2019 年第 5 期 第 14 卷

冠状动脉旁路移植术后镇痛效果的影响因素

Influence factors of analgesic effect after coronary artery bypass grafting

作者：吴宪宏蒙倩倩张钰于洋吴楚雄

英文作者：

单位：100029首都医科大学附属北京安贞医院麻醉中心（吴宪宏），心外科（于洋）；116027大连医科大学附属第二医院麻醉科（蒙倩倩、张钰）；132013吉林省吉林市，北华大学医疗系（吴楚雄）

英文单位：

关键词：冠状动脉旁路移植术；冠状动脉疾病；患者自控镇痛

英文关键词：

• 摘要：

• 【摘要】目的    探讨影响冠状动脉旁路移植术后镇痛效果的相关因素。方法    回顾性分析2017年5月至2018年6月在首都医科大学附属北京安贞医院行冠状动脉旁路移植术1 291例患者的临床资料，根据其术后镇痛表收集术后8、24、48 h的疼痛视觉模拟量表（VAS）评分（分别定义为VAS-8、VAS-24、VAS-48）以评估术后镇痛方案的效果。纳入可能影响VAS评分的相关变量包括年龄、性别、体重指数、吸烟史、长期饮酒史、高血压病史、糖尿病史、是否使用乳内动脉、手术时间、是否体外循环、术中是否输血。通过单因素分析及多因素Logistic回归分析，得出对VAS-48产生影响的危险因素。结果    在1 291例患者中，单因素分析结果提示，VAS-8的影响因素有糖尿病史、吸烟史和使用乳内动脉（均P＜0.05）；VAS-24的影响因素在VAS-8相关因素的基础上增加了年龄、性别和饮酒史（均P＜0.05）；而VAS-48的影响因素则包括所有影响VAS-8和VAS-24的因素（均P＜0.01）。多因素Logistic回归模型分析结果提示，对VAS-48有正相关影响的因素包括VAS-8（相关系数＝0.081，P＜0.001）、VAS-24（相关系数＝0.995，P＜0.001）、年龄＜55岁（相关系数＝0.161，P＝0.015）、男性（相关系数＝0.139，P＝0.045）和吸烟史（相关系数＝0.647，P＜0.001）；对VAS-48有负相关影响的包括年龄＞70岁（相关系数＝-0.411，P＜0.001）、糖尿病史（相关系数＝-0.308，P＜0.001）、手术时间＞6 h（相关系数＝-0.157，P＝0.013）。结论    预测冠状动脉旁路移植术后镇痛效果不佳的因素包括年龄（＜55岁）、男性、有吸烟史；高龄（＞70岁）、糖尿病史、手术时间（＞6 h）与术后48 h VAS评分呈负相关。术后8 h和24 h时的VAS评分能很好地预测术后48 h的VAS评分，提示若早期发现镇痛效果不佳，宜尽早启动多模式镇痛，避免慢性疼痛的发生。

• 【Abstract】Objective    To analyze the factors affecting analgesic effect after coronary artery bypass grafting. Methods    A total of 1 291 patients who underwent coronary artery bypass grafting in Beijing Anzhen Hospital, Capital Medical University from May 2017 to June 2018 were retrospectively analyzed. Postoperative 8, 24, 48 h Visual Analogue Scale(VAS) scores（VAS-8, VAS-24, VAS-48） were recorded. Relevant variables of analgesic effect included age, gender, body mass index, smoking history, drinking history, history of hypertension, history of diabetes, use of internal mammary artery, operative time, extracorporeal circulation and blood transfusion. Risk factors of VAS-48 were analyzed through single-factor analysis and multi-factor logistic regression. Results    Among the 1 291 patients, influence factors associated with VAS-8 were history of diabetes, smoking and use of internal mammary artery（all P＜0.05）; influence factors associated with VAS-24 were age, gender and drinking history in addition（all P＜0.05）; influence factors of VAS-48 included all the significant factors of VAS-8 and VAS-24（all P＜0.01）. Multivariate logistic regression showed that VAS-48 was positively related with VAS-8（coefficient of correlation＝0.081， P＜0.001）, VAS-24（coefficient of correlation＝0.995， P＜0.001）, age＜55 years（coefficient of correlation＝0.161， P＝0.015）, male（coefficient of correlation＝0.139， P＝0.045）, smoking history（coefficient of correlation＝0.647， P＜0.001） and negatively related with age＞70 years（coefficient of correlation＝-0.411， P＜0.001）, diabetes history（coefficient of correlation＝-0.308， P＜0.001） and operative time＞6 h（coefficient of correlation＝-0.157， P＝0.013）. Conclusions    Risk factors of insufficient postoperative analgesia include age(＜55 years), male and smoking history. Advanced age(＞70 years), diabetes history and operative time(＞6 h) are negatively correlated with VAS-48. VAS-8 and VAS-24 are good predictors of VAS-48, suggesting that if early analgesia is not effective, multimodal analgesia should be initiated as early as possible to avoid chronic pain.