【罂粟摘要】急性术后疼痛与非心脏手术后的心肌损伤有关
急性术后疼痛与非心脏手术后的心肌损伤有关
背景：非心脏手术后无法控制的疼痛激活交感神经系统，导致心动过速、高血压和心脏收缩力增加，所有这些都可能增加心肌氧需求。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后的心肌损伤(MINS)有关。
方法：我们对2012年1月至2015年12月在克利夫兰三级中心进行的普通、区域或联合麻醉下非心脏手术后常规术后肌钙蛋白监测的成人进行了回顾性队列分析。从所有可用的疼痛评分中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。术后72小时内肌钙蛋白T浓度峰值超过0.03 ng/mL即可诊断为MINS。我们使用一个广义线性混合模型来评估疼痛和MINS之间的联系，以3家医院为集群，调整潜在的混杂因素。
结果：2892例符合条件的患者中，4.5%的患者在术后72小时内出现心肌损伤。时间加权平均疼痛评分的增高与心肌损伤风险的增加有关。调整混杂变量后，疼痛评分增加1个单位的估计危险比为1.12(95%置信区间[CI], 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。
Acute Postoperative Pain Is Associated With Myocardial Injury After Noncardiac Surgery
BACKGROUND: Uncontrolled pain after noncardiac surgery activates the sympathetic ner-vous 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 myo-cardial 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 aver-age 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. (Anesth Analg 2020;131:822–9)
翻译：黄岁岁 编辑：佟睿 审校：曹莹
贵州医科大学 高鸿教授课题组