Bollmann A, Marx A, Sathavorn C, Mera F, DeLurgio D, Walter P F, Langberg J J
Section of Cardiac Electrophysiology, Cardiology Division, Emory University Hospital, Atlanta, Georgia, USA.
Pacing Clin Electrophysiol. 1999 Jan;22(1 Pt 2):212-5. doi: 10.1111/j.1540-8159.1999.tb00335.x.
The miniaturization of implantable cardioverter defibrillators (ICDs) has made pectoral implantation possible. However, postoperative pain following the procedure has not been systematically studied. The aim of the current study was to prospectively assess patient discomfort and identify factors influencing pain perception during follow-up.
Pain related to device implantation was quantified in 21 consecutive patients (age, 61 +/- 11 years; 17 men and 21 women; 16 of 21 had coronary artery disease; left ventricular ejection fraction, 32% +/- 15%) undergoing pectoral ICD implantation with conscious sedation (fentanyl 118 +/- 72 micrograms midazolam 14 +/- 9 mg). Patients completed the Visual Analogue Scale (VAS, 0-100) and the McGill Pain Questionnaire 24 hours and 1 month postoperatively. Regression analysis was used to define clinical and procedure related variables affecting patient discomfort and frequency of postoperative analgesic use.
The mean VAS score was 34 +/- 20 24 hours postoperatively. A single (4.8%) patient described postoperative pain as severe. Pain was reported to be moderate by 10 (47.6%) patients and mild by 10 (47.6%) patients. Intraoperative fentanyl requirement was a predictor of postoperative pain (R = 0.51, P = 0.036), and procedural duration was a strong predictor of postoperative analgesic use (R = 0.75, P < 0.001). Pain at 1 month decreased to a VAS score of 19 +/- 18 (P = 0.002 vs 24 hours) and was rated to be severe, moderate, and mild by 1, 3, and 17 patients, respectively. Late pain was related to a VAS score at 24 hours (R = 0.67, P = 0.004).
(1) Pectoral ICD implantation using conscious sedation is well tolerated. (2) Postoperative discomfort correlates with longer procedural times and larger intraoperative narcotic requirements.
植入式心脏复律除颤器（ICD）的小型化使得经胸植入成为可能。然而，该手术后的疼痛尚未得到系统研究。本研究的目的是前瞻性评估患者的不适情况，并确定随访期间影响疼痛感知的因素。
对21例连续接受经胸ICD植入术并采用清醒镇静（芬太尼118±72微克，咪达唑仑14±9毫克）的患者（年龄61±11岁；男性17例，女性21例；21例中有16例患有冠状动脉疾病；左心室射血分数32%±15%）与设备植入相关的疼痛进行量化。患者在术后24小时和1个月完成视觉模拟评分（VAS，0 - 100）和麦吉尔疼痛问卷。采用回归分析来确定影响患者不适和术后镇痛药物使用频率的临床及手术相关变量。
术后24小时VAS评分的平均值为34±20。仅有1例（4.8%）患者称术后疼痛严重。10例（47.6%）患者报告疼痛为中度，10例（47.6%）患者报告疼痛为轻度。术中芬太尼需求量是术后疼痛的一个预测因素（R = 0.51，P = 0.036），手术持续时间是术后镇痛药物使用的一个强预测因素（R = 0.75，P < 0.001）。1个月时疼痛降至VAS评分为19±18（与24小时相比，P = 0.002），分别有1例、3例和17例患者将疼痛评为严重、中度和轻度。晚期疼痛与24小时时的VAS评分相关（R = 0.67，P = 0.004）。
（1）采用清醒镇静进行经胸ICD植入耐受性良好。（2）术后不适与手术时间延长和术中麻醉药物需求量增加相关。
