心脏手术后持续性非心绞痛术后疼痛的患病率及危险因素：一项为期 2 年的前瞻性多中心研究。
Prevalence of and risk factors for persistent postoperative nonanginal pain after cardiac surgery: a 2-year prospective multicentre study.
出版信息
CMAJ. 2014 Apr 15;186(7):E213-23. doi: 10.1503/cmaj.131012. Epub 2014 Feb 24.
BACKGROUND
Persistent postoperative pain continues to be an underrecognized complication. We examined the prevalence of and risk factors for this type of pain after cardiac surgery.
METHODS
We enrolled patients scheduled for coronary artery bypass grafting or valve replacement, or both, from Feb. 8, 2005, to Sept. 1, 2009. Validated measures were used to assess (a) preoperative anxiety and depression, tendency to catastrophize in the face of pain, health-related quality of life and presence of persistent pain; (b) pain intensity and interference in the first postoperative week; and (c) presence and intensity of persistent postoperative pain at 3, 6, 12 and 24 months after surgery. The primary outcome was the presence of persistent postoperative pain during 24 months of follow-up.
RESULTS
A total of 1247 patients completed the preoperative assessment. Follow-up retention rates at 3 and 24 months were 84% and 78%, respectively. The prevalence of persistent postoperative pain decreased significantly over time, from 40.1% at 3 months to 22.1% at 6 months, 16.5% at 12 months and 9.5% at 24 months; the pain was rated as moderate to severe in 3.6% at 24 months. Acute postoperative pain predicted both the presence and severity of persistent postoperative pain. The more intense the pain during the first week after surgery and the more it interfered with functioning, the more likely the patients were to report persistent postoperative pain. Pre-existing persistent pain and increased preoperative anxiety also predicted the presence of persistent postoperative pain.
INTERPRETATION
Persistent postoperative pain of nonanginal origin after cardiac surgery affected a substantial proportion of the study population. Future research is needed to determine whether interventions to modify certain risk factors, such as preoperative anxiety and the severity of pain before and immediately after surgery, may help to minimize or prevent persistent postoperative pain.
背景
持续性术后疼痛仍然是一种未被充分认识的并发症。我们研究了心脏手术后这种类型疼痛的发生率和危险因素。
方法
我们纳入了 2005 年 2 月 8 日至 2009 年 9 月 1 日期间拟行冠状动脉旁路移植术或瓣膜置换术或两者皆行的患者。采用经验证的方法评估（a）术前焦虑和抑郁、面对疼痛时的灾难化倾向、健康相关生活质量和持续性疼痛的存在；（b）术后第一周的疼痛强度和干扰；以及（c）术后 3、6、12 和 24 个月时持续性术后疼痛的存在和强度。主要结局为术后 24 个月的持续性术后疼痛。
结果
共 1247 例患者完成了术前评估。术后 3 个月和 24 个月的随访保留率分别为 84%和 78%。持续性术后疼痛的发生率随着时间的推移显著下降，从术后 3 个月的 40.1%降至术后 6 个月的 22.1%、术后 12 个月的 16.5%和术后 24 个月的 9.5%；24 个月时疼痛评分为中度至重度的比例为 3.6%。急性术后疼痛预测了持续性术后疼痛的存在和严重程度。术后第一周疼痛越剧烈，对功能的干扰越大，患者报告持续性术后疼痛的可能性就越大。术前存在持续性疼痛和术前焦虑增加也预测了持续性术后疼痛的存在。
解释
非心绞痛来源的心脏手术后持续性术后疼痛影响了研究人群中的相当一部分。需要进一步的研究来确定是否可以通过干预某些危险因素来减轻或预防持续性术后疼痛，例如术前焦虑和手术前后疼痛的严重程度。
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