文献检索文档翻译深度研究
Suppr Zotero 插件Zotero 插件
邀请有礼套餐&价格历史记录

新学期,新优惠

限时优惠:9月1日-9月22日

30天高级会员仅需29元

1天体验卡首发特惠仅需5.99元

了解详情
不再提醒
插件&应用
Suppr Zotero 插件Zotero 插件浏览器插件Mac 客户端Windows 客户端微信小程序
高级版
套餐订阅购买积分包
AI 工具
文献检索文档翻译深度研究
关于我们
关于 Suppr公司介绍联系我们用户协议隐私条款
关注我们

Suppr 超能文献

核心技术专利:CN118964589B侵权必究
粤ICP备2023148730 号-1Suppr @ 2025

心脏手术后的疼痛轨迹:对测量、报告和个体化治疗的影响。

Trajectories of Pain After Cardiac Surgery: Implications for Measurement, Reporting, and Individualized Treatment.

机构信息

Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT (M.M., C.B., P.D., A.G.), Yale School of Medicine, New Haven, CT.

Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (M.M., Y.L., E.S.S., H.M.K.).

出版信息

Circ Cardiovasc Qual Outcomes. 2021 Aug;14(8):e007781. doi: 10.1161/CIRCOUTCOMES.120.007781. Epub 2021 Jul 26.


DOI:10.1161/CIRCOUTCOMES.120.007781
PMID:34304586
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8366534/
Abstract

BACKGROUND: Postoperative pain after cardiac surgery is a significant problem, but studies often report pain value as an average of the study cohort, obscuring clinically meaningful differences in pain trajectories. We sought to characterize heterogeneity in postoperative pain experiences. METHODS: We enrolled patients undergoing a cardiac surgery at a tertiary care center between January 2019 and February 2020. Participants received an electronically-delivered questionnaire every 3 days for 30 days to assess incision site pain level. We evaluated the variability in pain trajectories over 30 days by the cohort-level mean with confidence band and latent classes identified by group-based trajectory model. Group-based trajectory model estimated the probability of belonging to a specific trajectory of pain. RESULTS: Of 92 patients enrolled, 75 provided ≥3 questionnaire responses. The cohort-level mean showed a gradual and consistent decline in the mean pain level, but the confidence bands covered most of the pain score range. The individual-level trajectories varied substantially across patients. Group-based trajectory model identified 4 pain trajectories: persistently low (n=9, 12%), moderate declining (initially mid-level, followed by decline; n=26, 35%), high declining (initially high-level, followed by decline; n=33, 44%), and persistently high pain (n=7, 9%). Persistently high pain and high declining groups did not seem to be clearly distinguishable until approximately postoperative day 10. Patients in persistently low pain trajectory class had a numerically lower median age than the other 3 classes and were below the lower confidence band of the cohort-level approach. Patients in the persistently high pain trajectory class had a longer median length of hospital stay than the other 3 classes and were often higher than the upper confidence band of the cohort-level approach. CONCLUSIONS: We identified 4 trajectories of postoperative pain that were not evident from a cohort-level mean, which has been a common way of reporting pain level. This study provides key information about the patient experience and indicates the need to understand variation among sites and surgeons and to investigate determinants of different experience and interventions to mitigate persistently high pain.

摘要

背景:心脏手术后的疼痛是一个严重的问题,但研究通常报告研究队列的平均疼痛值,掩盖了疼痛轨迹的临床有意义的差异。我们试图描述术后疼痛体验的异质性。

方法:我们招募了 2019 年 1 月至 2020 年 2 月期间在一家三级保健中心接受心脏手术的患者。参与者在术后 30 天内每隔 3 天接受一次电子问卷调查,以评估切口疼痛程度。我们通过队列水平均值的置信带和基于群组的轨迹模型确定的潜在类别来评估 30 天内疼痛轨迹的变异性。基于群组的轨迹模型估计属于特定疼痛轨迹的概率。

结果:在 92 名入组患者中,75 名患者提供了≥3 次问卷回复。队列水平均值显示疼痛水平逐渐持续下降,但置信带涵盖了大部分疼痛评分范围。个体水平的轨迹在患者之间差异很大。基于群组的轨迹模型确定了 4 种疼痛轨迹:持续低水平(n=9,12%)、逐渐下降(初始中等水平,随后下降;n=26,35%)、高水平下降(初始高水平,随后下降;n=33,44%)和持续高水平疼痛(n=7,9%)。直到术后大约第 10 天,持续高水平疼痛和高水平下降组似乎还没有明显区分开来。持续低水平疼痛轨迹类别的患者年龄中位数明显低于其他 3 个类别,且低于队列水平方法的置信带下限。持续高水平疼痛轨迹类别的患者住院时间中位数明显长于其他 3 个类别,且经常高于队列水平方法的置信带上限。

结论:我们发现了 4 种术后疼痛轨迹,这在队列水平平均值中并不明显,这是一种常见的报告疼痛水平的方法。本研究提供了关于患者体验的关键信息,并表明需要了解不同部位和外科医生之间的差异,并研究不同体验的决定因素和缓解持续高水平疼痛的干预措施。

相似文献

[1]
Trajectories of Pain After Cardiac Surgery: Implications for Measurement, Reporting, and Individualized Treatment.

Circ Cardiovasc Qual Outcomes. 2021-8

[2]
Effect of acute postsurgical pain trajectories on 30-day and 1-year pain.

PLoS One. 2022

[3]
Association of Early Postoperative Pain Trajectories With Longer-term Pain Outcome After Primary Total Knee Arthroplasty.

JAMA Netw Open. 2019-11-1

[4]
Acute postoperative pain impact trajectories and factors contributing to trajectory membership.

Pain Med. 2023-7-5

[5]
Trajectories of opioid consumption from day of surgery to 28 days postoperatively: a prospective cohort study in patients undergoing abdominal, joint, or spine surgery.

Reg Anesth Pain Med. 2021-12

[6]
Distinguishing problematic from nonproblematic postsurgical pain: a pain trajectory analysis after total knee arthroplasty.

Pain. 2015-3

[7]

2017-8-25

[8]
Associations of physical activity participation trajectories with subsequent motor function declines and incident frailty: A population-based cohort study.

Front Psychiatry. 2022-10-26

[9]
Pain trajectories after bilateral orthotopic lung transplantation surgery performed via a clamshell incision.

Clin Transplant. 2024-2

[10]
Can Patients Forecast Their Postoperative Disability and Pain?

Clin Orthop Relat Res. 2019-3

引用本文的文献

[1]
The Effect of Perineural Adjuvants on Superficial Parasternal Intercostal Plane Blocks in Cardiac Surgery: A Triple-Blinded Randomized Controlled Feasibility Trial.

Cureus. 2024-12-18

[2]
Efficacy of parasternal peripheral nerve catheters no block for median sternotomy: a single-centre retrospective study.

BJA Open. 2024-6-20

[3]
Continuous Bilateral Transversus Thoracicmuscle Plane Block: An Analgesia Boon for Scoliotic Patients Undergoing Cardiac Surgery.

Ann Card Anaesth. 2024-1-1

[4]
Pain Trajectory after Short-Stay Anorectal Surgery: A Prospective Observational Study.

J Pers Med. 2023-3-15

[5]
Characterization of multi-domain postoperative recovery trajectories after cardiac surgery using a digital platform.

NPJ Digit Med. 2022-12-24

本文引用的文献

[1]
Protocol for project recovery after cardiac surgery: a single-center cohort study leveraging digital platform to characterise longitudinal patient-reported postoperative recovery patterns.

BMJ Open. 2020-9-1

[2]
Using Latent Class Analysis to Identify Hidden Clinical Phenotypes.

JAMA. 2020-8-18

[3]
Development of Persistent Opioid Use After Cardiac Surgery.

JAMA Cardiol. 2020-8-1

[4]
Opioid use trajectories after thoracic surgery among veterans in the United States.

Eur J Pain. 2020-9

[5]
The Evolving Burden of Drug Use Associated Infective Endocarditis in the United States.

Ann Thorac Surg. 2020-5-6

[6]
Trajectories of Pain in Patients Undergoing Lung Cancer Surgery: A Longitudinal Prospective Study.

J Pain Symptom Manage. 2020-4

[7]
Characterizing Patient-Centered Postoperative Recovery After Adult Cardiac Surgery: A Systematic Review.

J Am Heart Assoc. 2019-10-16

[8]
Risk of reoperative valve surgery for endocarditis associated with drug use.

J Thorac Cardiovasc Surg. 2019-7-10

[9]
The influence of prolonged intensive care stay on quality of life, recovery, and clinical outcomes following cardiac surgery: A prospective cohort study.

J Thorac Cardiovasc Surg. 2018-6-5

[10]
Association Between Functional Health Literacy and Postoperative Recovery, Health Care Contacts, and Health-Related Quality of Life Among Patients Undergoing Day Surgery: Secondary Analysis of a Randomized Clinical Trial.

JAMA Surg. 2018-8-1

文献AI研究员

20分钟写一篇综述,助力文献阅读效率提升50倍

立即体验

用中文搜PubMed

大模型驱动的PubMed中文搜索引擎

马上搜索

推荐工具

医学文档翻译智能文献检索