Department of Physiotherapy, Hospital Canselor Tunku Mukhriz, University, Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia; Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia.
Department of Nursing and Allied Health, School of Health Sciences, Swinburne University of Technology, Hawthorn, Australia; Department of Surgery, Melbourne Medical School, The University of Melbourne, Parkville, Australia; Australian Director, Outcomes Research Consortium, Cleveland Clinic, Cleveland, USA.
Heart Lung Circ. 2021 Aug;30(8):1232-1243. doi: 10.1016/j.hlc.2020.12.009. Epub 2021 Feb 16.
To investigate the specific clinical features of pain following cardiac surgery and evaluate the information derived from different pain measurement tools used to quantify and describe pain in this population.
A prospective observational study was undertaken at two tertiary care hospitals in Australia. Seventy-two (72) adults (mean age, 63±11 years) were included following cardiac surgery via a median sternotomy. Participants completed the Patient Identified Cardiac Pain using numeric and visual prompts (PICP), the McGill Pain Questionnaire-Short Form version 2 (MPQ-2) and the Medical Outcome Study 36-item version 2 (SF-36v2) Bodily Pain domain (BP), which were administered prior to hospital discharge, 4 weeks and 3 months postoperatively.
Participants experienced a high incidence of mild (n=45, 63%) to moderate (n=22, 31%) pain prior to discharge, which reduced at 4 weeks postoperatively: mild (n=28, 41%) and moderate (n=5, 7%) pain; at 3 months participants reported mild (n=14, 20%) and moderate (n=2, 3%) pain. The most frequent location of pain was the anterior chest wall, consistent with the location of the surgical incision and graft harvest. Most participants equated "pressure/weight" to "aching" or a "heaviness" in the chest region (based on descriptor of pain in the PICP) and the pain topography was persistent at 4 weeks and 3 months postoperatively. Each pain measurement tool provided different information on pain location, severity and description, with significant change (p<0.005) over time.
Mild-to-moderate pain was frequent after sternotomy, improved over time and was mostly located over the incision and mammary (internal thoracic) artery harvest site. Persistent pain at 3 months remained a significant problem in the community within this surgical population.
调查心脏手术后疼痛的具体临床特征，并评估用于量化和描述该人群疼痛的不同疼痛测量工具所提供的信息。
在澳大利亚的两家三级保健医院进行了一项前瞻性观察研究。经正中胸骨切开术后，纳入 72 名（72 名成人；平均年龄，63±11 岁）成年人。参与者在出院前、术后 4 周和 3 个月时完成了患者识别的心脏疼痛（使用数字和视觉提示的 PICP）、麦吉尔疼痛问卷-简短形式 2 版（MPQ-2）和医疗结果研究 36 项简短形式 2 版（SF-36v2）身体疼痛域（BP）。
参与者在出院前经历了较高的轻度（n=45，63%）到中度（n=22，31%）疼痛发生率，术后 4 周时疼痛减轻：轻度（n=28，41%）和中度（n=5，7%）疼痛；在 3 个月时，参与者报告轻度（n=14，20%）和中度（n=2，3%）疼痛。疼痛最常见的部位是前胸壁，与手术切口和移植物采集的位置一致。大多数参与者将“压力/重量”等同于“疼痛”或胸部区域的“沉重感”（基于 PICP 中疼痛描述），并且在术后 4 周和 3 个月时疼痛的位置仍然持续。每种疼痛测量工具都提供了关于疼痛位置、严重程度和描述的不同信息，并且随着时间的推移有显著变化（p<0.005）。
胸骨切开术后常出现轻至中度疼痛，随时间改善，主要位于切口和乳房（胸内）动脉采集部位。在该手术人群的社区中，3 个月时仍存在持续性疼痛是一个重大问题。
