标题：术前疼痛敏感度与术后血清炎性因子水平及术后慢性疼痛的相关性

      作者：邓乾，唐艳萍，李平，孙冰，李国宏    (深圳市光明新区人民医院麻醉科，广东 深圳 518106)

      卷次： 2017年28卷10期

      【摘要】 目的 探讨手术患者术前疼痛敏感度与术后慢性疼痛以及血清炎性因子水平的相关性。方法测试深圳市光明新区人民医院 2014年 6月至 2015年 5月期间收治的 186例择期手术患者术前痛阈与耐痛阈，根据耐痛阈水平分为低耐痛阈组(n=88)与高耐痛阈组(n=98)，比较两组患者术前痛阈、术后 2个月时疼痛程度(VAS评分)、血清白细胞介素-6 (IL-6)、白细胞介素-8 (IL-8)、肿瘤坏死因子-α (TNF-α)水平，同时探讨术前痛阈、耐痛阈与术后 2个月VAS评分、血清 IL-6、IL-8、TNF-α水平的相关性。结果 两组患者的术前痛阈水平分别为(1.42±0.72) mA、(1.44±0.69) mA，差异均无统计学意义(P>0.05)；术后24 h和2个月时，低耐痛阈组患者的VAS评分分别为(4.88±0.67)分和(2.67±0.34)分，IL-6水平分别为(7.32±0.51) pg/mL和(3.21±0.33) pg/mL，IL-8水平分别为(58.64±6.76) pg/mL和(45.43±5.88) pg/mL，高耐痛阈组患者的VAS评分分别为(3.27±0.70)分和(1.33±0.31)分，IL-6水平分别为(6.63±0.54) pg/mL和(2.04±0.28) pg/mL，IL-8水平分别为(44.78±6.82) pg/mL和(34.64±5.78) pg/mL，低耐痛阈组显著高于高耐痛阈组，差异均有统计学意义(P<0.01)，而TNF-α水平比较则差异无统计学意义(P>0.05)；186例患者痛阈与术后2个月VAS评分、IL-6、IL-8、TNF-α等炎性因子水平之间无显著相关性(P>0.05)，耐痛阈水平与术后 2个月VAS评分、IL-6、IL-8呈显著负相关(r=-0.18、-0.73、-0.68，P<0.05)，术后VAS评分与 IL-6、IL-8水平呈显著正相关(r=0.724，0.654，P<0.05)。结论 术前耐痛阈越高，术后慢性疼痛程度越轻，炎症因子水平越低，反之亦然。
      【关键词】 疼痛敏感度；炎性因子；术后慢性疼痛；相关性
      【中图分类号】 R619 【文献标识码】 A 【文章编号】 1003—6350（2017）10—1584—03

Relationship of preoperative pain sensitivity with serum inflammatory factor level and postoperative chronicpain.
DENG Qian, TANG Yan-ping, LI Ping, SUN Bing, LI Guo-hong. Department of Anesthesiology, Shenzhen MunicipalGuangming New People's Hospital, Shenzhen 518106, Guangdong, CHINA
【Abstract】 Objective To discuss the relationship of the preoperative pain sensitivity with postoperative seruminflammatory factor level and chronic pain. Methods The pain sensitivity of 186 patients scheduled for surgery fromShenzhen Municipal Guangming New People's Hospital from June 2014 to May 2015 were detected, and were dividedinto the low pain tolerance group (n=88) and the high pain tolerance group (n=98). Then the pain threshold, VAS score,serum IL-6, IL-8, TNF-α were compared between the two groups 2 months after the operation, and the relevance be-tween the pain threshold, pain tolerance and VAS score, serum IL-6, IL-8, TNF-α 2 months after the operation were an-alyzed. Results There was no significant difference in pain thresholdbetween the two groups, (1.42 ± 0.72) mA vs(1.44±0.69) mA (P>0.05). At postoperative 24 h and 2 months in the low pain tolerance group, the VAS score, IL-6,IL-8 levels were (4.88±0.67) and (2.67±0.34), (7.32±0.51) pg/mL and (3.21±0.33) pg/mL, (58.64±6.76) pg/mL and(45.43±5.88) pg/mL, which were significantly higher than VAS score (3.27±0.70) and (1.33±0.31), IL-6 level (6.63±0.54) pg/mL and (2.04±0.28) pg/mL, IL-8 level (44.78±6.82) pg/mL and (34.64±5.78) pg/mL in high pain tolerancegroup (P<0.01), but there was no significant difference in TNF-α level (P>0.05). Among the 186 patients, there was nosignificant correlation between the pain threshold and VAS score, IL-6, IL-8, TNF-α levels at postoperative 2 months(P>0.05), but significantly negative correlation between the pain tolerance threshold and VAS score, IL-6, IL-8,TNF-α levels at postoperative 2 months was found (r=-0.18, -0.73, -0.68, P<0.05). VAS score was significantly posi-tively correlated with IL-6 and IL-8 after the operation (r=0.724, 0.654, P<0.05). Conclusion If the preoperative paintolerance is higher, the degree of postoperative chronic pain is lighter and the level of inflammatory factors are lower,and vice versa.
      【Key words】 Pain sensitivity; Inflammatory factor; Postoperative chronic pain; Relationship·论 著·doi:10.3969/j.issn.1003-6350.2017.10.012