基于生态瞬时评估的扁桃体腺样体切除术后口咽部活动与疼痛的动态关联研究

Dynamic correlation between oropharyngeal activity and pain after tonsillectomy and adenoidectomy based on ecological momentary assessment

摘要:

目的 本研究采用生态瞬时评估（EMA）动态追踪儿童扁桃体腺样体切除术后口咽部活动与疼痛的时序变化特征，明确二者的动态关联，为临床开展术后精准疼痛管理与功能康复提供客观依据。方法 纳入2025年 10月—2026年4月于西安交通大学第二附属医院耳鼻咽喉头颈外科接受扁桃体腺样体切除术的疑似阻塞性睡眠呼吸暂停（OSA）患儿30例，所有受试者均根据临床病情指征接受对应术式，包括单纯扁桃体切除术、单纯腺样体切除术或扁桃体腺样体联合切除术；实时采集饮食相关口咽活动、非饮食相关口咽活动、口咽功能恢复状态及疼痛评估的数字评定量表（NRS）数据，采用线性混合效应模型分析变量间的关联以及时间效应关联。结果 饮食相关口咽活动、非饮食相关口咽活动均与疼痛程度呈显著正相关，且饮食相关口咽活动对术后疼痛的影响效应更为显著（P均< 0.001）；口咽功能恢复评分与疼痛程度呈显著负相关（P<0.001）；时间对疼痛程度存在显著负向预测作用，术后疼痛随时间推移呈进行性下降，且该变化趋势与口咽功能恢复评分的变化高度同步。结论 扁桃体腺样体切除术后前期口咽活动与后期疼痛程度存在显著时序相关，饮食相关口咽活动关联效应更强。本研究为观察性研究，尚不能证实其因果疗效。临床可依据二者时序变化特征开展分阶段个体化干预，优化术后疼痛管理。

Abstract:

Objective To dynamically track temporal changes in oropharyngeal activity and pain in children after tonsillectomy and adenoidectomy using ecological momentary assessment (EMA), and clarify their dynamic correlations, so as to provide an objective basis for precise postoperative pain management and functional rehabilitation in clinical practice. Methods Thirty suspected obstructive sleep apnea (OSA) pediatric patients undergoing tonsillectomy and/or adenoidectomy at the Department of Otorhinolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi’an Jiaotong University, between October 2025 and April 2026 were enrolled in this study. All children received surgery according to clinical indications, including tonsillectomy alone, adenoidectomy alone, or combined tonsillectomy and adenoidectomy. Real-time data on diet-related and non-diet-related oropharyngeal activities, oropharyngeal functional recovery status, and numerical rating scale (NRS) pain scores were collected. Linear mixed-effects models were used to analyze associations among variables and time-dependent effects. Results Both diet-related and non-diet-related oropharyngeal activities showed significant positive correlations with NRS pain scores, with diet-related activity having a more pronounced effect on postoperative pain (P< 0.001). Oropharyngeal functional recovery scores were significantly negatively correlated with pain intensity (P<0.001). Time had a significant negative effect on pain, pain decreased gradually over time and this trend was closely synchronized with oropharyngeal functional recovery scores. Conclusions There was a significant temporal correlation between early-phase oropharyngeal activity and subsequent postoperative pain severity after tonsillectomy and adenoidectomy, with diet-related oropharyngeal activity showing a stronger correlative effect. As this was an observational study, causal efficacy could not be confirmed. Staged individualized interventions can be implemented according to their temporal variation characteristics to optimize postoperative pain management.