急诊科创伤性骨折患者急性疼痛早期管理路径的构建及应用  

Construction and application of early management pathway for acute pain in patients with traumatic fracture in emergency department

作　　者：钟孟秋 张克标[1] 陈珍[1] 黄飞月 赵庆华[2] ZHONG Mengqiu;ZHANG Kebiao;CHEN Zhen;HUANG Feiyue;ZHAO Qinghua

机构地区：[1]重庆医科大学附属第一医院急诊医学科,重庆市400000 [2]重庆医科大学附属第一医院护理部,重庆市400000

出　　处：《中华急危重症护理杂志》2024年第6期552-556,共5页Chinese Journal of Emergency and Critical Care Nursing

基　　金：重庆市重点专科建设《临床护理》精品建设项目(0203[2023]47号202336)。

摘　　要：目的构建急诊科场景下创伤性骨折患者急性疼痛早期管理路径,并评价其应用效果。方法采用德尔菲专家函询法,构建急诊科创伤性骨折患者急性疼痛早期管理路径,并进行初步应用。选取2023年10月—11月在重庆市某三级甲等医院急诊科就诊的46例创伤性骨折患者为研究对象,应用创伤性骨折患者急性疼痛早期管理路径,评价急性疼痛评估率及再评估率、处置率及患者满意度。结果两轮函询问卷回收率均为100%,提出修改意见的专家分别为35.29%和11.77%,两轮专家权威程度系数分别为0.864和0.876,最终确定的急诊创伤性骨折患者急性疼痛早期管理路径,包括充分疼痛评估、设置疼痛处置目标、疼痛干预、疼痛再评估、健康教育5个方面、12条具体措施。临床应用后,急性疼痛评估率从8.71%提高到84.78%,再评估率从1.23%提高到80.43%,药物镇痛率、非药物镇痛率分别从14.81%和6.50%提高到69.57%和63.04%。结论构建的急诊科创伤性骨折患者急性疼痛早期管理路径,具有一定的科学性、实践性和可行性,有助于提高创伤性骨折患者急性疼痛评估率及再评估率、处置率。Objective To construct the early management pathway of acute pain in patients with traumatic fracture in the scene of emergency department and evaluate its application effects.Methods We developed the early management pathway of acute pain in patients with traumatic fracture in emergency department by Delphi expert consultation method,and conducted preliminary application.A total of 46 patients with traumatic fracture who were treated in the Emergency Department of a Class III Grade A hospital in Chongqing from October to November 2023 were selected as the research objects.The early management pathway of acute pain in patients with traumatic fracture was implemented and the assessment rate,reassessment rate,treatment rate and patient satisfaction were evaluated.Results The recovery rates of the two rounds of questionnaires were both 100%,and the proportion of experts who proposed revisions were 35.29%and 11.77%,respectively.The authority coefficients of the two rounds of experts were 0.864 and 0.876,respectively.There were 5 aspects including adequate pain assessment,setting pain treatment goals,pain intervention,pain reassessment,and health education,and 12 specific measures.After clinical application,the acute pain assessment rate increased from 8.71%to 84.78%,the reassessment rate increased from 1.23%to 80.43%,the drug analgesia rate and non-drug analgesia rate increased from 14.81%and 6.50%to 69.57%and 63.04%,respectively.Conclusion The early management pathway of acute pain in patients with traumatic fracture in emergency department is scientific,practical and feasible,which is helpful to improve the assessment rate,reassessment rate and treatment rate of acute pain in patients with traumatic fracture.

关 键 词：急诊室 医院 创伤和损伤 创伤护理 急性疼痛 临床路径 

分 类 号：R473.6[医药卫生—护理学]