成人心脏瓣膜置换术后疼痛及影响因素的临床研究  

Clinical study of pain and its influencing factors after cardiac valve replacement in adults

作　　者：李燚 张永恒[1] 唐龙[1] 刘建平[1] 马蓉[1] 唐小娇 LI Yi;ZHANG Yongheng;TANG Long;LIU Jianping;MA Rong;TANG Xiaojiao(Department of Cardiovascular Surgery,Suining Central Hospital,Suining 629000,Sichuan,China)

机构地区：[1]遂宁市中心医院心脏大血管外科,四川遂宁629000

出　　处：《西部医学》2025年第3期382-386,392,共6页Medical Journal of West China

基　　金：四川省卫生健康委员会科研课题(19PJ284)。

摘　　要：目的调查心脏瓣膜置换术后不同阶段患者疼痛发生情况,探讨术后不同阶段疼痛影响因素,为临床制定更精准化、个体化的疼痛管理方案提供参考证据。方法选取2020年1月—2021年7月遂宁市中心医院心脏大血管外科收治的行人工心脏瓣膜置换术的患者160例,有计划地收集患者围手术期资料;使用状态焦虑量表(SAI)调查患者术前1 d的焦虑程度;使用数字评定量表(NRS)和简明疼痛量表(BPI)评估患者术后疼痛发生情况;根据术后不同阶段(1、3、6月)是否发生疼痛分为疼痛组和无疼痛组,分析术后不同时间点疼痛影响因素。结果心脏瓣膜置换术后不同时间点疼痛发生率差异有统计学意义(P<0.001),总体呈下降趋势。术后1月单因素分析显示,年龄、糖尿病、术前1 d焦虑程度、术中瑞芬太尼使用量、胸骨固定材料、术后3 d急性疼痛是术后疼痛的相关性因素(P<0.05);多因素Logistic回归分析显示,年龄、术前1 d焦虑程度、胸骨固定材料是术后疼痛的独立影响因素(P<0.05)。术后3月单因素分析显示,年龄、术前1 d焦虑程度、术中瑞芬太尼使用量、体外循环时间、术后3 d急性疼痛是术后疼痛的相关性因素(P<0.05);多因素Logistic回归分析显示,年龄、术中瑞芬太尼使用量、术后3 d急性疼痛是术后疼痛的独立影响因素(P<0.05)。术后6月单因素分析显示,年龄、术前1 d焦虑程度、术中瑞芬太尼使用量、术后3 d急性疼痛是术后疼痛的相关性因素(P<0.05);多因素Logistic回归分析显示,术前1 d焦虑程度、术中瑞芬太尼使用量、术后3 d急性疼痛是术后疼痛的独立影响因素(P<0.05)。结论多数心脏瓣膜置换术后患者在各时间点均存在不同程度的疼痛,随着患者术后康复的推进,术后不同时间点总体疼痛发生率呈现逐渐降低的趋势。年龄、术前1 d焦虑程度、术中瑞芬太尼使用量、胸骨固定材料及术后3 d急性疼痛�Objective To investigate the occurrence of pain in patients at different stages after cardiac valve replacement,and explore the influencing factors of pain in different stages after surgery,so as to provide reference evidence for the clinical development of more accurate and individual pain management programs.Methods A total of 160 patients who underwent artificial heart valve replacement in the Department of Cardiovascular Surgery of Suining Central Hospital from January 2020 to July 2021 were selected,and the patients’perioperative data were collected in a systematic manner.The State Anxiety Inventory(SAI)was used to investigate the degree of anxiety 1 day before surgery.Numerical Rating Scale(NRS)and Brief Pain Inventory(BPI)was used to evaluate the incidence of postoperative pain.The subjects were divided into two groups according to whether pain occurred,to explore the influencing factors of pain at different time points after surgery.Results The incidence of pain at different time points after cardiac valve replacement showed a statistically significant difference(P<0.001),and the overall trend was downward.Univariate analysis of 1 month after surgery showed that age,diabetes,anxiety level 1 day before surgery,amount of remifentanil used during surgery,sternal fixation materials and acute pain 3 days after surgery were the correlation factors of postoperative pain(P<0.05).Multivariate logistic regression analysis showed that age,anxiety level 1 day before surgery and sternal fixation materials were independent influencing factors of postoperative pain(P<0.05).Age,anxiety level 1 day before surgery,amount of remifentanil used during surgery,CPB time,and acute pain 3 days after surgery were found to be correlation factors of postoperative 3 months pain(P<0.05).Multivariate logistic regression analysis showed that age,the amount of remifentanil used during operation,and acute pain 3 days after operation were independent influencing factors of postoperative pain(P<0.05).At 6 months after surgery univariate a

关 键 词：心脏瓣膜病 加速康复外科 术后疼痛 疼痛发生率 影响因素 

分 类 号：R654.2[医药卫生—外科学]