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从疼痛程度到疼痛体验：重新定义急性疼痛评估以加深对慢性术后疼痛的理解
贵州医科大学 麻醉与心脏电生理课题组
翻译：王婷婷 编辑：王婷婷 审校：曹莹
背景：慢性术后疼痛（CPSP）严重影响生活质量，并给医疗体系带来沉重负担，可影响高达四分之一的接受手术的患者。尽管急性疼痛被认为是CPSP发展的预测因素，但患者体验在这方面的作用尚未得到充分研究。本研究旨在探讨患者体验与传统风险因素在骨科手术后CPSP预测中的作用。
方法：对294名来自多中心随机临床试验的患者进行了探索性分析，该试验比较了连续神经周围麻醉与单次注射神经阻滞在门诊骨科手术中的效果。采用经过验证的通用麻醉评估量表（EVAN-G）评估患者体验。通过单变量和多变量分析，结合患者报告的疗效和经典变量，识别出术后90天出现CPSP的患者。
结果：在219名有完整数据的患者中，有63人（29%）在术后第90天出现CPSP。多变量分析显示，术后第2天采用EVAN-G疼痛维度评估的疼痛体验不佳是CPSP的独立预测因素（比值比6.45，95%置信区间1.65e-25.26，P<0.01）。不佳的疼痛体验与CPSP的风险增加有关。
结论：本研究强调了患者报告结果，特别是EVAN-G量表中捕捉的疼痛体验维度，在预测术后90天CPSP方面的作用。它表明，应从传统的疼痛强度评估转向全面理解疼痛体验，并提倡采用量身定制的疼痛管理方法，以减少慢性疼痛，从而改善患者的生活质量和功能恢复。
From pain level to pain experience: redefining acute pain assessment to enhance understanding of chronic postsurgical pain
Background: Chronic postsurgical pain (CPSP) significantly impairs quality of life and poses a substantial healthcare burden, affecting up to a quarter of patients undergoing surgery. Although acute pain is recognised as a predictor for CPSP development, the role of patient experience remains underexplored. This study examines the predictive value of patient experience alongside traditional risk factors for CPSP after orthopaedic surgery.
Methods: An exploratory analysis was conducted on 294 patients from a multicentre randomised clinical trial comparing continuous perineural analgesia and single-injection nerve block in ambulatory orthopaedic surgeries. Patient experience was assessed using the Evaluation du Vecu de l’Anesthesie G enerale (EVAN-G) validated questionnaire. Factors associated with CPSP at 90 days after surgery were identified through univariate and multivariate analyses, incorporating patient-reported outcomes and classical variables.
Results: Out of 219 patients with complete data, 63 (29%) developed CPSP at day 90. Multivariate analysis revealed a poor pain experience, as assessed by the pain dimension of EVAN-G on postoperative day 2, as an independent predictor of CPSP (odds ratio 6.45, 95% confidence interval 1.65e25.26, P<0.01). Poor pain experience was associated with an augmented risk of CPSP.
Conclusions: This study underscores the role of patient-reported outcomes, specifically the pain experience dimension captured by the EVAN-G scale, in prediction of CPSP 90 days after surgery. It suggests a shift from conventional assessments of pain intensity to a comprehensive understanding of pain experience, advocating for tailored pain management approaches that could reduce chronic pain, thereby improving patient quality of life and functional recovery.
