Cogan Jennifer
Montréal Heart Institute, Québec, Canada.
Semin Cardiothorac Vasc Anesth. 2010 Sep;14(3):201-4. doi: 10.1177/1089253210378401.
Pain levels after cardiac surgery are often severe and undertreated. The effects of undertreatment may be both severe and prolonged. The incidence of chronic pain after cardiac surgery varies between 21% and 55%. Pain syndromes that occur following cardiac surgery may be multiple and may be of visceral, musculoskeletal, or neurogenic origin. Risk factors for acute pain vary depending on the study but generally include younger age, longer duration of surgery, and the location of the surgery. Risk factors for chronic pain include depression and psychological vulnerability, both preoperative and postoperative. Other independent risk factors for chronic pain are more extensive surgery, surgery lasting longer than 3 hours, and ASA grade greater than III. Pain control is achieved with regular and systematic evaluation and the use of multimodal regimens. Treatment strategies that are commonly used include opioids, paracetamol, NSAIDS, and more recently anticonvulsants.
心脏手术后的疼痛程度通常很严重且治疗不足。治疗不足的影响可能既严重又持久。心脏手术后慢性疼痛的发生率在21%至55%之间。心脏手术后出现的疼痛综合征可能是多种的，可能源于内脏、肌肉骨骼或神经源性。急性疼痛的风险因素因研究而异，但通常包括年龄较小、手术时间较长以及手术部位。慢性疼痛的风险因素包括术前和术后的抑郁及心理易损性。慢性疼痛的其他独立风险因素是手术范围更广、手术持续时间超过3小时以及ASA分级大于III级。通过定期和系统的评估以及使用多模式方案来实现疼痛控制。常用的治疗策略包括阿片类药物、对乙酰氨基酚、非甾体抗炎药，以及最近的抗惊厥药。
