比較體外循環和非體外循環開心冠狀動脈繞道手術後之陣痛治療

Analgesia practice after Off-pump and On-pump CABG in Taiwan

背景：開心手術後的鎮痛治療是預防術後肺部並發症的關鍵。本研究描述了台灣在心臟手術後鎮痛的現行做法，並評估鎮痛治療與術後並發症之相關性。此外，我們也設法驗證是否非體外循環冠狀動脈繞道手術（OPCAB）的鎮痛需求會比傳統冠狀動脈繞道手術（ONCAB）少。方法：本研究採用台灣全民健保資料庫隨機選取的病人群為研究對象，此樣本約代表台灣總人口的1/20。於1998年1月1日至2006年12月31日之間樣本內所有接受首次冠狀動脈繞道手術的病人都納入分析。收集的數據包括病人的基本資料，口服及針劑鎮痛藥之使用，與術後並發症和短期結果。結果：共1111例患者被納入研究，劃分成926位ONCAB患者和185位OPCAB患者進行分析。術後並發症在兩組之間無統計學顯著差異。然而，住院天數，ICU停留時間，及呼吸器使用天數在ONCAB組均顯著較長。兩組在術後鴉片類針劑的使用（以嗎啡單位做計算）分別為：ONCAB組47.6毫克／人，OPCAB組32.0毫克／人。口 服止痛藥 除乙？氨基酚（Acetaminophen）以外很少使用，但針對ONCAB組有使用較高劑量和較強口服止痛藥的趨勢。結論：雖然OPCAB短期的結果較好，本研究顯示出ONCAB和OPCAB兩組的術後並發症無顯著性差異。然而，ONCAB患者易於使用較多的針劑鴉片類藥物及更強的口服止痛藥。

Background: Adequate and effective analgesia after cardiac surgery is the key to postoperative prevention and treatment of lung complications. This study is the first to illustrate the current practice of analgesia after cardiac surgery in Taiwan and its associations with postoperative lung complications. We also tested the hypothesis that off-pump CABG (OPCAB) would demand less post-operative analgesia than on-pump CABG (ONCAB) Methods: A randomly selected population representing 1/20 of the overall population registry in the BNHI database of Taiwan was used. All patients receiving first-time CABG between January 1st 1998 and December 31st 2006 were assessed. Data retrieval included patient demographics, oral and IV analgesics used, and short-term outcome and complications. Results: 1111 patients were retrieved and divided into 926 ONCAB patients and 185 OPCAB patients for analysis. There was no statistically significant difference in postoperative complications between the two groups. However, the in-hospital stay, ICU stay, and period of mechanical ventilation were all significantly longer in the ONCAB group. The overall opioid use in terms of morphine units was 47.6 mg of morphine/person use with the ONCAB group versus 32.0 mg of morphine/person use with the OPCAB group. The oral analgesics, except for acetaminophen, were rarely (<5%) used. But there is a tendency towards use of higher doses and more potent oral analgesics in the ONCAB group. Conclusion: Although short-term outcome was better with OPCAB, this study did not show a significant difference in postoperative complications between ONCAB and OPCAB. However, there is a tendency for greater use of IV opioids and the more potent oral analgesics among the ONCAB patients.