医护麻联合疼痛管理在腹部手术的应用研究  

Application of combination of medical care and anesthesia for pain management in abdominal surgery

作　　者：刘惠蓉[1] 杨孟昌[1] 伍沁 苟潇潇 彭雨 LIU Hui-rong;YANG Meng-chang;WU Qin;GOU Xiao-xiao;PENG Yu(Organ Transplantation Cen-ter,Sichuan Academy of Medical Sciences ＆ Sichuan Provincial People＇s Hospital,Chengdu 610072,China)

机构地区：[1]四川省医学科学院·四川省人民医院器官移植中心,四川成都610072

出　　处：《实用医院临床杂志》2018年第4期115-117,共3页Practical Journal of Clinical Medicine

摘　　要：目的探索医护麻联合的疼痛管理方法在腹部手术患者围手术期的应用效果,以期构建腹部手术患者围手术期疼痛管理效果评价指标。方法选取2017年4~7月在我中心的24例肝脏肿瘤、胰腺肿瘤、胆道肿瘤和肝内外胆管结石患者作为试验组,实施医生、护士、麻醉师联合疼痛管理:疼痛知识健康教育,口服预防性镇痛药,严密的疼痛评分;并回顾选取2017年1~3月26例肝脏肿瘤、胰腺肿瘤、胆道肿瘤和肝内外胆管结石患者作为对照组,比较分析2组患者术后3、6、12、24、48小时的视觉模拟疼痛评分(VAS);早期活动的依从性,胃肠道不良反应恶心呕吐的发生;肠功能恢复:肛门排气时间和第一次解便时间。结果试验组患者3、6、12、24、48小时VAS均低于对照组,患者术后床上坐起和下床活动好于对照组,肛门排气时间和第一次解便时间均早于对照组,差异有统计学意义(P<0.05)。两组胃肠道不良反应恶心呕吐的发生情况比较差异无统计学意义(P>0.05)。结论医护麻联合的疼痛管理能有效的缓解腹部手术患者的疼痛,促进其早期下床活动及肠功能的恢复,疼痛管理是快速康复管理的核心。Objective To investigate application effect of pain control method through combination efforts from doctors,nurses and anesthetists on the patients undergone abdominal surgery during perioperative period in order to build up an evaluation indicator of effectiveness.Methods A total of 24 patients with liver carcinoma,pancreas carcinoma,billiary carcinoma or intrahepatic bile duct stones in our center from April to July 2017 were selected as experimental group. The patients were given pain control method through combination efforts including health education of pain knowledge,oral medicine on pain prevention and precise pain rating.Meanwhile,26 patients with same diseases from January to March 2017 were retrospectively selected as the contrast group.The postoperative VAS at3 hours,6 hours,12 hours,24 hours and 48 hours,compliance on early mobilization,occurrence of gastrointestinal adverse reactions,intestinal function restoration,anal exhaust and defecation time were compared between the two groups. Results The VAS at 3 hours,6 hours,12 hours,24 hours and 48 hours of the experimental group was lower than that of the control group（ P〈0. 05）. The compliance on early mobilization on and off bed in the experimental group was better than that in the control group（ P〈0. 05）. The time of anal exhaust and the general defecation of the experimental group was earlier than the control group（ P〈0. 05）. There was no significant difference on gastrointestinal adverse reactions（ P〈0. 05）.Conclusion Pain control method through combination efforts can effectively relieve the pain,advance the early mobilization off bed,accelerate the intestinal function restoration and speed the rehabilitation.Pain management is the core of enhanced recovery management

关 键 词：腹部手术 医护麻联合 预防性镇痛 疼痛管理 

分 类 号：R441.1[医药卫生—诊断学] R656[医药卫生—临床医学]