【作者】 陈平；

【导师】 严敏；

【作者基本信息】 浙江大学 ， 麻醉学， 2016， 硕士

【摘要】 目的：对乳腺癌术后患者做流行病学调查,揭示国内乳腺癌患者术后慢性疼痛的现状,探讨引起乳腺癌患者术后慢性疼痛的相关因素。方法：本研究选取322名女性原发性乳腺癌术后患者,进行为期9个月的随访调查,分别记录术后3个月和术后9个月时慢性疼痛的性质和10项相关可能因素,包括年龄、身高体重指数(BMI)、术前焦虑抑郁、术前疼痛、术前化疗、乳房手术方式、腋窝手术方式、术后急性疼痛程度、术后化疗、术后放疗,并进行统计学分析。结果：研究表明术后3个月和术后9个月的慢性疼痛发生率分别为61.0%和56.2%。单因素分析显示,术后3个月慢性疼痛的相关因素有统计学差异的变量包括：年龄,腋窝手术方式,术后急性疼痛程度(P<0.05),而到术后9个月慢性疼痛的相关因素有统计学差异的变量除上述3个外,还增加了一项：术前疼痛综合症(P<0.05)。将单因素分析有统计学差异的变量导入二分类logistic回归分析,结果显示乳腺癌术后慢性疼痛的独立危险因素包括低龄,腋窝淋巴结清扫,中重度的术后急性疼痛(P<0.05,OR>1)。结论：在乳腺癌术后的9个月内,术后慢性疼痛的发生率高。乳腺癌术后慢性疼痛可能的独立危险因素包括低龄,腋窝淋巴结清扫,中重度的术后急性疼痛。减小手术尤其是相关神经的损伤,采取腋窝前哨淋巴结活检来替代传统的腋窝淋巴结清扫术式,对低龄患者进行积极干预,积极预防和减轻术后急性疼痛的发生,可能可以减少术后慢性疼痛的发生率,提高患者的生活质量。更多还原

【Abstract】 Objective:To explore the domestic status quo and the related factors of chronic post-surgical pain after breast cancer by performing the epidemiological investigations.Methods:A total of 322 women with primary breast cancer were investigated. A 9-month follow-up survey after surgery was conducted and 10 related factors of chronic pain were recorded 3 months and 9 months after surgery, including age, body mass index (BMI), preoperative anxiety depression, preoperative pain, preoperative chemotherapy, breast surgery way, axillary surgery way, acute postoperative pain, postoperative chemotherapy,and postoperative radiotherapy. The association of chronic post-surgical pain after breast cancer with each variable was evaluated by logistic regression analysis.Results:The incidence of chronic pain 3 months and 9 months after surgery was 61.0% and 56.2%, respectively. The univariate correlation analysis showed that the chronic pain after 3 months associated with three factors:age, axillary surgery way, acute postoperative pain (P<0.05), and one more factors after 9 months:preoperative pain syndrome P<0.05). Binary logistic regression analysis showed that younger age, axillary lymph node dissection, moderate to severe acute postoperative pain were significant independent risk factors of chronic pain following breast cancer surgery (P <0.05,OR>1).Conclusion:In 9 months after breast cancer surgery, the incidence of chronic post-surgical pain was high,which is associated with younger age, axillary lymphnode dissection and moderate to severe acute postoperative pain. The reduction of surgery injury, especially the nerve injury, the replacement of sentinel lymph node biopsy to traditional axillary lymph node surgery, the positive intervention of younger patients, the prevention and alleviation of acute postoperative pain may reduce the incidence of chronic post-surgical pain and improve the quality of life of patients.更多还原