Kamalipour Hamid, Vafaei Ali, Parviz Kazemi Asef, Khademi Saeed
Laparoscopy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Anesth Pain Med. 2014 Jun 21;4(3):e17969. doi: 10.5812/aapm.17969. eCollection 2014 Aug.
The prevalence of chronic postoperative pain after cardiac surgery has been reported from 17% to 56%.
We aimed to compare the prevalence of postoperative pain between patients who had undergone CABG using the internal mammary artery (IMA) and those who had undergone other cardiac surgeries including CABG using the saphenous vein or cardiac valvular surgeries.
In this cohort study, medical records of 188 patients were evaluated and divided into two equal groups (94 in each group); patients who had undergone CABG using the IMA (IMA group) and those who had undergone other cardiac surgeries using the saphenous vein or other cardiac valvular surgeries (non-IMA group). The patients' data were recorded in a self-structured questionnaire and then phone interviews were performed 3 months after the operations regarding the rate of postoperative pain. The severity of chronic pain was rated based on the numerical rating pain scale.
The two groups differed significantly regarding the prevalence of pain (P = 0.023). In the IMA group, 83 (88.3%) patients experienced pain lasting for more than three months compared to 71 (75.5%) patients in non-IMA group. The two groups differed significantly with respect to the severity of chronic pain after cardiac surgery via sternotomy (P = 0.001). The groups did not differ significantly regarding the effects of chronic pain on their sleep, referral to a physician, and drug consumption to alleviate their pain. The IMA group experienced more complications at work and during their occupational activity.
The rate and severity of chronic pain after cardiac surgery via sternotomy was higher in patients undergoing CABG with separation of IMA for revascularization.
据报道，心脏手术后慢性疼痛的患病率在17%至56%之间。
我们旨在比较使用乳内动脉（IMA）进行冠状动脉旁路移植术（CABG）的患者与接受其他心脏手术（包括使用大隐静脉进行CABG或心脏瓣膜手术）的患者术后疼痛的患病率。
在这项队列研究中，对188例患者的病历进行了评估，并将其分为两组（每组94例）；使用IMA进行CABG的患者（IMA组）和使用大隐静脉进行其他心脏手术或进行其他心脏瓣膜手术的患者（非IMA组）。患者的数据记录在一份自行编制的问卷中，然后在手术后3个月进行电话访谈，了解术后疼痛发生率。慢性疼痛的严重程度根据数字评分疼痛量表进行评定。
两组在疼痛患病率方面存在显著差异（P = 0.023）。IMA组中有83例（88.3%）患者经历了持续超过三个月的疼痛，而非IMA组中有71例（75.5%）患者。两组在胸骨切开术后心脏手术慢性疼痛的严重程度方面存在显著差异（P = 0.001）。两组在慢性疼痛对其睡眠、就医及使用药物缓解疼痛方面的影响上无显著差异。IMA组在工作和职业活动中经历了更多并发症。
在进行IMA分离以实现血运重建的CABG患者中，胸骨切开术后心脏手术慢性疼痛的发生率和严重程度更高。
