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术前新型冠状病毒感染患者慢性术后疼痛发生率及其危险因素分析：一项双向队列研究

车璐,  余佳文,  金迪,  白雪,  王怡,  张越伦,  许力,  申乐,  黄宇光

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文章导航 > 协和医学杂志  > 2024 >  15(2): 344-350
车璐, 余佳文, 金迪, 白雪, 王怡, 张越伦, 许力, 申乐, 黄宇光. 术前新型冠状病毒感染患者慢性术后疼痛发生率及其危险因素分析：一项双向队列研究[J]. 协和医学杂志, 2024, 15(2): 344-350. doi: 10.12290/xhyxzz.2023-0556
引用本文: 车璐, 余佳文, 金迪, 白雪, 王怡, 张越伦, 许力, 申乐, 黄宇光. 术前新型冠状病毒感染患者慢性术后疼痛发生率及其危险因素分析：一项双向队列研究[J]. 协和医学杂志, 2024, 15(2): 344-350. doi: 10.12290/xhyxzz.2023-0556
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CHE Lu, YU Jiawen, JIN Di, BAI Xue, WANG Yi, ZHANG Yuelun, XU Li, SHEN Le, HUANG Yuguang. Chronic Postsurgical Pain Among Patients with Preoperative COVID-19: An Ambispective Cohort Study[J]. Medical Journal of Peking Union Medical College Hospital, 2024, 15(2): 344-350. doi: 10.12290/xhyxzz.2023-0556
Citation: CHE Lu, YU Jiawen, JIN Di, BAI Xue, WANG Yi, ZHANG Yuelun, XU Li, SHEN Le, HUANG Yuguang. Chronic Postsurgical Pain Among Patients with Preoperative COVID-19: An Ambispective Cohort Study[J]. Medical Journal of Peking Union Medical College Hospital, 2024, 15(2): 344-350. doi: 10.12290/xhyxzz.2023-0556
shu

术前新型冠状病毒感染患者慢性术后疼痛发生率及其危险因素分析：一项双向队列研究

doi: 10.12290/xhyxzz.2023-0556
  • 1.

    中国医学科学院北京协和医院麻醉科，北京 100730

  • 2.

    中国医学科学院北京协和医院病案科，北京 100730

  • 3.

    中国医学科学院北京协和医院医学科学研究中心，北京 100730

基金项目: 

中央高水平医院临床科研专项 2022-PUMCH-B-007

详细信息
    通讯作者:

    申乐，E-mail: pumchshenle@163.com

  • 中图分类号: R614; R619; R441.1

Chronic Postsurgical Pain Among Patients with Preoperative COVID-19: An Ambispective Cohort Study

  • 1.

    Department of Anesthesiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • 2.

    Department of Medical Records, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

  • 3.

    Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China

Funds: 

National High-Level Hospital Clinical Research Funding 2022-PUMCH-B-007

More Information

    摘要
  • 摘要:   目的  探究术前新型冠状病毒感染(corona virus disease 2019，COVID-19)患者慢性术后疼痛(chronic postsurgical pain, CPSP)发生现况，并进一步分析CPSP的危险因素。  方法  本研究为一项双向队列研究，研究对象来源于一项已完成随访的前瞻性队列研究。回顾性纳入2022年12月1日—2023年2月28日北京协和医院术前合并COVID-19且接受手术治疗患者的临床资料，并前瞻性对入组患者随访至术后6个月，主要结局指标为CPSP。采用多因素Logistic回归模型分析COVID-19相关暴露指标与CPSP的相关性。  结果  共入选符合纳入与排除标准的手术患者4117例，术前均合并COVID-19。其中急性期轻症4002例，重症62例，危重症53例。术后6个月时伴有长新冠综合征1298例(31.53%)，CPSP发生率为5.59%(95% CI：4.88%~6.28%)。多因素Logistic回归分析校正年龄、性别、合并症、麻醉方法、手术种类等混杂因素后发现，急性期危重症COVID-19(aOR=3.35, 95% CI: 1.48~7.62, P＜0.001)、有术后长新冠综合征(aOR=2.50, 95% CI: 1.90~3.29, P＜0.001)与CPSP相关。  结论  本研究首次明确急性期危重症及术后存在长新冠综合征与术前COVID-19患者CPSP具有相关性。
    Abstract:   Objective  To investigate the occurrence of chronic postsurgical pain (CPSP) among patients with preoperative COVID-19, and further analyze the risk factors for CPSP.  Methods  This study was a ambispective cohort study, with subjects from a completed cohort study with follow-up. We included the clinical data of the patients with preoperative COVID-19 who underwent surgery at Peking Union Medical College Hospital from December 1, 2022 to February 28, 2023. Follow-up was conducted up to 6 months postoperatively, with the primary outcome being CPSP. Multivariate Logistic regression analysis was used to analyze the correlation between COVID-19-related exposure indicators and CPSP.  Results  A total of 4117 surgical patients were included, all of whom had preoperative COVID-19. Among them, 4002 cases had mild symptoms during the acute phase, 62 cases had severe symptoms, and 53 cases were critically ill. At 6th month postoperatively, 1298 cases (31.53%) had long COVID-19 syndrome, and the incidence of CPSP was 5.59% (95% CI: 4.88%-6.28%). After adjusting for confounding factors including age, gender, comorbidities, anesthesia method, and type of surgery, multivariate Logistic regression analysis revealed that critically ill COVID-19 during the acute phase (aOR=3.35, 95% CI: 1.48-7.62, P < 0.001) and presence of long COVID-19 syndrome postoperatively (aOR=2.50, 95% CI: 1.90-3.29, P < 0.001) were associated with CPSP.  Conclusions  It is clear for the first time that critically ill COVID-19 during the acute phase and the presence of long COVID-19 syndrome postoperatively are the risk factors for CPSP among patients with preoperative COVID-19.
    作者贡献：车璐负责研究设计、数据提取、论文撰写；余佳文、金迪负责临床资料整理；白雪、王怡、许力负责随访数据收集；张越伦负责数据分析及论文审校；申乐提出研究思路并负责论文修订; 黄宇光负责研究过程监管。
    利益冲突：所有作者均声明不存在利益冲突
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  • 表  1  4117例患者临床资料比较

    Table  1.   Clinical data of 4117 patients

    指标 无CPSP患者
    (n=3887)    		 有CPSP患者
    (n=230)    		 P值
    年龄(x±s, 岁) 46.56±15.29 47.43±13.58 0.395
    性别[n(%)] 0.235
      女 2791(71.8) 174(75.7)
      男 1096(28.2) 56(24.3)
    BMI(x±s, kg/m2) 23.79±3.83 23.7±3.49 0.750
    吸烟[n(%)] 222(5.7) 13(5.7) ＞0.999
    合并症[n(%)]
      高血压 833(21.4) 45(19.6) 0.556
      糖尿病 397(10.2) 18(7.8) 0.291
      冠心病 181(4.7) 13(5.7) 0.595
      慢性肾功能不全 43(1.1) 3(1.3) ＞0.999
      哮喘 57(1.5) 6(2.6) 0.274
      COPD 45(1.2) 5(2.2) 0.290
    ASA体能分级[n(%)] 0.091
      Ⅰ 847(21.8) 34(14.8)
      Ⅱ 2688(69.2) 172(74.8)
      Ⅲ 319(8.2) 22(9.6)
      Ⅳ 33(0.8) 2(0.9)
    麻醉方法[n(%)] 0.803
      全身麻醉 3707(95.4) 218(94.8)
      椎管内麻醉 180(4.6) 12(5.2)
    手术种类[n(%)] ＜0.001
      腹腔手术 1096(28.1) 64(27.8)
      乳腺手术 177(4.5) 24(10.4)
      心胸手术 300(7.7) 23(10.0)
      口腔手术 31(0.8) 1(0.4)
      妇产科手术 941(24.2) 37(16.1)
      头颈部手术 443(11.4) 23(10.0)
      骨科手术 244(6.3) 29(12.6)
      整形重建修复手术 58(1.5) 4(1.7)
      泌尿外科手术 271(7.0) 10(4.3)
      血管外科手术 36(0.9) 0(0)
      其他 298(7.7) 15(6.5)
    手术时间(x±s, min) 100.24±89.13 122.38±89.26 ＜0.001
    麻醉持续时间(x±s, min) 147.33±102.01 173.58±102.12 ＜0.001
    急诊手术[n(%)] 270(6.9) 24(10.4) 0.062
    CPSP(chronic postsurgical pain): 慢性术后疼痛；BMI(body mass index)：体质量指数；COPD(chronic obstructive pulmonary disease)：慢性阻塞性肺疾病；ASA(American Society of Aneshesiologists)：美国麻醉医师协会
    下载: 导出CSV

    表  2  有/无CPSP患者COVID-19相关暴露因素分布情况[n(%)]

    Table  2.   Distribution of COVID-19 related exposures among patients with and without CPSP [n(%)]

    COVID-19相关暴露因素 无CPSP患者
    (n=3887)    		 有CPSP患者
    (n=230)    		 P值
    急性期严重程度 0.003
      轻症 3786(97.4) 216(93.9)
      重症 56(1.4) 6(2.6)
      危重症 45(1.1) 8(3.5)
    急性期症状
      发热 3467(89.2) 198(86.1) 0.211
      咳嗽 2332(60.0) 130(56.5) 0.351
      呼吸困难 234(6.0) 23(10.0) 0.022
      咽痛 1454(37.4) 81(35.2) 0.798
      疲劳 1348(34.7) 91(39.6) 0.143
      肌肉酸痛 1318(33.9) 93(40.4) 0.048
      消化道症状 252(6.5) 13(5.7) 0.725
      头痛 112(2.9) 7(3.0) ＞0.999
      嗅觉味觉丧失 137(3.5) 11(4.8) 0.412
      心悸 17(0.4) 1(0.4) ＞0.999
    长新冠综合征 1176(30.3) 122(53.0) ＜0.001
      记忆力受损 693(17.8) 69(30.0) ＜0.001
      淋巴结疼痛 74(1.9) 14(6.1) ＜0.001
      肌肉酸痛 14(0.4) 4(1.7) 0.011
      关节痛 238(6.1) 40(17.4) ＜0.001
      头痛 162(4.2) 23(10.0) ＜0.001
      疲劳 62(1.6) 6(2.6) 0.371
      精力减退 292(7.5) 28(12.2) 0.016
      体位性低血压 176(4.5) 17(7.4) 0.070
    COVID-19(corona virus disease 2019)：新型冠状病毒感染; CPSP: 同表 1
    下载: 导出CSV

    表  3  CPSP发生风险的多因素Logistic回归分析结果

    Table  3.   Multivariate Logistic regression analysis results for the risk of CPSP

    COVID-19相关暴露因素 aOR(95% CI)* P值
    急性期严重程度(以轻症为参照)
      重症 1.56(0.65~3.76) 0.324
      危重症 3.35(1.48~7.62) ＜0.001
    有长新冠综合征(以无长新冠综合征为参照) 2.50(1.90~3.29) ＜0.001
    *调整了年龄、性别、体质量指数、吸烟、合并症(高血压、糖尿病、冠心病、慢性肾功能不全、哮喘、慢性阻塞性肺疾病)、美国麻醉医师协会体能分级、手术种类、手术时间、是/否急诊手术、麻醉方法、麻醉持续时间的影响；CPSP: 同表 1；COVID-19：同表 2
    下载: 导出CSV
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  • 收稿日期:  2023-11-21
  • 录用日期:  2023-11-29
  • 网络出版日期:  2024-02-26
  • 刊出日期:  2024-03-30

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