腹部手术患者慢性术后疼痛发生的神经心理危险因素分析^*

Neuropsychological Risk Factors for Chronic Postoperative Pain Following Abdominal Surgery

摘要

目的 分析腹部手术患者慢性术后疼痛（chronic postoperative pain, CPSP）的发生情况及神经心理危险因素。方法 选取2023年1月-2025年1月本院行腹部手术的102例患者为研究对象，收集患者一般人口学资料及手术相关资料；术后3个月通过门诊随访或电话随访，采用疼痛数字评分法（numerical rating scale, NRS）评估CPSP发生情况，同时采用简易精神状态检查表（Mini-Mental State Examination, MMSE）、焦虑自评量表（Self-Rating Anxiety Scale, SAS）、抑郁自评量表（Self-Rating Depression Scale, SDS）及疼痛灾难化量表（Pain Catastrophizing Scale, PCS）评估患者神经心理状态。采用单因素和多因素logistic回归分析筛选CPSP的独立影响因素。结果 102例患者中，术后3个月CPSP发生率为31.37%（32例）。CPSP组和非CPSP组在年龄、手术时长、术后住院天数、SDS、PCS方面差异有统计学意义（P<0.05）；多因素logistic回归分析显示年龄〔比值比（odds ratio, OR）=1.336，95%置信区间（confidence interval, CI）：1.046～1.710〕、术后住院天数（OR=0.495，95%CI：0.296～0.829）及PCS（OR=2.437，95%CI：1.137～5.224）为腹部手术患者术后3个月发生CPSP的独立影像因素（P<0.05）。结论 年龄和PCS是腹部手术患者发生CPSP的危险因素，术后住院天数是保护因素。临床应针对高风险人群实施术前筛查、心理干预及疼痛管理，以降低CPSP发生率。

Abstract

Objective To analyze the incidence of chronic postoperative pain (CPSP) after patients have undergone abdominal surgery and identify the neuropsychological risk factors involved. Methods A total of 102 patients who underwent abdominal surgery at our hospital between January 2023 and January 2025 were enrolled. The general demographic and surgery-related data were collected. Three months after surgery, follow-up assessments were conducted via outpatient visits or telephone interviews. The occurrence of CPSP was assessed using the Numerical Rating Scale (NRS). Neuropsychological status was evaluated using the Mini-Mental State Examination (MMSE), the Self-Rating Anxiety Scale (SAS), the Self-Rating Depression Scale (SDS), and the Pain Catastrophizing Scale (PCS). Univariate and multivariate logistic regression analyses were performed to identify independent influencing factors associated with CPSP. Results Among the 102 patients, the incidence of CPSP at 3 months post-surgery was 31.37% (32 cases). Significant differences were observed between the CPSP and non-CPSP groups with respect to age, duration of surgery, postoperative length-of-stay in the hospital, SDS scores, and PCS scores (P < 0.05). Multivariate logistic regression analysis revealed that age (odds ratio [OR] = 1.336, 95% CI: 1.046-1.710), postoperative length-of-stay (OR = 0.495, 95% CI: 0.296-0.829), and PCS score (OR = 2.437, 95% CI: 1.137-5.224) were independent influencing factors associated with the development of CPSP at 3 months after abdominal surgery ( P < 0.05). Conclusion Age and PCS are risk factors for CPSP in patients undergoing abdominal surgery, while the length of postoperative length-of-stay is a protective factor. Targeted strategies, including preoperative screening, psychological interventions, and optimized pain management for high-risk patients are recommended to reduce the incidence of CPSP.

关键词

腹部手术 / 慢性术后疼痛 / 流行病学特征 / 神经心理因素

Key words

Abdominal surgery / Chronic postoperative pain / Epidemiologic characteristics / Neuropsychological factors

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基金资助

*河南省高等学校重点科研项目(23B310009)