Ⅲ期结核性脓胸患者术后急性疼痛现状及影响因素分析

doi:10.19871/j.cnki.xfcrbzz.2026.01.006

摘要/Abstract

摘要： 目的本研究旨在阐明Ⅲ期结核性脓胸患者术后急性疼痛发生情况,并深入探讨其影响因素,为临床治疗决策提供依据。方法回顾性分析成都市公共卫生临床医疗中心胸外科2023年6月至2025年4月因Ⅲ期结核性脓胸行手术治疗的105例患者临床资料。根据数字评定量表（numeric rating scale,NRS）对患者疼痛程度进行数字化量化评估,分为疼痛组（NRS评分≥4分,n=46）,对照组（NRS评分<4分,n=59）使用术后3d内采用数字评定量表评估两组患者术后急性疼痛情况。采用多因素Logistic回归分析Ⅲ期结核性脓胸患者术后急性疼痛发生的影响因素。结果 Ⅲ期结核性脓胸患者术后急性疼痛发生率为43.81%。单因素分析结果显示,疼痛组与对照组的性别、是否饮酒、胸膜厚度、手术方式、手术时间、术后引流量的差异均具有统计学意义（P<0.05）。多因素Logistic回归分析显示,手术时间延长（OR=1.013,95%CI：1.002~1.025,P=0.025）、胸膜厚度增加（OR=1.189,95%CI：1.020~1.387,P=0.027）、开胸（OR=4.503,95%CI：1.532~13.231,P=0.006）、术后引流量增多（OR=1.001,95%CI：1.000~1.003,P=0.027）均是术后急性疼痛的危险因素,男性（OR=0.101,95%CI：0.029~0.351,P<0.001）是术后急性疼痛的保护因素。结论 Ⅲ期结核性脓胸患者术后急性疼痛发生率较高,且与性别、手术时间、胸膜厚度、手术方式、术后引流量等因素有关。临床应重点关注女性、开胸手术、胸膜增厚、手术时间延长及术后引流量增多的急性疼痛患者,加强早期疼痛干预。

关键词: Ⅲ期结核性脓胸, 术后急性疼痛, 影响因素

Abstract: Objective To analyze the incidence of acute postoperative pain in patients with stage Ⅲ tuberculous empyema and its influencing factors. Method A retrospective analysis was conducted on the clinical data of 105 patients with stage Ⅲ tuberculous empyema who underwent surgical treatment at the Department of Thoracic Surgery, Public Health Clinical Center of Chengdu, from June 2023 to April 2025. Pain levels were assessed using the numeric rating scale (NRS) and categorized into a pain group (NRS score≥4, n=46) and a control group (NRS score<4, n=59). Postoperative acute pain within the first three days was evaluated using the NRS for both groups. Using binary logistic regression analysis was used to investigate the influencing factors of acute postoperative pain in patients with stage Ⅲ tuberculous empyema. Result The incidence of postoperative acute pain in patients with stage Ⅲ tuberculous empyema was 43.81%. Univariate analysis revealed significant differences in gender, alcohol consumption, pleural thickness, surgical method, operation duration, and postoperative drainage volume between the pain group and the control group (P<0.05). Multivariate logistic regression analysis indicated that prolonged operation duration (OR=1.013, 95%CI:1.002-1.025, P=0.025), increased pleural thickness (OR=1.189, 95%CI:1.020-1.387, P=0.027), thoracotomy surgical method (OR=4.503, 95%CI:1.532-13.231, P=0.006), and increased postoperative drainage volume (OR=1.001, 95%CI:1.000-1.003, P=0.027) were risk factors for postoperative acute pain (P<0.05), while being male (OR=0.101, 95%CI:0.029-0.351, P<0.001) was a protective factor against acute postoperative pain. Conclusion Patients with stage Ⅲ tuberculous empyema exhibit a higher incidence of postoperative acute pain, which correlates with factors such as gender, surgical duration, pleural thickness, surgical approach, and postoperative drainage volume. Clinicians should prioritize acute pain management in female patients, those undergoing thoracotomy, those with pleural thickening, prolonged operative time, and increased postoperative drainage, while implementing early pain intervention strategies.

Key words: Ⅲ tuberculous empyema, Acute postoperative pain, Influencing factors

中图分类号:

R529.3
R563

李婷婷, 蒋良双, 曾晓丽, 龚胜, 贾霜, 袁晔, 王宁, 周余, 白秋灵, 周君. Ⅲ期结核性脓胸患者术后急性疼痛现状及影响因素分析[J]. 新发传染病电子杂志, 2026, 11(1): 39-43.

Li Tingting, Jiang Liangshuang, Zeng Xiaoli, Gong Sheng, Jia Shuang, Yuan Ye, Wang Ning, Zhou Yu, Bai Qiuling, Zhou Jun. Analysis of the current status and influencing factors of acute postoperative pain in patients with stage Ⅲ tuberculous empyema[J]. Electronic Journal of Emerging Infectious Diseases, 2026, 11(1): 39-43.

参考文献

[1] ZHAO S, SHUO Z, QIN S, et al.Uniportal versus triportal video-assisted thoracic surgery in the treatment of tuberculous empyema[J]. Int Med Res, 2023, 51(5): 1-9.
[2] SUN W, YIN G, CAI H, et al.The efficacy and safety of uniportalvideo-assisted thoracic surgery on the treatment for stage II-Illtuberculous empyema: a single-arm clinical retrospective studyfrom 2016 to 2021 in a thoracic surgery center in China[J]. BMC Pulm Med, 2022,22(1): 398.
[3] 蒋钰辉, 戴希勇, 申磊. 单孔胸腔镜与开胸纤维板剥脱术治疗慢性结核性脓胸的比较[J]. 中国微创外科杂志, 2023, 23(2): 98-102.
[4] ZHOU Y, LI X, DAI Q, et al.Uniportal thoracoscopic decortication for stage l tuberculous empyema withsevere rib crowding[J]. Ann Thorac Surg, 2021, 112(1): 289-294.
[5] 中华医学会麻醉学分会. 成人手术后疼痛处理专家共识[J]. 临床麻醉学杂志, 2017, 33(9):911-917.
[6] 张俊, 罗湘玉, 张立, 等. 多模式联合预防性镇痛对胸腔镜肺叶切除术后快速康复的影响[J]. 湖北医药学院学报, 2021, 40(1): 11-15.
[7] 王莎, 侯征, 贺豪杰, 等. 子宫切除术后慢性疼痛的相关因素分析[J]. 实用妇产科杂志, 2021, 37(5): 385-390.
[8] 孙婉琛, 王娟, 范菁一, 等. 脊髓神经鞘瘤切除术患者术后慢性疼痛的危险因素[J]. 临床麻醉学杂志, 2022, 38(8): 825-833.
[9] JIA L, YAN L, QING H, et al.Measures to accelerate recovery from stage III tuberculous empyema: tuberculous empyema surgical and recovery methods[J]. Perioper Med (Lond), 2025, 14(1): 43-52.
[10] 乔名坤, 崔超. 结核性脓胸的外科治疗进展[J]. 继续医学教育, 2022, 36(4): 153-156.
[11] 邱迪, 王星明, 刘清仁, 等. 急性术后疼痛危险因素和疼痛程度预测方法的研究进展[J]. 临床麻醉学杂志, 2022, 38(2): 194-198.
[12] 严广斌. NRS疼痛数字评价量表numerical rating scale[J/CD]. 中华关节外科杂志(电子版), 2014, 8(3): 410.
[13] 赵雨帆, 欧阳文, 胡中华, 等. 老年患者围术期神经认知障碍与术后急性疼痛的研究进展[J]. 临床麻醉学杂志, 2021, 37(5): 542-547.
[14] 张颖, 朱海芳, 方晓霞. 老年胸部肿瘤患者胸腔镜术后急性疼痛的影响因素[J]. 中国老年学杂志, 2025, 45(4): 807-810.
[15] 何爽, 杨慧, 陈瑞云, 等. 胸外科患者围手术期疼痛管理的最佳证据总结[J]. 中国实用护理杂志, 2025, 41(9): 657-663.
[16] ATHNAIEL O, CANTILLO S, PAREDES S, et al.The Role of Sex Hormones in Pain -Related Conditions[J]. Int J Mol Sci, 2023, 24(3): 1866.
[17] MING Z, ZI N, JUN M, et al.A neural circuit for sex-dependent conditioned pain hypersensitivity in mice[J]. Nat Commun, 16(1), 36-39.
[18] NAGELLA AB, YALAMURU B.Genetics and Gender in Acute Pain and Perioperative Opioid Analgesia[J]. Anesthesiol Clin, 2025, 43: 127-140.
[19] 刘鑫, 仵倩红, 陈其亮, 等.Ⅲ期结核性脓胸继发胸廓塌陷畸形情况及相关影响因素分析[J]. 结核与肺部疾病杂志, 2024, 5(4):283-288.
[20] LING J, CHEN W, JIE T, et al.Comparison between thoracic epidural analgesia VS patient controlled analgesia on chronic postoperative pain after video-assisted thoracoscopic surgery: A prospective randomized controlled study[J]. Clin Anesth, 2024, 100: 111685.
[21] ESTHER M, POGATZKI Z, DANIEL S, et al.Postoperative pain-from mechanisms to treatment[J]. Pain Rep, 2018, 2(2): 588-604.
[22] JIA L, YAN L, QING H, et al.Measures to accelerate recovery from stage III tuberculous empyema: tuberculous empyema surgical and recovery methods[J] .Perioper Med (Lond), 2025, 14(1): 43.
[23] METHODS IN MEDICINE CAM. Methods In Medicine,Retracted: Analysis of the Need for Postoperative Drainage Application for Hip Arthroplasty: A Systematic Review and Meta-Analysis[J]. Comput Math Methods Med, 2023, 9791725.
[24] YUAN Z, HAN Z, GANG Z, et al.Research on Motion Transfer Method from Human Arm to Bionic Robot Arm Based on PSO-RF Algorithm[J]. Biomimetics (Basel), 2025,10(6): 392-410
[25] 万涛, 郑军. 外科手术后疼痛与炎症因子关系的研究进展[J]. 中华疼痛学杂志, 2023, 19(3): 513-518.
[26] PHILIPP S, GUSTAY J, TYLER A, et al.Mast cell-derived BH4 and serotonin are critical mediators of postoperative pain[J]. Sci Immunol, 2024, 9(98): 504-545.