age, gender, smoking history, drinking history, educational level, diabetes, hypertension, preoperative anxiety, preoperative depression, preoperative fear score (Fear of Pain Questionnaire-Ⅲ-FPQ-Ⅲ), history of chest and back pain, and TNM stage (Ⅰ, Ⅱ, Ⅲ) were compared between the two groups Stage A), surgery and postoperative conditions (American Society of Anesthesiologists classification, operation time, surgical site, days of postoperative analgesia, number of closed thoracic drainage tubes, days of closed thoracic drainage tubes, postoperative hospital stay, anesthesia time, consumption of analgesic drugs within 7 days after surgery, presence or absence of complications), Logistic regression was used to analyze the factors of moderate to severe acute pain after surgery.

The results of multivariate analysis indicated that the history of alcohol consumption (OR=2.038, 95%CI: 1.345~3.088), preoperative anxiety (OR=2.375, 95%CI: 1.314~4.293), and preoperative fear score (OR=1.923, 95%CI: 1.414~2.616), diameter (OR=2.625, 95%CI: 1.595~4.318), operation time (OR=2.421, 95%CI: 1.184~4.950), postoperative hospital stay (OR=2.237, 95%CI: 1.660~3.013), anesthesia time (OR=2.136, 95%CI: 1.139~4.007), postoperative analgesia method (intercostal nerve resistance) (OR=0.521, 95%CI: 0.312~0.871), incision intercostal space width (≥1.5 cm) (OR=0.470, 95%CI: 0.285~0.772) is an influencing factor for moderate to severe acute pain in patients after bronchogenic lung cancer surgery (P<0.05).

Factors such as drinking history, preoperative anxiety, preoperative fear score, diameter, and operation time are risk factors for moderate to severe acute pain after thoracoscopic segmental resection of bronchogenic lung cancer. Early identification and treatment are helpful to reduce the incidence of moderate to severe acute pain after surgery and improve the quality of life after surgery.