Diegeler A, Walther T, Metz S, Falk V, Krakor R, Autschbach R, Mohr F W
Klinik für Herzchirurgie, Herzzentrum, Universität Leipzig, Germany.
Heart Surg Forum. 1999;2(4):290-5; discussion 295-6.
This prospective clinical trial focuses on pain and quality of life (QOL) after minimally invasive direct coronary artery bypass (MIDCAB) grafting versus conventional coronary artery bypass grafting (CABG).
Group A consisted of 65 consecutive MIDCAB patients using an anterolateral mini-thoracotomy and the "off-pump" technique. Group B consisted of 95 computer-matched patients who underwent conventional CABG with cardiopulmonary bypass (CPB). Pain was graduated using the visual analog scale (VAS), and the verbal rating scale (VRS) [Troidl 1990]. QOL was evaluated at the time of discharge and three months after surgery using modified Nottingham Health Questionnaires that separate physical, social, activity, emotional, pain, and sleeping conditions.
Postoperative pain was higher after MIDCAB on postoperative day (POD) 1 (p< 0.002). From POD 4 onwards MIDCAB patients had less pain compared with the conventional group (p<0.04). MIDCAB patients required less pain medication from POD 4 onwards (p<0.05). QOL was significantly better in the MIDCAB group on POD 7 for physical (p< 0.038), activity (p< 0.016), pain (p< 0.041), and sleep (p<0.038) conditions. The three-month questionnaire showed significantly better levels for MIDCAB patients regarding physical (p< 0.03) and pain (p< 0.001) conditions, and a trend for activity (p< 0.08) and emotional (p<0.08) conditions.
Compared to patients undergoing conventional surgery, MIDCAB patients suffer more pain in the first three postoperative days, probably as a result of the lateral thoracotomy. From POD 4 onwards, MIDCAB patients are significantly better, experiencing less pain and showing better physical, activity, and sleeping conditions even three months after surgery. This can be attributed to the absence of median sternotomy and/or the avoidance of cardiopulmonary bypass.
这项前瞻性临床试验聚焦于微创直接冠状动脉旁路移植术（MIDCAB）与传统冠状动脉旁路移植术（CABG）后的疼痛及生活质量（QOL）。
A组由65例连续采用前外侧小切口开胸及“非体外循环”技术的MIDCAB患者组成。B组由95例通过计算机匹配、接受传统体外循环（CPB）下CABG的患者组成。使用视觉模拟量表（VAS）和言语评定量表（VRS）[特罗伊德尔1990]对疼痛进行分级。在出院时及术后三个月使用改良的诺丁汉健康问卷对生活质量进行评估，该问卷可区分身体、社会、活动、情绪、疼痛及睡眠状况。
MIDCAB术后第1天（POD 1）的术后疼痛程度更高（p < 0.002）。从POD 4起，MIDCAB患者的疼痛程度低于传统组（p < 0.04）。从POD 4起，MIDCAB患者所需的止痛药物更少（p < 0.05）。在POD 7时，MIDCAB组在身体（p < 0.038）、活动（p < 0.016）、疼痛（p < 0.041）及睡眠（p < 0.038）状况方面的生活质量明显更好。三个月的问卷显示，MIDCAB患者在身体（p < 0.03）和疼痛（p < 0.001）状况方面明显更好，在活动（p < 0.08）和情绪（p < 0.08）状况方面有改善趋势。
与接受传统手术的患者相比，MIDCAB患者在术后头三天疼痛更严重，可能是由于侧胸壁切开术所致。从POD 4起，MIDCAB患者明显好转，疼痛减轻，甚至在术后三个月时身体、活动及睡眠状况也更好。这可归因于未进行正中胸骨切开术和/或避免了体外循环。
