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

doi:10.12290/xhyxzz.2023-0556

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

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

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.

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