微创主动脉手术后疼痛、焦虑抑郁及生活质量的评估

Assessment of pain, anxiety and depression, and quality of life after minimally invasive aortic surgery.

作者信息

Sicouri Serge, Shah Vishal N, Orlov Cinthia P, Buckley Meghan, Dedeilia Katerina, Plestis Konstadinos A

机构信息

Lankenau Institute for Medical Research, Wynnewood, Pennsylvania, USA.

Department of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA.

出版信息

J Card Surg. 2021 Mar;36(3):886-893. doi: 10.1111/jocs.15320. Epub 2021 Jan 13.

DOI:10.1111/jocs.15320

PMID:33442874

Abstract

BACKGROUND

Minimally invasive cardiac surgery may reduce surgical trauma, diminish postoperative pain and improve quality of life (QOL). The aim of this study is to assess pain, hospital anxiety and depression scale (HADS), and QOL in patients undergoing minimally invasive aortic surgery.

METHODS

This is a prospective, single-center cohort study of 24 consecutive patients undergoing upper ministernotomy aortic valve, aortic root, and concomitant aortic valve and ascending aorta replacement. Visual analog scale (VAS) pain scores and HADS and Short-Form-36 (SF-36) questionnaires were evaluated at preoperative baseline, during hospitalization, and at 1 and 3 months postoperatively.

RESULTS

At discharge, the average VAS pain score was significantly lower than postoperative Day 1 (2.7 ± 0.4 vs. 6.5 ± 0.4; p ≤ .001). By 1 month, the pain scores were not significantly different from baseline (1.7 ± 0.4 vs. 1.0 ± 0.4; p = 1.000), and by 3 months, pain scores returned to baseline (1.0 ± 0.4; p = 1.000). HADS scores show that compared with preoperative baseline, average anxiety scores decreased by 1 month (3.1 ± 0.7 vs. 4.3 ± 0.6; p = 1.000) and decreased significantly by 3 months (1.8 ± 0.7 vs. 4.3 ± 0.6; p = .012). Additionally, depression scores were unchanged at 1 month (3.0 ± 0.4 vs. 3.1. ± 0.4; p = 1.000) and decreased by 3 months (1.3 ± 0.5 vs. 3.0 ± 0.4; p = .060). SF-36 scores revealed no changes in scores in 7 of 8 domains at 1 month and a significant increase in "physical functioning," "energy," and "general health" domains compared to preoperative baseline at 3 months.

CONCLUSIONS

Following minimally invasive aortic surgery, VAS pain scores, HADS and scores in 7 of 8 SF-36 domains returned to preoperative baseline or improved compared to preoperative baseline at 1 month. At 3 months, scores in 3 of 8 SF-36 domains significantly improved compared to preoperative baseline. Larger studies are necessary for further investigation.

摘要

背景

微创心脏手术可减少手术创伤，减轻术后疼痛并改善生活质量（QOL）。本研究的目的是评估接受微创主动脉手术患者的疼痛、医院焦虑抑郁量表（HADS）及生活质量。

方法

这是一项前瞻性、单中心队列研究，纳入连续24例接受上半胸骨切开主动脉瓣、主动脉根部以及同期主动脉瓣和升主动脉置换术的患者。在术前基线、住院期间以及术后1个月和3个月时，评估视觉模拟量表（VAS）疼痛评分、HADS及简明健康状况调查量表（SF-36）问卷。

结果

出院时，平均VAS疼痛评分显著低于术后第1天（2.7±0.4 vs. 6.5±0.4；p≤0.001）。到1个月时，疼痛评分与基线无显著差异（1.7±0.4 vs. 1.0±0.4；p = 1.000），到3个月时，疼痛评分恢复至基线水平（1.0±0.4；p = 1.000）。HADS评分显示，与术前基线相比，平均焦虑评分在1个月时下降（3.1±0.7 vs. 4.3±0.6；p = 1.000），在3个月时显著下降（1.8±0.7 vs. 4.3±0.6；p = 0.012）。此外，抑郁评分在1个月时无变化（3.0±0.4 vs. 3.1±0.4；p = 1.000），在3个月时下降（1.3±0.5 vs. 3.0±0.4；p = 0.060）。SF-36评分显示，1个月时8个领域中的7个领域评分无变化，3个月时与术前基线相比，“身体功能”“精力”和“总体健康”领域评分显著增加。