Roediger L, Larbuisson R, Lamy M
University Hospital of Liége, Department of Anaesthesia and Intensive Care Medicine, Belgium.
Eur J Anaesthesiol. 2006 Jul;23(7):539-50. doi: 10.1017/S0265021506000548.
To evaluate the effect of postoperative pain control in cardiac surgical patients on morbidity, mortality and other outcome measures.
New approaches in pain control have been introduced over the past decade. The impact of these interventions, either alone or in combination, on perioperative outcome was evaluated in cardiac surgical patients.
We searched Medline for the period of 1980 to the present using the key terms analgesics, opioid, non-steroidal anti-inflammatory drugs, cardiac surgery, regional analgesia, spinal, epidural, fast-track cardiac anaesthesia, fast-track cardiac surgery, myocardial ischaemia, myocardial infarction, postoperative care, accelerated care programmes, postoperative complications, and we examined and discussed the articles that were identified to be included in this review.
Pain management in cardiac surgery is becoming more important with the establishment of minimally invasive direct coronary artery bypass surgery and fast-track management of conventional cardiac surgery patients. Advances have been made in this area and encompass specific techniques, such as central neuraxial blockade or selective nerve blocks, and drugs (opioids, sedative-hypnotics and non-steroidal anti-inflammatory drugs). Ideally, these therapies provide not only patient comfort but also mitigate untoward cardiovascular responses, pulmonary responses, and other inflammatory and secondary sympathetic responses. The introduction of these newer approaches to perioperative care has reduced morbidity, but not mortality, in cardiac surgical patients.
Understanding perioperative pathophysiology and implementation of care regimes to reduce the stress of cardiac surgery, will continue to accelerate rehabilitation associated with decreased hospitalization and increased satisfaction and safety after discharge. Reorganization of the perioperative team (anaesthesiologists, surgeons, nurses and physical therapists) will be essential to achieve successful fast-track cardiac surgical programmes. Developments and improvements of multimodal interventions within the context of 'fast-track' cardiac surgery programmes represents the major challenge for the medical professionals working to achieve a 'pain and risk free' perioperative course.
评估心脏手术患者术后疼痛控制对发病率、死亡率及其他预后指标的影响。
在过去十年中已引入疼痛控制的新方法。对这些干预措施单独或联合使用时对心脏手术患者围手术期结局的影响进行了评估。
我们使用关键词镇痛药、阿片类药物、非甾体抗炎药、心脏手术、区域镇痛、脊髓、硬膜外、快速通道心脏麻醉、快速通道心脏手术、心肌缺血、心肌梗死、术后护理、加速护理方案、术后并发症，检索了1980年至今的Medline数据库，并对确定纳入本综述的文章进行了审查和讨论。
随着微创直接冠状动脉搭桥手术的建立以及传统心脏手术患者的快速通道管理，心脏手术中的疼痛管理变得愈发重要。该领域已取得进展，涵盖特定技术，如中枢神经阻滞或选择性神经阻滞，以及药物（阿片类药物、镇静催眠药和非甾体抗炎药）。理想情况下，这些疗法不仅能让患者感到舒适，还能减轻不良的心血管反应、肺部反应以及其他炎症和继发性交感神经反应。这些围手术期护理新方法的引入降低了心脏手术患者的发病率，但并未降低死亡率。
了解围手术期病理生理学并实施护理方案以减轻心脏手术的应激，将继续加速康复进程，减少住院时间，提高出院后的满意度和安全性。围手术期团队（麻醉医生、外科医生、护士和物理治疗师）的重组对于成功实施快速通道心脏手术方案至关重要。在“快速通道”心脏手术方案背景下开发和改进多模式干预措施，是致力于实现“无痛且无风险”围手术期过程的医学专业人员面临 的主要挑战。
