Analysis of risk factors affecting pain after percutaneous nephrolithotomy and clinical management
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摘要: 目的:研究经皮肾镜取石术(PCNL)术后中重度疼痛的危险因素,为预防术后疼痛提供决策依据,同时介绍围术期处理经验。方法:对我院131例接受PCNL的患者进行前瞻性研究,采用视觉模拟评分法(VAS),分别记录术后6 h、24 h、48 h患者的疼痛评分,对中重度疼痛患者进行多元有序logistic回归分析,找出可能影响患者术后疼痛的原因。结果:术后不同阶段VAS评分的影响因素不尽相同,影响PCNL术后中重度疼痛的危险因素主要有:女性、较大的BMI、较大的穿刺通道(24F vs.18F)、肾上盏穿刺、术前并存病(均P<0.05)。术后疼痛的影响因素与患者的年龄、手术史、结石最大长径、结石宽度、结石CT值、S.T.O.N.E.评分、结石数目、肾积水分级、穿刺定位方法、手术时间无关。术后6 h、24 h及48 h的舒适度评分(BCS)与止痛药的应用呈显著相关(均P<0.05)。结论:女性、较大的BMI、较大的穿刺通道(24F vs.18F)、肾上盏穿刺和术前并存病是PCNL术后中重度疼痛的独立危险因素,及时使用止痛药物可明显减轻疼痛,获得较好舒适度。Abstract: Objective: To study the risk factors of moderate and severe pain in patients after percutaneous nephrolithotomy, to provide decision-making basis for preventing postoperative pain, and to introduce the experience of perioperative treatment.Methods: A prospective study was carried out on 131 patients undergoing percutaneous nephrolithotomy in our hospital. Visual analogue scale(VAS) was used to record the pain scores of patients at 6 hours, 24 hours, and 48 hours after surgery. The multiple ordered logistic regression analysis was carried out on the patients with moderate and severe pain to find out the reasons that may affect the postoperative pain.Results: The influencing factors of VAS score in different stages after operation were different. The risk factors of moderate and severe pain after percutaneous nephrolithotomy mainly included female, larger BMI, larger puncture channel(24 F vs.18 F), upper calyceal puncture approach, coexisting diseases before operation. The influencing factors of postoperative pain were not related to patients' age, operation history, maximum length of stone, width of stone, CT value of stone, S. T. O. N. E. score, number of stone, grade of hydronephrosis, puncture positioning method and operation time. Bruggrmann comfort scale(BCS) at 6 h, 24 h and 48 h after operation were significantly correlated with the use of analgesics(all P<0.05).Conclusion: Female, larger BMI, larger puncture channel(24 F vs. 18 F), upper calyceal puncture approach, and coexisting diseases before operation are independent risk factors for moderate and severe pain after PCNL operation, and timely use of analgesic drugs can significantly reduce pain and obtain better comfort.
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