Pain after cardiac surgery: A prospective cohort study of 1-year incidence and intensity
Pain after cardiac surgery: A prospective cohort study of 1-year incidence and intensity
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DOI：
10.1097/00000542-200610000-00026
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发表时间：
2006-10-01
期刊：
影响因子：
8.8
通讯作者：
Hynynen, Markku
中科院分区：
文献类型：
--
作者：
Lahtinen, Pasi;Kokki, Hannu;Hynynen, Markku
背景：持续性胸痛可能起源于心脏手术。已报告了胸骨切开术后持续性疼痛发生率的验证结果，回顾性报告与评估该疼痛的前瞻性研究之间存在相当大的差异。因此，作者对213例胸骨切开术患者进行了心脏手术后前12个月的随访调查。作者对心脏手术前后的急性和慢性胸骨切开术后疼痛进行了前瞻性调查。213例冠状动脉搭桥术患者在术前、术后4天、术后1、3、6和12个月接受了问卷调查。所有患者均被问及他们的期望、偏好以及术后疼痛的部位和强度。在1个月和12个月后，邮寄问卷的返回率分别为203（95%）和186（87%）。患者术后休息时的疼痛比术前预期的要多。静息时，最严重的实际术后疼痛为6（0-10），术前评估的最严重预期疼痛为5（0-10）（P = 0.013）。据报告，49%的患者在休息时、78%的患者在咳嗽时和62%的患者在运动时的最严重术后疼痛为重度（数字评定量表评分7-10）。术后1年，26例患者（14%）报告轻度慢性胸骨切开术后静息疼痛，1例患者（1%）中度疼痛，3例患者（2%）重度疼痛。在运动时，持续性疼痛更常见：45例患者（24%）有轻度疼痛，5例患者（3%）有中度疼痛，7例患者（4%）有重度疼痛。经历中度至重度急性术后疼痛的患者也更频繁地报告任何慢性胸骨切开术后疼痛（数字评定量表评分1-10）。虽然常见，但胸骨切开术后持续疼痛的发生率低于以前的报道。此外，令人放心的是，手术后1年，这种疼痛在休息和运动时大多是轻微的。
Background: Persistent chest pain may originate from cardiac surgery. Conflicting results have been reported on the incidence of persistent poststernotomy pain with considerable discrepancies between the retrospective reports and the one prospective study conducted to assess this pain. Therefore, the authors conducted a follow-up survey for the first 12 months after cardiac surgery in 213 patients who had a sternotomy.Methods. The authors performed a prospective inquiry of acute and chronic poststernotomy pain both before and after cardiac surgery. Two hundred thirteen coronary artery bypass patients received a questionnaire preoperatively, 4 days post-operatively, and 1, 3, 6, and 12 months postoperatively. All patients were asked about their expectations, their preferences, and the location and intensity of postoperative pain.Results. The return rates for the postal questionnaires were 203 (95%) and 186 (87%) after 1 and 12 months, respectively. Patients experienced more pain postoperatively at rest than they had expected to preoperatively. At rest, the worst actual postoperative pain was 6 (0-10), and the worst expected pain as assessed preoperatively was 5 (0-10) (P = 0.013). The worst reported postoperative pain was severe (numeric rating scale score 7-10) in 49% at rest, in 78% during coughing, and in 62% of patients on movement. One year after the operation, 26 patients (14%) reported mild chronic poststernotomy pain at rest, 1 patient (1%) had moderate pain, and 3 patients (2%) had severe pain. Upon movement, persistent pain was even more common: 45 patients (24%) had mild, 5 patients (3%) had moderate, and 7 patients (4%) had severe pain. Patients who experienced moderate to severe acute postoperative pain also reported any chronic poststernotomy pain (numeric rating scale score 1-10) more frequently.Conclusions. Although common, the incidence of persistent pain after sternotomy was lower than previously reported. Also, reassuringly, 1 year after surgery this pain was mostly mild in nature both at rest and on movement.