国际麻醉学与复苏杂志   2024, Issue (7): 8-8
    
外周神经阻滞术后反跳痛状况的调查研究
马素琴, 赵廷涛, 樊瑞昌1()
1.封丘华庚医院
Investigation of rebound pain after peripheral nerve block
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摘要：

目的 探讨外周神经阻滞（PNB）术后反跳痛发生状况及其对患者术后临床结局的影响。 方法 选择在医院进行手术并行PNB的患者225例作为研究对象。其中，封丘华庚医院83例，辉县市人民医院77例，河南宏力医院65例。根据患者术后是否出现反跳痛分为反跳痛组和无反跳痛组，对比两组患者的一般资料，应用logistic回归分析探讨影响患者术后反跳痛的相关因素，并探讨反跳痛对患者术后临床结局的影响。 结果 225例患者中发生反跳痛109例，反跳痛发生率48.44%。反跳痛组年龄大于无反跳痛组（P<0.05），反跳痛组术前1 d疼痛评分中、重度率及骨科手术率、术后30 d再入院率高于无反跳痛组（均P<0.05），反跳痛组地塞米松应用率、手术满意度率、会再次选择PNB率低于无反跳痛组（均P<0.05）。老年［比值比（OR）1.46，95%置信区间（CI）1.14~1.87，P=0.003］、女性（OR 1.18，95%CI 1.00~1.39，P=0.047）、骨科手术（OR 1.99，95%CI 1.37~2.90，P<0.001）是患者术后发生反跳痛的危险因素，术后应用地塞米松辅助镇痛是患者术后发生反跳痛的保护因素（OR 0.78，95%CI 0.65~0.94，P=0.008）。相较于非反跳痛，反跳痛是患者手术不满意（OR 1.77，95%CI 1.30~2.41，P<0.001）、术后30 d再入院（OR 1.37，95%CI 1.11~1.69，P=0.003）、不会再次选择PNB（OR 2.04，95%CI 1.38~3.01，P<0.001）的危险因素。 结论 临床医师应重点关注老年和女性患者，以预防其反跳痛的发生。
关键词： 外周神经阻滞； 反跳痛； 影响因素
Abstract:

Objective To investigate the occurrence of rebound pain after peripheral nerve block (PNB) and its effect on postoperative clinical outcomes. Methods A total of 225 patients who underwent surgery with PNB in hospitals were selected as subjects. Among them, 83 patients were from Fengqiu Huageng Hospital, 77 from Huixian People's Hospital, and 65 from Henan Hongli Hospital. According to the presence of rebound pain after surgery, the patients were divided into two groups: a rebound pain group and a non-rebound pain group. Both groups were compared for general information. Then, logistic regression analysis was conducted to explore the related factors affecting postoperative rebound pain and postoperative clinical outcomes. Results Rebound pain occurred in 109 of 225 patients, with a rebound pain rate of 48.44%. The age of rebound pain group was older than that of non-rebound pain group (P<0.05), moderate and severe pain scores were obtained 1 day before operation, the rate of orthopedic operation and the rate of readmission 30 d after operation were higher than non-rebound pain group (all P<0.05), the use rate of dexamethasone, the rate of satisfaction with operation and the rate of choosing PNB again were lower than non-rebound pain group (all P<0.05). Old age [odds ratio (OR) 1.46 (95% confidence interval (CI) 1.14, 1.87), P=0.003], female [OR 1.18 (95%CI 1.00, 1.39), P=0.047], orthopedic surgery [OR 1.99 (95%CI 1.37, 2.90), P<0.001] were risk factors for postoperative rebound pain, and postoperative dexamethasone-assisted analgesia [OR 0.78 (95%CI 0.65, 0.94), P=0.008] was a protective factor for postoperative rebound pain. Compared with non-rebound pain, rebound pain was a risk factor for patients who were unsatisfied with surgery [OR 1.77 (95%CI 1.30, 2.41), P<0.001], readmission to hospital at postoperative 30 days [OR 1.37 (95%CI 1.11, 1.69), P=0.003], and not choosing PNB again [OR 2.04 (95%CI 1.38, 3.01), P<0.001]. Conclusion Clinicians should pay more attention to old and female patients, in an effort to prevent the occurrence of rebound pain.
Key words: Peripheral nerve block; Rebound pain; Influencing factor