Milgrom Lesley B, Brooks Jo Ann, Qi Rong, Bunnell Karen, Wuestfeld Susie, Beckman Daniel
School of Nursing, Indiana University, Indianapolis, Ind, USA.
Am J Crit Care. 2004 Mar;13(2):116-25.
Acute pain is common after cardiac surgery and can keep patients from participating in activities that prevent postoperative complications. Accurate assessment and understanding of pain are vital for providing satisfactory pain control and optimizing recovery.
To describe pain levels for 5 activities expected of patients after cardiac surgery on postoperative days 1 to 6 and changes in pain levels after chest tube removal and extubation.
Adults who underwent cardiac surgery were asked to rate the pain associated with various types of activities on postoperative days 1 to 6. Pain levels were compared by postoperative day, activity, and type of cardiac surgery. Pain scores before and after chest tube removal and extubation also were analyzed.
Pain scores were higher on earlier postoperative days. The order of overall pain scores among activities (P < .01) from highest to lowest was coughing, moving or turning in bed, getting up, deep breathing or using the incentive spirometer, and resting. Changes in pain reported with coughing (P = .03) and deep breathing or using the incentive spirometer (P = .005) differed significantly over time between surgery groups. After chest tubes were discontinued, patients had lower pain levels at rest (P = .01), with coughing (P = .05), and when getting up (P = .03).
Pain relief is an important outcome of care. A comprehensive, individualized assessment of pain that incorporates activity levels is necessary to promote satisfactory management of pain.
心脏手术后急性疼痛很常见，会阻碍患者参与预防术后并发症的活动。准确评估和理解疼痛对于提供满意的疼痛控制和优化恢复至关重要。
描述心脏手术后第1至6天患者预期的5项活动的疼痛程度，以及拔除胸管和气管插管后的疼痛程度变化。
要求接受心脏手术的成年人对术后第1至6天各种活动相关的疼痛进行评分。根据术后天数、活动和心脏手术类型比较疼痛程度。还分析了拔除胸管和气管插管前后的疼痛评分。
术后早期疼痛评分较高。活动中总体疼痛评分（P <.01）从高到低的顺序为咳嗽、在床上移动或翻身、起床、深呼吸或使用激励肺活量计、休息。手术组之间，咳嗽（P =.03）和深呼吸或使用激励肺活量计（P =.005）时报告的疼痛随时间变化有显著差异。拔除胸管后，患者在休息时（P =.０1）、咳嗽时（P =.05）和起床时（P =.03）的疼痛程度较低。
疼痛缓解是护理的重要结果。有必要对疼痛进行全面、个性化的评估，包括活动水平，以促进疼痛的满意管理。
