心脏外科术后胸痛的多模式镇痛策略
Multimodal Analgesia Strategies for Postoperative Chest Pain Following Cardiac Surgery
DOI: 10.12677/acm.2026.1682958, PDF,   
作者: 岳 森：内蒙古自治区人民医院麻醉科，内蒙古 呼和浩特；侯子健：包头医学院第一附属医院麻醉科，内蒙古 包头；王 智：鄂尔多斯市东胜区人民医院麻醉科，内蒙古 鄂尔多斯；王诗秋*：内蒙古自治区人民医院神经外科，内蒙古 呼和浩特
关键词: 心脏外科；术后胸痛；多模式镇痛；肌筋膜平面阻滞；加速康复外科；Cardiac Surgery； Postoperative Chest Pain； Multimodal Analgesia； Myofascial Plane Block； Enhanced Recovery after Surgery (ERAS)
摘要: 心脏外科术后剧烈胸痛易引发严重并发症并向慢性胸骨切开后疼痛综合征(PSPS)转化。传统阿片类药物与胸段硬膜外镇痛因引发呼吸抑制、术后恶心呕吐及抗凝安全等问题，已难以满足现代加速康复外科的需求。本文系统综述了心脏外科术后多模式镇痛(MMA)的前沿进展，重点探讨以“少阿片化”为核心的两大支柱：静脉靶向辅助策略的应用，以及超声引导下肌筋膜平面阻滞技术的演变。尽管目前面临阻滞技术标准化缺失及单次阻滞反弹痛等挑战，多模式镇痛已显著改善急性期疼痛管理。未来，依托长效局麻药递送系统以及基于人工智能与药物基因组学的精准预警与干预，将成为优化围术期胸痛控制、改善远期预后的核心方向。
Abstract: Severe postoperative chest pain after cardiac surgery tends to trigger serious complications and progress to chronic post-sternotomy pain syndrome (PSPS). Conventional opioid agents and thoracic epidural analgesia (TEA) can no longer meet the requirements of modern Enhanced Recovery after Surgery (ERAS), due to adverse events including respiratory depression, postoperative nausea and vomiting (PONV), and safety concerns related to perioperative anticoagulation. This article system-atically reviews the cutting-edge advances in multimodal analgesia (MMA) for cardiac surgery, fo-cusing on two core pillars centered on the opioid-sparing principle: the clinical application of intra-venous targeted adjuvant analgesic strategies, and the evolution of ultrasound-guided myofascial plane block techniques. Despite ongoing challenges such as the lack of standardized block protocols and rebound pain after single-injection blocks, multimodal analgesia has significantly improved acute-phase pain management. Looking forward, long-acting local anesthetic delivery systems, as well as precise risk early warning and personalized intervention based on artificial intelligence and pharmacogenomics, will become the core directions for optimizing perioperative chest pain control and improving long-term prognosis.
文章引用：岳森, 侯子健, 王智, 王诗秋. 心脏外科术后胸痛的多模式镇痛策略[J]. 临床医学进展, 2026, 16(8): 1751-1759. https://doi.org/10.12677/acm.2026.1682958

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