剖腹產病患併發術後神經性疼痛之風險因子：族群基礎之研究報告

Risk Factors of Post-Surgical Neuropathic Pain in Cesarean Section Patients A Population-based Study

背景：吾人探討剖腹產病患併發術後神經性疼痛之發生率及其風險因子。方法：吾人擷取並分析2000年至2008年台灣健保資料庫數據。剖腹產病患併發術後神經性疼痛族群乃以被診斷為術後神經性疼痛並於後續至少接受兩次治療之病患為收案標準；而非術後神經性疼痛族群則以剖腹產病患未被診斷有術後神經性疼痛之病患為收案標準。個案之排除標準包括部腹產前曾被診斷為神經性疼痛、年齡小於16歲或大於50歲或麻醉方式不明者。結果：剖腹產病患併發術後神經性疼痛之族群總共有85位，非術後神經性疼痛之族群則有11284位。多變項邏輯式迴歸分析顯示糖尿病為剖腹產病患併發術後神經性疼痛之風險因子（風險比值=27.0，95% 信賴區間：15.73-46.36；P<0.001）；其他之風險因子則包括年齡≧35歲（風險比值= 3.25，95% 信賴區間：2.01-5.28； P<0.001）、高血壓（風險比值= 2.48，95% 信賴區間：1.12-5.50；P=0.026）、高血脂（風險比值= 3.08，95%信賴區間：1.29-7.39；P=0.012）、長期飲酒（風險比值= 9.61，95% 信賴區間：1.53-60.27；P=0.016）、抽菸（風險比值= 3.09，95% 信賴區間=：1.54-6.21；P=0.001）及使用抗憂鬱藥物（風險比值=7.40，，95% 信賴區間：3.56-15.37；P<0.001）.。結論：剖腹產病患併發術後神經性疼痛之發生率為0.74%。其風險因子包括糖尿病、年齡≧35歲、高血壓、高血脂、長期飲酒、抽菸及使用抗憂鬱藥物。

Background: We elucidated the incidence and the risk factors of post-surgical neuropathic pain (PSNP) in Cesarean section (CS) patients. Methods: Data from the Taiwan Longitudinal Health Insurance Database were analyzed. CS patients with a primary diagnosis of PSNP and had at least two ambulatory visits for PSNP treatments were identified as the PSNP subjects. CS patients without PSNP diagnosis were identified as the non-PSNP subjects. The PSNP and non-PSNP subjects were tracked from the surgery date until the end of 2008 or until loss of follow-up. Subjects with a previous history of PSNP before CS, age less than 16 or more than 50 years or missing data of anesthetic mode were excluded. Results: A total of 85 PSNP subjects and 11284 non-PSNP subjects were included. Multivariate logistic regression analyses revealed that diabetes mellitus was a risk factor of PNSP in CS patients odds ratio (OR)=27, 95% confidence intervals (CI): 15.73 - 46.36; P<0.001). The other risk factors of PSNP in CS patients included aged 35 years (OR=3.25,95% CI: 2.01 - 5.28; P<0.001), hypertension (OR=2.48, 95% CI: 1.12 - 5.50; P=0.026), hyperlipidemia (OR=3.08, 95% CI: 1.29 - 7.39; P=0.012), chronic alcohol exposure (OR=9.61, 95% CI: 1.53 - 60.27; P=0.016), smoking (OR=3.09, 95% CI: 1.54 - 6.21; P=0.001) and use of antidepressants (OR=7.40, 95% CI: 3.56 – 15.37; P<0.001). Conclusions: The incidence of PSNP in CS patients was 0.74% and the risk factors included DM, age≧35 years, hypertension, hyperlipidemia, chronic alcohol exposure, smoking and use of antidepressants.