患者自主疼痛评估在全膝关节置换术围手术期疼痛管理中的应用效果  

Application of self-assessment of pain in perioperative pain management of total knee arthroplasty

作　　者：秦瑕[1] 何洁[1] 易德坤[1] 袁玉霞[1] 张玉梅[1] 

机构地区：[1]第三军医大学新桥医院骨科,重庆400037

出　　处：《华西医学》2017年第9期1333-1338,共6页West China Medical Journal

摘　　要：目的探讨患者自主疼痛评估在全膝关节置换术(total knee arthroplasty,TKA)围手术期疼痛管理中的应用。方法将2016年3月—2017年3月共收治的行TKA的140例患者随机分为对照组和试验组,两组患者均接受相同的疼痛相关知识教育,对照组由护士进行疼痛评估,试验组则由患者进行自主疼痛评估,根据两组相应的评估结果进行处理。观察记录两组疼痛评估需要的时间、临时解救药的类型及使用次数、疼痛评分、康复自我效能量表评分及膝关节活动度。结果纳入并完成最终观察的患者为132例,其中试验组67例,对照组65例。两组患者术后疼痛评估时间(t=–2.736,P=0.007)、术后临时解救药物使用(χ2=10.276,P<0.05)、术后疼痛评分总计(Z=–2.146,P=0.032)、术后住院天数(t=–2.468,P=0.015)、术后第7天康复自我效能感量表评分(F=2.390,P=0.018)、术后第14天康复自我效能感量表评分(F=3.427,P=0.001)、术后第7天的膝关节活动度(F=2.109,P=0.037)的比较,差异均有统计学意义;两组患者术后平均每日疼痛评分(Z=–1.779,P=0.077)、术后第3天康复自我效能感量表评分(F=1.010,P=0.314)、术后第1天膝关节活动度(F=1.319,P=0.189)、术后第14天膝关节活动度(F=1.603,P=0.111)的组间比较,差异均无统计学意义。结论患者自主的疼痛评估能调动膝关节置换患者主动参与疼痛管理,可更准确地反映患者的疼痛强度,在减少医护工作量的同时,有利于围手术期疼痛管理措施的优化,从而促进其快速康复。Objective To explore the effect of self-assessment of pain in perioperative pain management of total knee arthroplasty （TKA）. Methods A total of 140 patients undergoing TKA from March 2016 to March 2017 were randomly divided into the control group and the trial group. The patients in the two groups were received the same education relating to pain knowledge. The intensity of pain was assessed by nurses in the control group, while in the trial group, it was assessed by patients themselves. According to the assessment of pain, treatments were given to both groups. Time of pain assessment, types and frequencies of temporary rescue medicine, pain intensity, the score of Self-efficacy for Rehabilitation Outcome Scale （SER） and the range of motion （ROM） of knee were observed and recorded. Results There were 132 patients who completed the final observation, with 67 in the trial group and 65 in the control group. There were significant differences between the two groups in evaluation time of pain （t=-2.736, P=0.007）, types and frequencies of temporary rescue medicine （X2=10.276, P〈0.05）, the overall postoperative pain score （Z=-2.146, P=0.032）, average hospitalization time after surgery （t=-2.468, P=0.015）, SER scores 7 days after surgery （F=2.390, P=0.018） and 14 days after surgery （F=3.427, P=0.001）, and ROM at the postoperative day 7 （F=2.109, P=0.037）; there were no significant differences in postoperative daily pain scores （Z=-1.779, P=0.077）, SER scores at the postoperative day 3 （F=I.010, P=0.314）, ROM at the postoperative day 1 （F=1.319, P=0.189） and day 14 （F=1.603, P=0.111）. Conclusion Self- assessment of pain can motivate TKA patients to take part in pain management, and more accurate response to the pain intensity will help to optimize the management of perioperative pain and reduce the workload of the health staff, thereby contributing to enhanced recovery.

关 键 词：加速康复外科 自主疼痛评估 全膝关节置换 围手术期 

分 类 号：R473.6[医药卫生—护理学]