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目的:评价术前唾液皮质醇早/晚分泌比值预测患者术后急性疼痛的价值。方法:本研究为前瞻性队列研究。选择江苏省苏北人民医院2023年1月至10月择期行单孔腹腔镜子宫切除术患者120例，年龄18～64岁，ASA分级Ⅰ或Ⅱ级，BMI 18～28 kg/m 2，术前应用医院焦虑抑郁量表(HADS)评估焦虑和抑郁状况。术前1 d早晨和晚间采集唾液样本，采用ELISA法测定皮质醇浓度，计算术前早晨皮质醇浓度与术前晚间皮质醇浓度的比值(皮质醇AM/PM比值)。采用数字评分量表(NRS)评估患者术后疼痛程度，根据术后48 h内NRS最高评分将患者分为2组：无或轻度疼痛组，NRS最高评分≤3分；中重度疼痛组，NRS最高评分≥4分。采用多因素logistic回归筛选术后中重度急性疼痛的危险因素，绘制受试者工作特征曲线评价其预测价值。 结果:多因素logistic回归分析显示，年龄、术前HADS焦虑评分、术前HADS抑郁评分和术前皮质醇AM/PM比值是术后中重度急性疼痛发生的独立危险因素( P<0.05)。受试者工作特征曲线结果显示，术前皮质醇AM/PM比值预测术后中重度急性疼痛的曲线下面积为0.803(95%置信区间0.708～0.898， P<0.001)，最佳截断值为3.46，灵敏度为71.1%，特异度为87.7%。 结论:术前唾液皮质醇早/晚分泌比值可预测患者术后急性疼痛的发生。

Objective:To assess the value of preoperative salivary cortisol morning/night secretion ratio (AM/PM ratio) in predicting acute postoperative pain in patients.Methods:This was a prospective cohort study. A total of 120 patients, aged 18-64 yr, of American Society of Anesthesiologists Physical Status classification Ⅰ or Ⅱ, with body mass index of 18-28 kg/m 2, undergoing elective single-port laparoscopic hysterectomy from January to October 2023 in Subei People′s Hospital of Jiangsu Province, were selected, and their anxiety and depression status was evaluated by using the Hospital Anxiety and Depression Mood Measurement Scale (HADS) before surgery. Saliva samples were collected in the morning and evening 1 day before operation, and the cortisol concentration was determined by enzyme-linked immunosorbent assay. The ratio of morning cortisol concentration to night cortisol concentration before operation was calculated (cortisol AM/PM ratio). The patients were divided into two groups according to the highest numerical rating scale (NRS) score within 48 h after surgery: no or mild pain group with the highest NRS score ≤3 and moderate to severe pain group with the highest NRS score ≥ 4. Multivariate logistic regression was used to identify the risk factors of moderate to severe acute pain after surgery, and the receiver operating characteristic curve was plotted to evaluate the predictive value. Results:Multivariate logistic regression analysis showed that age, preoperative HADS anxiety score, preoperative HADS depression score and preoperative cortisol AM/PM ratio were independent risk factors for moderate to severe acute pain after surgery ( P<0.05). The results of the receiver operating characteristic curve showed that the area under the curve of preoperative cortisol AM/PM ratio in predicting moderate to severe acute postoperative pain was 0.803 (95% confidence interval 0.708-0.898, P<0.001), the optimal cut-off value was 3.46, the sensitivity was 71.1%, and the specificity was 87.7%. Conclusions:Preoperative salivary cortisol morning/night secretion ratio can predict the occurrence of acute postoperative pain in patients.