Clinical Study Of Pain And Its Influencing Factors After Cardiac Valve Replacement In Adults

Objective:To investigate the occurrence of pain in patients at different stages after cardiac valve replacement,observe its changing trend,analyse the impact of pain on quality of life,and explore the influencing factors of pain in different stages after cardiac valve replacement,so as to provide reference evidence for the clinical development of more accurate and individual pain management programs,and provide ideas for further research on the mechanism of pain influencing factors.Methods:A total of 160 patients with cardiopulmonary bypass median thoracotomy who underwent artificial heart valve replacement in the Department of Cardiovascular Surgery of Suining Central Hospital from January 2020 to July 2021 were selected.The influencing factors of postoperative pain were predicted through literature review,clinical observation and expert consultation,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)was used to evaluate the incidence of postoperative pain at 3 days,7 days and 14 days.The incidence of pain at 1,3,and 6 months after surgery and the impact of pain on daily life were assessed using the Brief Pain Inventory(BPI).The incidence of postoperative pain at each time point and its influence on daily life were compared by the Chi-square test and one-way analysis of variance(ANOVA),and the changing trend was described.Subjects were divided into two groups according to whether pain occurred at each time point after surgery:the pain group and the no pain group.Univariate difference analysis and multivariate logistic regressionanalysis were performed,respectively,to explore the influencing factors of pain at different time points after surgery.Results:(1)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.The proportion of mild pain gradually increased,and the difference was statistically significant(P<0.001).The proportion of moderate pain gradually decreased,and the difference was statistically significant(P<0.05).There was no significant difference in the proportion of severe pain(P>0.05).(2)The influence of pain on daily life at 1,3 and 6 months after cardiac valve replacement was statistically significant(P<0.001).The influence of pain on daily life in the month following surgery was significantly higher than that in 3 and 6 months following surgery(P<0.05).There was no significant difference in the impact of pain on daily life between 3 months after the operation and 6 months after the operation(P>0.05).(3)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 analysis showed that age,anxiety level 1 day before surgery,amount of remifentanil used during surgery and acute pain 3 days after surgery were the correlation factors of postoperative pain(P<0.05).Multivariate logistic regression analysis showed that the anxiety level 1 day before surgery,the amount of remifentanil used during surgery,and acute pain 3 days after surgery were independent influencing factors of postoperative pain(P<0.05).Conclusion:(1)Most of the patients had different degrees of pain at each time point after heart valve replacement,most of them were mild pain;with the progress of patients’ rehabilitation,the overall incidence of pain at different time points after heart valve replacement showed a trend of gradual decrease.(2)Pain at different time points after cardiac valve replacement continued to affect patients’ quality of life,with the most significant effect at 1 month after surgery.(3)The independent influencing factors of pain at different time points after cardiac valve replacement were age,anxiety level 1 day before surgery,amount of remifentanil used during surgery,sternal fixation materials and acute pain 3 days after surgery,which provided a reference for the prevention and treatment of postoperative pain.