目的 了解胸腔镜下肺癌根治患者术后24 h内早期疼痛发生现状并分析其影响因素，为实施个体化精准疼痛管理策略提供参考。方法 采用前瞻性队列研究设计，连续选取2025年7月—8月在浙江省某三级甲等医院行胸腔镜肺癌根治术的210例患者为研究对象，使用一般资料调查表、数字评定量表、中文版功能活动评定法进行调查，采用单因素及Logistic回归分析筛选胸腔镜术后早期疼痛的影响因素。结果 最终纳入201例患者，术后早期疼痛发生率为100%，其中中度疼痛发生率为49.7%（100/201），重度疼痛发生率为0。功能活动评定结果显示，患者疼痛时活动受限程度Ⅱ级占87.7%（176/201），Ⅲ级和Ⅳ级分别占11.4%（23/201）和0.9%（2/201）。术后疼痛程度与功能活动限制呈弱正相关（r=0.252，P<0.001），但仅能解释约6.4%的功能活动限制变异。Logistic回归分析结果显示，年龄<65岁（OR=0.970）和出麻醉恢复室时存在疼痛（OR=2.344）的患者发生中度疼痛的风险较高（P<0.001）；与胸腔镜下肺楔形切除术相比，接受肺段切除术的患者发生中度疼痛的风险显著降低（OR=0.097）。结论 胸腔镜肺癌根治术后中度疼痛发生率较高，受到年龄、手术方式和出麻醉恢复室时存在疼痛的影响，针对年龄<65岁、行胸腔镜下肺楔形切除术和出麻醉恢复室时存在疼痛的患者应加强疼痛监测并及时调整镇痛策略，促进术后早期康复。

Objective To understand the current situation of early postoperative pain within 24 hours in patients undergoing thoracoscopic lung cancer radical resection and analyze the influencing factors，in order to provide a reference for implementing individualized and precise pain management strategies. Methods A prospective cohort study design was adopted. 210 patients who underwent thoracoscopic lung cancer radical resection in a tertiary grade A hospital in Zhejiang Province from July to August 2025 were selected as the research subjects. General information questionnaires，Numerical Rating Scales，and the Chinese version of the functional activity assessment method were used for investigation. Univariable and logistic regression analysis were used to screen the influencing factors of early postoperative pain after thoracoscopic surgery. Results A total of 201 patients was finally included. The incidence of early postoperative pain was 100%. Among them，the incidence of moderate pain was 49.7% （100/201），and the incidence of severe pain was 0%. The results of functional activity assessment showed that 87.7%（176/201） of the patients had a level Ⅱ degree of activity limitation during pain，11.4%（23/201） had a level Ⅲ degree，and 0.9%（2/201） had a level Ⅳ degree. The postoperative pain degree was significantly weakly positively correlated with functional activity limitation（r=0.252，P<0.001），but it could only explain about 6.4% of the variation in functional activity limitation. The results of logistic regression analysis showed that patients with age <65 years（OR=0.970） and pain existing when leaving the anesthesia recovery room（OR=2.344） had a higher risk of moderate pain（P<0.001）. Compared with thoracoscopic lung wedge resection，patients undergoing lung segment or resection had a significantly lower risk of moderate pain（OR=0.097）. Conclusion The incidence of moderate pain after thoracoscopic lung cancer radical resection is relatively high. It is influenced by age，surgical method，and the presence of pain when leaving the anesthesia recovery room. For patients under 65 years old，undergoing wedge surgery，and having pain when leaving the anesthesia recovery room，pain monitoring should be strengthened and the analgesic strategy should be adjusted in time to promote early postoperative rehabilitation.