早期非小细胞肺癌单孔胸腔镜术后急性疼痛发展轨迹及影响因素分析<sup>*</sup>

doi:10.3969/j.issn.1671-7171.2026.01.013

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摘要 【目的】 探讨早期非小细胞肺癌(NSCLC)单孔胸腔镜术后急性疼痛发展轨迹,并分析术后急性疼痛发展轨迹的影响因素。【方法】 选择2021年7月至2023年11月本院收治的171例早期NSCLC患者,所有患者均接受单孔胸腔镜手术治疗。术后1~7 d采用数字分级评分法(NRS)评估患者术后疼痛,采用基于群体的轨迹模型(GBTM)描述早期NSCLC患者单孔胸腔镜术后急性疼痛发展轨迹,分为A组(n=61,轻度至中度疼痛明显缓解)、B组(n=81,中度至重度疼痛缓慢缓解)、C组(n=29,持续重度疼痛)。采用多因素Logistic回归模型分析术后急性疼痛发展轨迹类型的影响因素。【结果】 随着时间推移,A组、B组、C组患者NRS评分逐渐降低(P<0.05),C组患者NRS评分显著高于A组、B组(P<0.05)。A组、B组、C组手术时间、体重指数、年龄、切口肋间隙宽度、术毕使用静脉镇痛泵比例、引流管留置时间、引流管数量≥2根所占比例、术前医院抑郁量表(HDS)评分、术前医院焦虑量表(HAS)评分、术前疼痛灾难化量表(PCS)评分比较,差异有统计学意义(P<0.05);C组手术时间、体重指数、年龄、术毕静脉镇痛泵使用比例、引流管留置时间、引流管数量≥2根所占比例、术前HDS评分、术前HAS评分、术前PCS评分高于A组、B组(P<0.05)。多因素Logistic回归分析显示,切口肋间隙宽度、引流管留置时间、术前HDS评分、手术时间、术毕镇痛方案为早期NSCLC患者单孔胸腔镜术后急性疼痛发展轨迹类型的影响因素(P<0.05)。【结论】 早期NSCLC患者单孔胸腔镜术后存在异质性的急性疼痛发展轨迹,临床需密切关注切口肋间隙宽度较窄、引流管留置时间较长、术前PCS评分较高、手术时间较长、术毕行静脉镇痛泵的患者,根据患者具体情况采用合适的术后疼痛干预措施。

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	钱世国
	唐杰
	刘海明
	王山

关键词 ：癌,非小细胞肺, 胸腔镜检查, 肺切除术, 疼痛,手术后, 影响因素分析

Abstract：【Objective】 To investigate the progression of acute pain after single-aperture thoracoscopic surgery(VATS) in early non-small cell lung cancer(NSCLC), and to analyze the factors influencing the progression of acute pain. 【Methods】 A total of 171 early-stage NSCLC patients admitted to our hospital from July 2021 to November 2023 were selected, all of whom underwent uniportal VATS. Postoperative pain was assessed using the Numerical Rating Scale(NRS) within 1 to 7 days after surgery. The Group-Based Trajectory Model(GBTM) was employed to describe the development trajectory of acute postoperative pain in early-stage NSCLC patients undergoing uniportal VATS, categorized into Group A(n=61, mild to moderate pain significantly alleviated), Group B(n=81, moderate to severe pain gradually alleviated), and Group C(n=29, persistent high pain). A multifactorial logistic regression model was used to analyze the influencing factors of postoperative acute pain trajectory types. 【Results】 Over time, NRS scores gradually decreased in Groups A, B, and C(P<0.05), with Group C showing significantly higher NRS scores than Groups A and B(P<0.05). Statistically significant differences were observed among Groups A, B, and C in terms of operative time, body mass index, age, incision rib gap width, patient-controlled intravenous analgesia(PCIA) postoperatively, drainage tube retention time, the proportion of patients with ≥2 drainage tubes, preoperative Hospital Depression Scale(HDS) scores, preoperative Hospital Anxiety Scale(HAS) scores, and preoperative Pain Catastrophizing Scale(PCS) scores(P<0.05). Group C exhibited higher operative time, body mass index, age, postoperative PCIA proportion, drainage tube retention time, proportion of patients with ≥2 drainage tubes, preoperative HDS scores, preoperative HAS scores, and preoperative PCS scores compared to Groups A and B(P<0.05). Multivariate logistic regression analysis identified incision rib gap width, drainage tube retention time, preoperative HDS scores, operative time, and postoperative analgesic regimen as influencing factors of acute postoperative pain trajectory types in early-stage NSCLC patients undergoing uniportal VATS(P<0.05). 【Conclusion】 Patients with early NSCLC present heterogeneous acute pain development trajectory after single-aperture thoracoscopic surgery. Clinical attention should be paid to patients with narrow incisional costal space width, longer retention time of drainage tube, higher preoperative PCS score, longer operation time, and postoperative intravenous self-controlled pump, whose appropriate intervention measures should be adopted.

Key words： Carcinoma, Non-Small-Cell Lung Thoracoscopy Pneumonectomy Pain, Postoperative Root Cause Analysis

收稿日期: 2024-05-09

中图分类号:

R734.2

基金资助:*盐城市2022—2024年市级科技计划项目(编号:YCBE202470)

引用本文:

钱世国, 唐杰, 刘海明, 王山. 早期非小细胞肺癌单孔胸腔镜术后急性疼痛发展轨迹及影响因素分析^*[J]. 医学临床研究, 2026, 43(1): 47-51.
QIAN Shiguo¹, TANG Jie², LIU Haiming², WANG Shan². Analysis of the Development Trajectory and Influencing Factors of Acute Pain after Single-Aperture Thoracoscopic Surgery in Early Non-Small Cell Lung Cancer Patients. JOURNAL OF CLINICAL RESEARCH, 2026, 43(1): 47-51.

链接本文:

http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2026.01.013 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2026/V43/I1/47

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