非心脏手术后的急性术后疼痛与心肌损伤有关
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非心脏手术后的急性术后疼痛与心肌损伤有关
翻译：任文鑫 编辑：冯玉蓉 审校：曹莹
背景：非心脏手术后无法控制的疼痛会激活交感神经系统，引起心动过速、高血压和心肌收缩力增加，这些因素可能增加心肌耗氧量。因此，我们确定了术后最初72小时的时间加权平均疼痛评分是否与非心脏手术(MINS)后的心肌损伤有关。
方法:我们对2012年1月至2015年12月克利夫兰三级中心非心脏手术后在全麻、区域麻醉或复合麻醉下常规监测肌钙蛋白的成人进行了回顾性队列分析。根据所有可用的疼痛评分计算时间加权平均疼痛评分，通常每隔4小时计算一次，直到检测到肌钙蛋白升高。MINS定义为术后72h内肌钙蛋白T峰值浓度超过0.03 ng/mL。我们使用一个广义线性混合模型来评估疼痛与MINS之间的关联，以3家医院为集群，调整潜在的混杂因素。
结果：在2892例符合条件的患者中，4.5%的患者术后72小时内有心肌损伤。时间加权平均疼痛评分越高，心肌损伤风险越高。经混杂变量调整后，疼痛评分每增加1个单位的风险比估计为1.12(95%可信区间，1.02-1.22；P=0.013)。
结论：在接受非心脏手术的患者中，术后72小时内的时间加权平均疼痛评分与心肌损伤显著相关。
文献来源：Alparslan Turan, Steve Leung, Gausan Ratna Bajracharya, et al.Acute Postoperative Pain Is Associated With Myocardial Injury After Noncardiac Surgery.Anesth Analg 2020;131:822–9.
Acute Postoperative Pain Is Associated With Myocardial Injury After Noncardiac Surgery
BACKGROUND: Uncontrolled pain after noncardiac surgery activates the sympathetic nervous system, which causes tachycardia, hypertension, and increased cardiac contractility—all of which may increase myocardial oxygen demand. We therefore determined whether time-weighted average pain scores over the initial 72 postoperative hours are associated with myocardial injury after noncardiac surgery (MINS).
METHODS: We conducted a retrospective cohort analysis of adults with routine postoperative troponin monitoring after noncardiac surgery under general, regional, or combined anesthesia at tertiary level centers in Cleveland from January 2012 to December 2015. Time-weighted average pain scores were calculated from all the available pain scores, typically at 4-hour intervals, until a troponin elevation was detected. MINS was defined as peak troponin T concentrations exceeding 0.03 ng/mL within 72 hours after surgery. We used a generalized linear mixed model to assess the association between pain and MINS with 3 hospitals as clusters, adjusting for
potential confounders.
RESULTS: Among 2892 eligible patients, 4.5% had myocardial injury within 72 hours after surgery. Higher time-weighted average pain scores were associated with increased hazard of myocardial injury. The estimated hazard ratio for a 1-unit increase in pain score was 1.12 (95% confidence interval [CI], 1.02–1.22; P = .013), adjusting for confounding variables.
CONCLUSIONS: Among patients undergoing noncardiac surgery, time-weighted average pain scores within 72 hours after surgery were significantly associated with myocardial injury
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