慢性神经肌肉骨骼疼痛是心脏直视手术(OHS)的重要并发症。为了更好地了解OHS后即刻神经肌肉骨骼疼痛的发展和自然过程,这项前瞻性纵向研究评估了疼痛和肩关节残疾的患病率和程度,以及OHS前后的疼痛区域。通常的医疗,护理,提供理疗护理,包括早期拔管,教育,走路,从床上坐下来,和上层,下肢,手术后第一天开始的躯干锻炼。在114名提供同意的选择性患者中,98名受试者进行了术前调查,在OHS后的第6周和第12周。开放式和封闭式问题包括各个身体部位的疼痛量表的数字评分,汇总为总疼痛评分(TPS)。肩关节残疾评分(SDS),行使合规性,和胸骨点击。通常的护理包括流动性锻炼,步行程序,和心脏康复转诊。调查回报率为100%,88%,82%,分别。在76名(78%)拥有完整数据集的受试者中,68%的受试者报告了术前神经肌肉骨骼损伤/疾病的病史,而神经肌肉骨骼疼痛的患病率为64%。88%,67%和38%,63%,42%为肩部残疾,在三项评估中。总之,11%的受试者在第6周报告胸骨点击,7%在第12周报告。术前疼痛通常发生在下背部和颈部,在胸部前面,脖子,胸腔,上背部,第六周左肩.到OHS后第12周,单独的肋骨笼疼痛仍明显高于术前水平。术前SDS与OHS后住院时间呈正相关;女性在第6周和第12周的SDS高于男性,第12周SDS与身高呈负相关。手术风险评分与术前至第12周的SDS和TPS变化呈负相关。总之,神经肌肉骨骼疼痛和肩关节残疾在术前很常见,而患病率在OHS后第6周增加,术前整体水平在第12周恢复.
Chronic neuro-musculoskeletal pain is an important complication of open-heart surgery (OHS). To better understand the development and natural course of neuro-musculoskeletal pain in the immediate post-OHS period, this prospective longitudinal study assessed the prevalence and degree of pain and shoulder disability, and areas of pain pre- and post-OHS. Usual medical, nursing, and physiotherapy care was provided including early extubation, education, walking, sitting out of bed, and upper, lower limb, and trunk exercises from day 1 post-operation. Of 114 elective patients who provided consent, 98 subjects were surveyed preoperatively, and at week 6 and week 12 post-OHS. Open and closed questions encompassed numerical rating of pain scales for various body areas summed as a total pain score (TPS), the shoulder disability score (SDS), exercise compliance, and sternal clicking. Usual care comprised mobility exercises, walking program, and cardiac rehabilitation referral. Survey return rates were 100%, 88%, and 82%, respectively. Of the 76 (78%) subjects with complete data sets, 68% subjects reported a history of previous neuro-musculoskeletal injuries/conditions preoperatively while prevalence for neuro-musculoskeletal pain was 64%, 88%, and 67% and 38%, 63%, and 42% for shoulder disability, at the three assessments. In all, 11% subjects reported sternal clicking at week 6 and 7% at week 12. Pain commonly occurred in the lower back and neck preoperatively, and in front of the chest, neck, rib cage, upper back, and left shoulder at week 6. Rib cage pain alone remained significantly greater than preoperative levels by week 12 post-OHS. Preoperative SDS was positively correlated with post-OHS length of stay; women had higher SDSs than men at week 6 and week 12 and week 12 SDS was negatively correlated with height. Surgical risk score was negatively correlated with change in SDS and TPS from pre-operation to week 12. In conclusion, neuro-musculoskeletal pain and shoulder disability were common preoperatively and while prevalence increased at week 6 post-OHS, overall preoperative levels were restored by week 12.