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中华普通外科学文献(电子版)

中华普通外科学文献(电子版) ›› 2019, Vol. 13 ›› Issue (04) : 269 -273. doi: 10.3877/cma.j.issn.1674-0793.2019.04.003

所属专题： 文献；

论著

术前血胆固醇水平与结直肠癌加速康复外科术后疼痛的相关性研究
熊伟昕1,†(), 成玲1, 陈创奇1, 蔡世荣1   
  1. 1. 518000　广州，中山大学附属第一医院胃肠外科中心
  • 收稿日期:2019-01-05 出版日期:2019-08-01
  • 通信作者: 熊伟昕
  • 基金资助:
    国家自然科学基金资助项目(81372341)

Preoperative blood cholesterol level as a risk factor for poor pain control after colorectal cancer surgery with enhanced recovery

Weixin Xiong1,†(), Ling Cheng1, Chuangqi Chen1, Shirong Cai1   

  1. 1. Center of Gastrointestinal Surgery, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 518000, China
  • Received:2019-01-05 Published:2019-08-01
  • Corresponding author: Weixin Xiong
  • About author:
    Corresponding author: Xiong Weixin, Email:
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熊伟昕, 成玲, 陈创奇, 蔡世荣. 术前血胆固醇水平与结直肠癌加速康复外科术后疼痛的相关性研究[J]. 中华普通外科学文献(电子版), 2019, 13(04): 269-273.

Weixin Xiong, Ling Cheng, Chuangqi Chen, Shirong Cai. Preoperative blood cholesterol level as a risk factor for poor pain control after colorectal cancer surgery with enhanced recovery[J]. Chinese Archives of General Surgery(Electronic Edition), 2019, 13(04): 269-273.

目的

探讨结直肠癌患者术前血清总胆固醇水平与加速康复外科（ERAS）术后疼痛情况的相关性。

方法

回顾性分析2016年10月至2018年10月在中山大学附属第一医院胃肠外科中心围手术期实施ERAS方案的121例结直肠癌患者，依据术前血清总血胆固醇水平分为低胆固醇组（女<4.35 mmol/L，男<4.10 mmol/L）、中胆固醇组（女4.35~5.30 mmol/L，男4.10~4.70 mmol/L）、高胆固醇组（女>5.30 mmol/L，男>4.70 mmol/L）。比较3组患者术后0~3 d NRS疼痛评分、疼痛控制不良（NRS≥5分）发生率的差异。

结果

患者术后疼痛发生率为98.3%（119/121），疼痛控制不良发生率为12.4%（15/121），其中低胆固醇组疼痛控制不良发生率为21.1%（8/38），显著高于中胆固醇组的6.4%（3/47）和高胆固醇组的11.4%（4/35）（χ2=9.458，P=0.003）。3组间术后0~3 d的疼痛NRS评分差异无统计学意义（χ2=0.135，P=0.405）。Logistic回归分析显示，患者术前血清总胆固醇水平与术后疼痛控制不良发生率呈负相关关系（β=-0.212，OR=0.921，P<0.05）。

结论

术前低血胆固醇水平可能会增加术后疼痛控制不良发生的风险，检测术前血清总胆固醇水平有利于结直肠癌ERAS术后的个性化疼痛控制管理。

关键词: 疼痛，手术后, 胆固醇, 结直肠外科手术, 加速康复外科, 疼痛测定
Objective

To explore the correlation between preoperative blood cholesterol level and poorly controlled postoperative pain in enhanced recovery after surgery (ERAS) patients with colorectal cancer.

Methods

From October 2016 to October 2018, data of one hundred and twenty-one patients with colorectal cancer who underwent ERAS in the First Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. According to preoperative serum total cholesterol level, the patients were divided into low cholesterol group (for female <4.35 mmol/L, for male <4.10 mmol/L), medium cholesterol group (for female 4.35-5.30 mmol/L, for male 4.10-4.70 mmol/L), and high cholesterol group (for female >5.30 mmol/L, for male >4.70 mmol/L). The differences of NRS pain score and the incidence of poor pain control (NRS≥5) were compared among the three groups at 0-3 days after operation.

Results

The incidence of postoperative pain and poor pain control were 98.3% (119/121) and 12.4% (15/121), respectively. The incidence of poor pain control in low cholesterol group was 21.1% (8/38), which was significantly higher than 6.4% (3/47) in medium cholesterol group and 11.4% (4/35) in high cholesterol group (χ2=9.458, P=0.003). There was no significant difference in pain NRS scores among the three groups at 0-3 days after operation (χ2=0.135, P=0.405). Logistic regression analysis showed that preoperative serum total cholesterol level was negatively correlated with the incidence of postoperative pain control (β= -0.212, OR=0.921, P<0.05).

Conclusion

Low blood cholesterol level may increase the risk of poor pain control after operation, which provides reference for personalized pain control management after ERAS for colorectal cancer.

Key words: Pain, postoperative, Cholesterol, Colorectal surgery, Enhanced recovery after surgery, Pain measurement
表1 3组结直肠癌患者的基本资料比较
组别 例数 年龄(岁)a 性别(例) 体质量指数(kg/m2) a 手术方式[例(%)]
男 女 半结肠切除术 经腹骶直肠切除术 经腹骶低位直肠切除术
低胆固醇组 38 57.07±16.91 23(60.5) 15(39.5) 22.52±5.12 10(26.3) 13(34.2) 15(39.5)
中胆固醇组 47 58.16±11.58 30(63.8) 17(36.2) 21.42±4.32 13(27.7) 17(36.2) 17(36.2)
高胆固醇组 35 54.78±18.42 21(60.0) 14(40.0) 23.48±5.66 9(25.7) 12(34.3) 14(40.0)
统计值 ? 0.566 0.155 0.698 0.157
P值 ? 0.741 0.925 0.675 0.997
组别 ASA分级a 手术时间(min) a 肿瘤类型[例(%)] 肿瘤浸润[例(%)] AJCC病理分期[例(%)]
结肠癌 直肠癌 是 否 Ⅰ~Ⅱ期 Ⅲ~Ⅳ期
低胆固醇组 1.59±0.56 142.10±98.62 20(52.6) 18(47.4) 25(65.8) 13(34.2) 19(50.0) 19(50.0)
中胆固醇组 1.53±0.55 154.25±109.85 25(53.2) 22(46.8) 30(63.8) 17(36.2) 21(44.7) 26(55.3)
高胆固醇组 1.56±0.53 131.13±86.12 19(54.3) 16(45.7) 21(60.0) 14(40.0) 17(48.6) 18(51.4)
统计值 0.892 0.988 0.021 0.271 0.261
P值 0.121 0.156 0.090 0.873 0.878
表2 3组结直肠癌患者术后住院情况及疼痛NRS评分结果
组别 例数 术后疼痛NRS评分 术后住院时间(d) 总住院时间(d)
当天 第1天 第2天 第3天
低胆固醇组 38 5(0~7) 3(2~6) 2(0~6) 2(0~3) 4(1~28) 7(2~37)
中胆固醇组 47 5(2~7) 2(0~6) 3(2~5) 2(0~3) 5(2~28) 9(2~37)
高胆固醇组 35 5(1~7) 3(2~4) 2(1~5) 1(0~2) 5(1~10) 7(2~18)
χ2值 ? 0.135 0.143 0.348
P值 ? 0.405 0.451 0.256
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