基于倾向性评分匹配分析术后疼痛评分与肝癌切除术后发生肺部感染的关系

摘要/Abstract

摘要： 目的基于倾向性评分匹配探讨术后疼痛评分与肝癌切除术后发生肺部感染的关系。
方法：选取2015年3月至2020年10月于贺州市人民医院行肝切除术的270例肝癌患者进行回顾性分析。采用数字评定量表（numerical rating scale,NRS）评分于术后麻醉清醒进入病房开始24h内对患者疼痛进行评分,将NRS≤3分的患者纳入NRS低分组（n=175）、NRS>3分的患者纳入NRS高分组（n=95）。运用倾向性评分匹配将NRS低分组与NRS高分组以1∶1的比例进行匹配,匹配因素包括年龄、脑血管意外史、既往肺部疾病史、术前深静脉穿刺、术前住院时间、手术时间、术中出血量、术后使用呼吸机情况、留置鼻胃管时间、腹腔引流管留置时间,以及术前白细胞、降钙素原（procalcitonin,PCT）、C反应蛋白（C-reactive protein,CRP）水平。比较匹配前后NRS低分组与NRS高分组的基线资料及术后肺部感染发生率。
结果：匹配前,NRS低分组与NRS高分组患者年龄、脑血管意外史、既往肺部疾病史、术前深静脉穿刺、术前住院时间、手术时间、术中出血量、术后使用呼吸机情况、留置鼻胃管时间、腹腔引流管留置时间及术前白细胞计数、PCT、CRP水平差异均有统计学意义（P<0.05）;且NRS低分组与NRS高分组术后肺部感染发生率差异也无统计学意义（P>0.05）。匹配后,NRS低分组与NRS高分组患者基线资料差异均无统计学意义（P>0.05）;NRS低分组患者术后肺部感染发生率为8.1%,低于NRS高分组患者的21.0%,且差异有统计学意义（P<0.05）。
结论：术后疼痛评分与肝癌切除术后发生肺部感染有一定的关联,术后严重疼痛会增加肝癌切除术后患者发生肺部感染的风险。因此,临床应积极对患者进行术后疼痛评估,及早给予镇痛干预,消除或减轻患者疼痛,以降低术后肺部感染的风险。

关键词: 倾向性评分匹配, 术后疼痛评分, 肝癌, 肝切除术, 肺部感染

Abstract: Objective: To investigate the relationship between postoperative pain score and pulmonary infection after liver resection for liver cancer.
Method: A retrospective selection of 270 patients with liver cancer who underwent hepatectomy in Hezhou People's Hospital from March 2015 to October 2020 was used as the research object. Numerical rating scal (NRS) was used to enter the ward within 24 hours after anesthesia consciously. The patients were scored for pain, and patients with NRS≤3 points were included in the low NRS group (n=175), and patients with NRS>3 points were included in the high NRS group (n=95). Use the propensity score matching method to match the NRS low group with the NRS high group at a ratio of 1:1. The matching factors include age, history of cerebrovascular accident, past history of lung disease, preoperative deep vein puncture, preoperative hospital stay, Operation time, intraoperative blood loss, postoperative ventilator use, nasogastric tube indwelling time, abdominal drainage tube indwelling time, and preoperative white blood cell, procalcitonin (PCT), C-reactive protein (CRP) levels. Compare the baseline data of the low NRS group and the high NRS group before and after matching, and the incidence of postoperative lung infection.
Results: Before matching, there were significant differences in some baseline data between the two groups (P<0.05), and there was no significant difference in the incidence of lung infection between the low NRS group and the high NRS group (P>0.05). After matching, the differences in the matching variables between the two groups were not statistically significant (P>0.05). The incidence of postoperative lung infection in the low NRS group (8.1%) was significantly lower than that in the high NRS group (21.0%) (P<0.05) .
Conclusion: There is a certain correlation between postoperative pain score and pulmonary infection after hepatectomy for liver cancer. Severe postoperative pain may increase the risk of pulmonary infection after hepatectomy. Therefore, clinically, patients are actively evaluated for postoperative pain, and analgesic interventions are given as early as possible to eliminate or alleviate patients' pain and reduce the risk of postoperative lung infection.

Key words: Propensity score matching, Postoperative pain score, Liver cancer, Hepatectomy, Lung infection

黄佣初, 蔡瑞强, 刘念, 周凤声, 毛献双. 基于倾向性评分匹配分析术后疼痛评分与肝癌切除术后发生肺部感染的关系[J]. 肝癌电子杂志, 2022, 9(3): 17-21.

Huang Yongchu, Cai Ruiqiang, Liu Nian, Zhou Fengsheng, Mao Xianshuang. Analysis of postoperative pain score and risk of lung infection after liver resection based on propensity score matching[J]. Electronic Journal of Liver Tumor, 2022, 9(3): 17-21.

参考文献

[1] 曹永, 揭彬, 郑树国, 等. 26例肝癌行ALPPS围手术期并发症的观察分析[J]. 第三军医大学学报, 2019, 41(15): 1491-1496.
[2] 周凯妃, 莫新少. 肝切除术后肺部感染危险因素的Meta分析[J]. 中国感染控制杂志, 2019, 18(4): 305-313.
[3] 冯慧悦, 祝胜美, 吴祎洁, 等. 肝癌患者术后感染的危险因素分析[J]. 中华医院感染学杂志, 2016, 26(12): 2750-2752.
[4] HODGE A, RAPCHUK I L, GURUNATHAN U.Postoperative Pain Management and the Incidence of Ipsilateral Shoulder Pain After Thoracic Surgery at an Australian Tertiary-Care Hospital: A Prospective Audit[J]. J Cardiothorac Vasc Anesth, 2021, 35(2): 555-562.
[5] 陈瑜, 黄道琼, 李海燕, 等. 肝癌栓塞术后疼痛患者择时给药时间点的改进及效果[J]. 中华护理杂志, 2019, 54(3): 393-395.
[6] 中华人民共和国国家卫生健康委员会医政医管局. 原发性肝癌诊疗规范(2019年版)[J/CD]. 肝癌电子杂志, 2020, 7(1): 5-23.
[7] 王立芹, 郭维恒, 郭志旺, 等. PNPLA3、TM6SF2基因多态性及其与吸烟、饮酒交互作用对HBV相关肝癌的影响[J]. 中华流行病学杂志, 2018, 39(12): 1611-1616.
[8] 中华人民共和国卫生部. 医院感染诊断标准(试行)[J]. 中华医学杂志, 2001, 81(5): 314-320.
[9] 李彩云, 刘艳, 郭环飞, 等. 基于加速康复外科理念的疼痛管理模式在肝癌围术期的应用研究[J/CD]. 肝癌电子杂志, 2020, 7(2): 61-65.
[10] NADA E M, ALABDULKAREEM A.Morphine versus fentanyl patient-controlled analgesia for postoperative pain control in major hepatic resection surgeries including living liver donors: A retrospective study[J]. Saudi J Anaesth, 2018, 12(2): 250-255.
[11] 王桂杰, 顾巍巍, 张敏, 等. 肝癌患者术后肺部感染对机体免疫功能及RAAS的影响及机制研究[J]. 实用医学杂志, 2019, 35(1): 109-112.
[12] 刘建军, 袁西景, 阚和平. 有效镇痛对肝癌术后肝功能恢复的影响[J]. 实用医学杂志, 2017, 33(15): 2517-2520.
[13] 艾叶青, 张诚华, 刘卉芳. 原发性肝癌患者术后并发肺部感染的危险因素分析[J]. 临床肝胆病杂志, 2016, 32(7): 1334-1337.
[14] 任锐, 王伟, 陆昌友. 肝癌患者肝切除术后合并肺部感染的现状及相关因素分析[J]. 癌症进展, 2018, 16(2): 245-247.
[15] 雷小妮, 侯小娟. 肝癌外科手术后肺部并发症危险因素分析[J]. 胃肠病学和肝病学杂志, 2017, 26(4): 404-406.
[16] 许丽琴, 严虹, 陈佛, 等. 多模式镇痛对肺癌患者术后肺部感染及肺功能的影响[J]. 中华医院感染学杂志, 2019, 29(9): 1384-1387.
[17] 焦明旭, 张晓, 刘迪, 等. 倾向性评分匹配在非随机对照研究中的应用[J]. 中国卫生统计, 2016, 33(2): 350-352.
[18] BORAH B J, MORIARTY J P, CROWN W H, et al.Applications of propensity score methods in observational comparative effectiveness and safety research: where have we come and where should we go?[J]. J Comp Eff Res, 2014, 3(1): 63-78.