Roca J, Valero R, Gomar C
Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, España.
Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Universidad de Barcelona, Barcelona, España.
Rev Esp Anestesiol Reanim. 2017 Aug-Sep;64(7):391-400. doi: 10.1016/j.redar.2017.01.002. Epub 2017 Feb 22.
Postoperative pain after cardiac surgery (CS) can be generated at several foci besides the sternotomy.
Prospective descriptive longitudinal study on the chronological evolution of pain in 11 sites after CS including consecutive patients submitted to elective CS through sternotomy. The primary endpoints were to establish the main origins of pain, and to describe its chronological evolution during the first postoperative week. Secondary endpoints were to describe pain characteristics in the sternotomy area and to correlate pain intensity with other variables. Numerical Pain Rating Scale from 0 to 10 at rest and at movement on postoperative days 1, 2, 4 and 6. Numerical Pain Rating Scale>3 was considered moderate pain. Statistical analysis consisted in Mann-Whitney U-test, a Chi-squared, a Fisher exact text and Pearson's correlations.
Forty-seven patients were enrolled. In 4 of 11 locations pain was reported as Numerical Pain Rating Scale>3 (sternotomy, oropharynx, saphenectomy and musculoskeletal pain in the back and shoulders). Maximum intensity of pain on postoperative days 1 and 2 was reported in the sternotomy area, while on postoperative days 4 and 6 it was reported at the saphenectomy. Pain at rest and at movement differed considerably in the sternotomy, saphenectomy and oropharynx. Pain at back and shoulders and at central venous catheter entry were not influenced by movement. Pain in the sternotomy was mainly described as oppressive. Patients with arthrosis and younger patients presented higher intensity of pain (P=.004; P=.049, respectively).
Four locations were identified as the main sources of pain after CS: sternotomy, oropharynx, saphenectomy, and back and shoulders. Pain in different focuses presented differences in chronologic evolution and was differently influenced by movement.
心脏手术后（CS）的术后疼痛除胸骨切开部位外还可在多个部位产生。
对CS术后11个部位疼痛的时间演变进行前瞻性描述性纵向研究，纳入通过胸骨切开术接受择期CS的连续患者。主要终点是确定疼痛的主要来源，并描述术后第一周内疼痛的时间演变。次要终点是描述胸骨切开部位的疼痛特征，并将疼痛强度与其他变量相关联。在术后第1、2、4和6天，采用0至10的数字疼痛评分量表评估静息和活动时的疼痛。数字疼痛评分量表>3被认为是中度疼痛。统计分析包括曼-惠特尼U检验、卡方检验、费舍尔精确检验和皮尔逊相关性分析。
共纳入47例患者。在11个部位中的4个部位，疼痛被报告为数字疼痛评分量表>3（胸骨切开部位、口咽、大隐静脉切除术部位以及背部和肩部的肌肉骨骼疼痛）。术后第1天和第2天疼痛强度最高的部位是胸骨切开部位，而术后第4天和第6天是大隐静脉切除术部位。胸骨切开部位、大隐静脉切除术部位和口咽部位静息和活动时的疼痛差异很大。背部和肩部以及中心静脉导管穿刺部位的疼痛不受活动影响。胸骨切开部位的疼痛主要描述为压迫性。患有关节病的患者和年轻患者的疼痛强度更高（分别为P = 0.004；P = 0.049）。
确定了CS术后疼痛的四个主要来源部位：胸骨切开部位、口咽、大隐静脉切除术部位以及背部和肩部。不同部位的疼痛在时间演变上存在差异，并且受活动的影响也不同。
