Marcassa Claudio, Faggiano Pompilio, Greco Cesare, Ambrosetti Marco, Temporelli Pier Luigi
aSalvatore Maugeri Foundation, IRCCS, Division of Cardiac Rehabilitation, Scientific Institute of Veruno (NO) bDivision of Cardiology, Spedali Civili, University of Brescia, Brescia cSan Giovanni-Addolorata Hospital Complex, Division of Cardiology III, Rome dCardiovascular Rehabilitation Unit, Le Terrazze Clinic, Cunardo (VA), Italy.
J Cardiovasc Med (Hagerstown). 2015 Nov;16(11):768-74. doi: 10.2459/JCM.0000000000000271.
There are limited data on sternotomy as a cause of chronic postsurgical pain, mainly restricted to 1 year after surgery.
To assess the prevalence of chronic post-sternotomy pain and its interference on daily living.
In three groups of patients, a standardized telephone interview was obtained at 3 months (n = 313), 1 year (n = 313), and 3 years (n = 319) following the rehabilitation program after cardiac surgery, in 11 rehabilitation centers. Presence, site, and the severity and interference of pain on selected daily living items were assessed.
The prevalence of pain after cardiac surgery was 35.3% in the 3-month group, 26.8% in the 1-year group, and 19.8% in the 3-year group (P < 0.0001). Pain in the 3-year group was rated as moderate to severe in one-third of the patients. In patients aged above 75 years, the prevalence of pain in the 3-month and the 3-year group was nonsignificantly different [34.2 and 29.3%, respectively (NS)]. In the 3-month group, pain was more frequent in the female (51.4%) than in the male patients (31.3%; P < 0.01); in the remaining groups, a comparable prevalence was documented.
Results form this large, retrospective, multicenter survey indicated that one out of five patients still complain pain at 3 years after cardiac surgery; persistence of pain was more common in the older patients. The approach to management of chronic pain by cardiologists and cardiac surgeons should be improved.
关于胸骨切开术作为慢性术后疼痛病因的数据有限,主要局限于术后1年。
评估慢性胸骨切开术后疼痛的患病率及其对日常生活的干扰。
在11个康复中心,对三组患者在心脏手术后康复计划后的3个月(n = 313)、1年(n = 313)和3年(n = 319)进行标准化电话访谈。评估疼痛的存在、部位、严重程度以及对选定日常生活项目的干扰。
心脏手术后疼痛的患病率在3个月组为35.3%,1年组为26.8%,3年组为19.8%(P < 0.0001)。3年组中三分之一的患者疼痛被评为中度至重度。在75岁以上的患者中,3个月组和3年组的疼痛患病率无显著差异[分别为34.2%和29.3%(无统计学意义)]。在3个月组中,女性(51.4%)疼痛比男性患者(31.3%)更频繁(P < 0.01);在其余组中,记录的患病率相当。
这项大型回顾性多中心调查的结果表明,五分之一的患者在心脏手术后3年仍抱怨疼痛;疼痛持续在老年患者中更常见。心脏病专家和心脏外科医生对慢性疼痛的管理方法应予以改进。