摘要： 目的 探讨经颞入路手术后慢性疼痛与术后48 h 内急性疼痛之间的相关关系。方法 选择176 例经颞入路手术患者，术后分别接受吗啡（30 mg）、曲马多（1000 mg）和吗啡（20 mg）+ 氟比洛芬酯（200 mg）自控镇痛治疗，采用视觉模拟评分（VAS）评价术后4、16、24 和48 h 静息和运动状态下疼痛程度，术后3 个月时进行简易McGill 疼痛问卷（SF-MPQ）调查，比较急慢性疼痛发生特点、分析二者之间相关关系，以及3 种镇痛药物之镇痛效果。结果 对可能影响术后疼痛程度的观察指标比较，其差异无统计学意义（P > 0.05）。术后48 h 内，各组患者不同观察时间点VAS 评分随时间的延长有所改善，曲马多组（2.91 ± 1.64）患者分别高于吗啡组（2.19 ± 1.68）和氟比洛芬酯组（1.71 ± 1.17，P < 0.05）；但各组慢性疼痛发生率和严重程度差异无统计学意义（P > 0.05），慢性疼痛总发生率约为71.02%（125/176）、中至重度疼痛15.91%（28/176）。慢性疼痛与术后急性疼痛（48 h 内）严重程度呈正相关（静息状态：r_s = 0.171，P =0.012；运动状态：r_s = 0.190，P = 0.006）；慢性疼痛SF-MPQⅡ 评分> 0 与SF-MPQⅡ = 0 对应的急性疼痛VAS 评分差异有统计学意义（P < 0.05）。结论 经颞入路手术后慢性疼痛与术后48 h 内急性疼痛有关，术后早期有效控制急性疼痛可降低慢性疼痛之发生率。

关键词: 疼痛, 手术后, 神经外科手术, 镇痛, 病人控制, 疼痛测定

Abstract: Objective  To investigate the correlation of chronic pain after surgery and acute pain within 48 h after temporal craniotomy.  Methods  One hundred and seventy-six patients who underwent surgery through temporal approach were divided into 3 groups and treated with morphine 30 mg (Group M, N = 57), tramadol 1000 mg (Group T, N = 60) and morphine 20 mg + flurbiprofen 200 mg (Group F, N = 59) by patient-controlled intravenous analgesia (PCIA). Postoperative acute pain (resting and movement) was evaluated by Visual Analogue Scale (VAS) at 4, 16, 24 and 48 h respectively. Chronic pain was measured by Short-Form McGill Pain Questionnaire (SF-MPQ) 3 months after surgery. The characteristics of acute and chronic pain, the relationship between them and analgesic effect of 3 kinds of analgesic drugs were analyzed.  Results  The differences of observed indicators including gender, age, weight and operating time, which might affect the degree of postoperative pain between before and after surgery were not statistically significant (P > 0.05). VAS scores at different time points within 48 h after surgery in each group decreased gradually. The VAS scores in group T (2.91 ± 1.64) was significantly higher than group M (2.19 ± 1.68) and group F (1.71 ± 1.17, P < 0.05). There was no significant difference in the incidence and severity of chronic pain among 3 groups (P > 0.05). The overall incidence rate of chronic pain was 71.02% (125/176), with moderate and severe pain in 15.91% (28/176). Chronic pain and acute postoperative pain severity were positively correlated (resting: r_s = 0.171, P = 0.012; movement: r_s = 0.190, P = 0.006). The difference of the acute pain (VAS) corresponding to SF-MPQ Ⅱ score > 0 and SF-MPQ Ⅱ score = 0 was statistically significant (P < 0.05).  Conclusion  The postoperative chronic pain following temporal craniotomy is related to acute pain within 48 h after operation. Effective treatment of early postoperative acute pain may reduce the incidence of chronic pain.

Key words: Pain, postoperative, Neurosurgical procedures, Analgesia, patient-controlled, Pain measurement