CAJ | 학술논문

目的：探讨局部麻醉下无张力腹股沟疝修补术术后早期疼痛的高危因素。方法选取2012年2月至2014年3月，北京中日友好医院收治的腹股沟疝患者420例，其中男393例，女27例，平均年龄58．6岁。术前收集相关危险因素，于术后12 h采用视觉模拟评分法评测术后疼痛程度。结果单因素分析显示年龄、手术放置补片类型以及术后局部注射麻醉药物种类均为影响局部麻醉下无张力腹股沟疝修补术术后疼痛的高危因素；多因素分析显示年龄与术后疼痛评分呈负相关，年龄小于50岁者，疼痛程度最高。放置生物补片及巴德114700补片者术后中重度疼痛者比其他补片（通用星形、D10及巴德80）升高，术后局部注射1％罗哌卡因及0．375％布比卡因组与局部注射1％利多卡因及不注射任何药物组相比术后12 h的疼痛评分明显升高。而性别、侧别、身体质量指数、疝分型以及手术时间长短均无明显相关。结论该研究可评估局部麻醉下无张力腹股沟疝修补术术后早期疼痛的高危因素，并可对疼痛高危患者术后早期疼痛干预进行指导。
목적：탐토국부마취하무장력복고구산수보술술후조기동통적고위인소。방법선취2012년2월지2014년3월，북경중일우호의원수치적복고구산환자420례，기중남393례，녀27례，평균년령58．6세。술전수집상관위험인소，우술후12 h채용시각모의평분법평측술후동통정도。결과단인소분석현시년령、수술방치보편류형이급술후국부주사마취약물충류균위영향국부마취하무장력복고구산수보술술후동통적고위인소；다인소분석현시년령여술후동통평분정부상관，년령소우50세자，동통정도최고。방치생물보편급파덕114700보편자술후중중도동통자비기타보편（통용성형、D10급파덕80）승고，술후국부주사1％라고잡인급0．375％포비잡인조여국부주사1％리다잡인급불주사임하약물조상비술후12 h적동통평분명현승고。이성별、측별、신체질량지수、산분형이급수술시간장단균무명현상관。결론해연구가평고국부마취하무장력복고구산수보술술후조기동통적고위인소，병가대동통고위환자술후조기동통간예진행지도。
Objective To investigate the risk factors associated with postoperative pain following tension-free inguinal hernia repair under local anesthesia .Methods A total of 420 patients ( 393 male, 27 female;mean age 58.6 years) with inguinal hernia admitted to China-Japan Friendship Hospital during February 2012 and March 2012 were enrolled .Related risk factors were collected preoperatively , and the postoperative pain at 12 hours later was assessed using a visual analogue scale ( VAS ) .Results Single factor analysis showed that age , mesh types and postoperative local injections of anesthesia drug species as the main factors affecting postoperative pain; Multiple factors analysis showed that age was negatively correlated with postoperative pain score , that when age was less than 50 years old, the group had highest degree of pain .Meanwhile the higher BMI was , the higher proportion of the moderate and severe pain .The group which placed biological mesh or Bard 114700 mesh had higher proportion of moderate and severe postoperative pain rate than the group with other mesh ( Aspide star-sharped, D10 and Bard 118800 ). Postoperative local injections with 1% ropivacaine or 0.375% bupivacaine could make the pain score at 12 hours after operation increased significantly compared with the group with lidocaine or no drug. But the other factors including sex , hernia side, BMI, classification of hernia and length of operation time were not significantly related with the degree of postoperative pain .Conclusion This study can evaluate the high risk factors of postoperative pain after tension-free inguinal hernia under local anesthesia , and can be used to guide the early intervention for vulnerable patients of postoperative pain .