非复杂型电生理研究和心脏节律装置手术中的疼痛。
Pain During "Noncomplex" Electrophysiological Studies and Cardiac Rhythm Device Surgery.
机构信息
Sven Fikenzer, PhD, MSc Scientist, Medical Department IV-Cardiology, University of Leipzig Medical Center, Germany. Kati Fikenzer, MD Senior Physician, Medical Department IV-Cardiology, University of Leipzig Medical Center, Germany. Yvonne Bauer Pain Nurse, Department of Anesthesia, Heart Center Leipzig, Germany. Michael Kuehl, MD Senior Physician, Department of Cardiology, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom. Gerhard Hindricks, MD Professor, Head, Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Germany. Andreas Bollmann, MD Professor, Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Germany. Kerstin Bode, MD, MSc Senior Physician, Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Germany.
出版信息
J Cardiovasc Nurs. 2019 Nov/Dec;34(6):517-527. doi: 10.1097/JCN.0000000000000601.
BACKGROUND
There are only limited data about peri-interventional pain during cardiac electrophysiological procedures without analgosedation. In this study, peri-interventional pain and recollection of it after the intervention were evaluated.
METHODS
A total of 101 patients (43 electrophysiological/ablation procedures and 58 device surgeries) reported pain on a numerical rating scale (NRS; 0-10) before (pre), during (peri), and after (post) the intervention. Maximum pain (maxNRS) and the average of pain (meanNRS) were used for statistical analysis. Peri-interventional pain was compared with postinterventional data of the recollection of peri-interventional pain (peri-post). Patients were allocated into 2 groups (with 51 and 50 patients, respectively) to evaluate the mode of patient-staff interaction on pain recollection. Depressive, anxiety, and somatic symptom scales (Patient Health Questionnaire-15, Generalized Anxiety Disorder-7, and Patient Health Questionnaire-15) were used to analyze their influence on pain recollection.
RESULTS
In total, 49.6% of patients (n = 50) complained of moderate to severe pain (maxNRS) at least once during the procedure. The comparison between peri and peri-post data revealed the following (median (range)-maxNRS, peri: 3 (0-10) versus peri-post: 4 (0-9) (ns), and meanNRS, peri: 1.4 (0-7) versus peri-post: 2.0 (0-6) (ns). The mode of patient-staff interaction had no influence on pain. No effect was found for psychosocial factor concerning pain and the recollection of pain. The results of the linear regression showed no influence of low-dose midazolam on recollection of pain.
CONCLUSION
Half of the patients reported moderate to severe pain at least once during cardiac electrophysiological procedures without analgosedation. However, on average, patients reported only low pain levels. Postinterventional derived data on discomfort reflect the peri-interventional situation.
背景
在无镇静的情况下，心脏电生理程序期间的围手术期疼痛数据有限。本研究评估了介入期间和介入后的围手术期疼痛和回忆情况。
方法
共有 101 例患者（43 例电生理/消融术和 58 例器械手术）在干预前（pre）、期间（peri）和后（post）用数字评分量表（NRS；0-10）报告疼痛。最大疼痛（maxNRS）和平均疼痛（meanNRS）用于统计分析。将围手术期疼痛与回忆围手术期疼痛的术后数据（peri-post）进行比较。将患者分为 2 组（每组 51 例和 50 例），以评估患者与医务人员互动模式对疼痛回忆的影响。使用抑郁、焦虑和躯体症状量表（患者健康问卷-15、广泛性焦虑障碍-7 和患者健康问卷-15）分析其对疼痛回忆的影响。
结果
总共有 49.6%的患者（n=50）在手术过程中至少有一次抱怨中度至重度疼痛（maxNRS）。围手术期和围手术期后数据的比较如下（中位数（范围）-maxNRS，peri：3（0-10）与 peri-post：4（0-9）（无统计学差异），meanNRS，peri：1.4（0-7）与 peri-post：2.0（0-6）（无统计学差异）。患者与医务人员互动模式对疼痛无影响。疼痛和疼痛回忆的心理社会因素没有影响。线性回归结果显示，小剂量咪达唑仑对疼痛回忆无影响。
结论
在无镇静的情况下进行心脏电生理程序时，有一半的患者至少报告了一次中度至重度疼痛。然而，平均而言，患者报告的疼痛水平较低。术后不适数据反映了围手术期情况。
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