【罂粟摘要】剖宫产术中疼痛的发生率、危险因素和医生感知

剖宫产术中疼痛的发生率、危险因素和医生感知

贵州医科大学    麻醉与心脏电生理课题组

翻译：牛振瑛  编辑：马艳燕  审校：曹莹

清明见芽   谷雨见茶

背景：术中疼痛可能是剖腹产神经轴麻醉（硬膜外或脊麻）的并发症。关于它的发病率、危险因素和医生的看法，可获得的信息很少。

方法：研究对象为择期剖宫产接受脊麻的产妇。术前对产妇进行术前焦虑(VNS)、预期止痛量、术后疼痛程度、Spielberger（斯皮尔伯格）状态-特质焦虑问卷、疼痛灾害化评分的问卷调查。手术后，产妇被要求回答问题(术中VNS疼痛)。麻醉医生和产科医生被要求填写一份问卷，询问感觉到的术中疼痛。术前焦虑对术中疼痛(是/否)的影响采用Logistic回归分析。计算Mc Fadden的R2（参数估计分析，模型的拟合水平情况，为伪R2值，其值越大越好，但其无法非常有效的表达模型的拟合程度，意义相对较小）。通过计算 Cohen's kappa系数和95%的可信区间(CI)来检验医生对术中疼痛的感知与产妇报告的疼痛的一致性。 

结果 ：我们的分析包括193名产妇。术中疼痛发生率为11.9%。有疼痛的产妇术中VNS疼痛评分中位数为4.0(第1四分位数为4.0；第3四分位数为9.0)。术前焦虑不是术中疼痛(β系数p值=0.43，Mc Fadden‘s R2=0.01)很好的预测指标。包括更多的术前变量并不能得到一个好的预测模型。产妇报告的疼痛与产科医生报告的疼痛之间的Cohen‘s kappa系数为0.21(95%CI：0.01，0.41)，麻醉医生报告的疼痛的Cohen’s kappa系数为0.3(95%CI：0.12，0.48)。

结论

我们发现剖宫产术中疼痛的发生率很高(11.9%)。术前焦虑并不预示术中疼痛。医生没有准确地识别产妇的术中疼痛。

原始文献来源

Keltz A, et al. Intraoperative pain during caesarean delivery: Incidence, risk factors and physician perception[J].Eur J Pain. 2022 Jan;26(1):219-226.

  英文原文

Intraoperative pain during caesarean delivery: Incidence, risk factors and physician perception

Background: Intraoperative pain is a possible complication of neuraxial anaesthesia for caesarean delivery. There is little information available about its incidence, risk factors and physician perception.

Methods: Parturients undergoing spinal anaesthesia for elective caesarean delivery were enrolled. Before surgery, parturients were asked about preoperative anxiety on a verbal numerical scale (VNS), anticipated analgesic requirement, postopera-tive pain levels, Spielberger STATE-TRAIT inventory index, Pain Catastrophizing Scale. After surgery, parturients were asked to answer questions (intraoperative VNS pain). The anaesthesiologist and obstetrician were asked to fill out a questionnaire asking about perceived intraoperative pain. Influence of preoperative anxiety on intraoperative pain (yes/no) was assessed using logistic regression. Mc Fadden's R2 was calculated. The agreement in physician perception of intraoperative pain with reported pain by the parturient was examined by calculating Cohen's kappa and 95% Confidence Intervals (CI).

Results: We included 193 parturients in our analysis. Incidence of intraoperative pain was 11.9%. Median intraoperative VNS pain of parturients with pain was 4.0(1st quartile 4.0; 3rd quartile 9.0). Preoperative anxiety was not a good predictorof intraoperative pain (p-value ofβ-coefficient=0.43, Mc Fadden's R2=0.01). Including further preoperative variables did not result in a good prediction model.Cohen's kappa between reported pain by parturient and by the obstetrician was 0.21(95% CI: 0.01, 0.41) and by the anaesthesiologist was 0.3 (95% CI: 0.12, 0.48).

Conclusions: We found a substantial incidence (11.9%) of intraoperative pain during caesarean delivery. Preoperative anxiety did not predict intraoperative pain.Physicians did not accurately identify parturients’ intraoperative pain. 

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