女性盆底重建术后疼痛管理的最佳证据应用  

From best evidence to best practice:pain management after female pelvic floor reconstruction

作　　者：赵月娇[1] 陈静雯 顾春怡[2] 谢博钦[3] Zhao Yuejiao;Chen Jingwen;Gu Chunyi;Xie Boqin(Gynecology Department of Western Medicine and TCM,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200090,China)

机构地区：[1]复旦大学附属妇产科医院中西医结合妇科,上海200090 [2]复旦大学附属妇产科医院护理部,上海200090 [3]复旦大学护理学院

出　　处：《护理学杂志》2019年第22期1-5,共5页Journal of Nursing Science

基　　金：复旦大学循证护理中心证据转化与临床应用项目(Fudanebn825）;复旦大学临床护理特色专科(盆底康复护理）建设项目(FNSF201701)

摘　　要：目的将盆底重建术后疼痛管理最佳证据应用于临床,以缓解患者术后疼痛,提高医护人员对患者疼痛管理的认知及重视度。方法对盆底功能障碍性疾病行盆底重建术后患者疼痛管理相关主题进行系统检索和质量评价,总结生成14条最佳证据,结合临床情景和专业判断,制定12条基于证据的质量审查指标,证据应用前后分别以30例患者及20名护理人员为对象,开展分阶段质量审查和效果评价。结果与基线审查结果相比,证据应用后患者术后疼痛评分、对镇痛管理的满意程度、患者镇痛行为的自主性、患者疼痛知识掌握程度、护士疼痛知识掌握程度显著提升(P<0.05,P<0.01);证据应用后,医护人员为患者共同制定个性化疼痛管理方案的比率由53.3%升至100%、药物+非药物联合镇痛模式的应用率由10.0%升至53.3%(均P<0.01)。结论盆底重建术后患者疼痛管理最佳证据的临床应用,可规范护士的临床行为,促进护理管理质量的持续改进,从而缓解患者术后疼痛程度,提高患者对术后镇痛的正向体验和自我效能。Objective To apply the best evidence regarding pain management after pelvic floor reconstruction into clinical practice,thus to relieve postoperative pain of patient and to enhance medical staff′s awareness of and attention to pain management.Methods Literature regarding pain management after pelvic floor reconstruction for the treatment of pelvic dysfunction were retrieved and the quality of the literature was evaluated,then fourteen best evidence were concluded.Combining actual clinical situation and professional judgment,12 audit criteria were established.Then the evidence were implemented into clinical practice involving 30 patients and 20 nurses in baseline audit and re-audit respectively.Results The postoperative intensity was significantly milder,whereas patient satisfaction with pain management,autonomy of analgesic behavior and knowledge of pain management,as well as nurse′s knowledge of pain management were significantly higher at the re-audit compared with the baseline audit(P<0.05,P<0.01).The rate of personalized pain management regimen made by physician in collaboration with nurse increased from 53.3%to 100%,and the rate of combining use of pharmacological and non-pharmacological interventions increased from 10.0%to 53.3%(P<0.01 for both).Conclusion The implementation of best evidence into clinical practice can standardize nurse′s behavior,thus to alleviate postoperative pain of patient after pelvic floor reconstruction,and improve patient′s positive experience of postoperative analgesia and self-efficacy.

关 键 词：盆底功能障碍性疾病 盆底重建术 术后疼痛 疼痛管理 最佳实践 

分 类 号：R473.71[医药卫生—护理学]