基于循证的截肢患者幻肢痛管理方案的构建及应用  

Construction and application of evidence-based phantom limb pain management program for amputees

作　　者：王丽元 方曙静 刘梅 钱考亮 吴艳 宋美谕 WANG Li-yuan;FANG Shu-jing;LIU Mei;QIAN Kao-liang;WU Yan;SONG Mei-yu(Department of Orthopaedics,Jiangsu Provincial Hospital,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210000,Jiangsu,China)

机构地区：[1]南京医科大学第一附属医院·江苏省人民医院骨科,江苏南京210000

出　　处：《川北医学院学报》2024年第9期1283-1287,共5页Journal of North Sichuan Medical College

基　　金：中国社会福利基金会护爱基金(HLCXKT-20230170)。

摘　　要：目的:基于循证原则构建截肢患者幻肢痛(PLP)管理方案,并评价该管理方案的临床应用效果。方法:纳入80例实施截肢并发生PLP的患者作为研究对象,按照围术期护理方法的不同分为对照组(n=40)和观察组(n=40)。对照组实施常规护理;观察组实施基于循证原则构建的PLP管理方案。两组均干预1个月,比较干预前后两组患者疼痛情况[疼痛程度(VAS)及PLP次数]、负性情绪[焦虑自评量表(SAS)及抑郁自评量表(SDS)]、睡眠情况[匹兹堡睡眠质量指数(PSQI)]、舒适度[舒适状况量表(GCQ)],并记录两组患者干预期间并发症发生情况。结果:干预后,两组患者VAS量表评分均下降(P<0.05),且观察组低于对照组(P<0.05);两组患者PLP次数均减少(P<0.05),且观察组少于对照组(P<0.05)。干预后,两组患者SAS评分、SDS量表评分、PSQI量表各维度评分及总分均下降(P<0.05),且观察组低于对照组(P<0.05)。干预后,两组患者GCQ量表总分及各维度评分均上升(P<0.05),且观察组高于对照组(P<0.05)。相较于对照组的25.00%,观察组总并发症发生率(7.50%)更低(P<0.05)。结论:基于循证原则的管理方案可显著缓解截肢PLP患者疼痛程度,减少PLP发作次数,进而改善患者焦虑、抑郁等负性情绪,提升其睡眠质量,促进患者舒适。Objective:To construct a management plan for phantom limb pain(PLP)in amputees based on evidence-based principles,and to evaluate the clinical application effect of the management plan.Methods:80 patients who underwent amputation and PLP were included.According to the different perioperative nursing methods,they were divided into control group(n=40)and observation group(n=40).The control group was given routine nursing,and the observation group was given PLP management program based on evidence-based principles.Both groups were intervened for 1 month.The pain[pain degree(VAS)and PLP times],negative emotions[self-rating anxiety scale(SAS)and self-rating depression scale(SDS)],sleep[Pittsburgh sleep quality index(PSQI)],comfort[comfort status scale(GCQ)]before and after intervention were compared between the two groups,and the complications of the two groups during the intervention were recorded.Results:After intervention,the VAS scores of the two groups decreased(P<0.05),and the observation group was lower(P<0.05).The number of PLP in both groups decreased(P<0.05),and the observation group was less(P<0.05).After intervention,the scores of SAS,SDS,and scores of each dimension and total score of PSQI scale in the two groups decreased(P<0.05),and those in the observation group were lower(P<0.05).After intervention,the total score of GCQ scale and the scores of each dimension in the two groups increased(P<0.05),and those in the observation group were higher(P<0.05).Compared with 25.00%in the control group,the incidence of total complications in the observation group(7.50%)was lower(P<0.05).Conclusion:The management program based on evidence-based principles can significantly relieve the pain of patients with amputation PLP,reduce the number of PLP attacks,and then improve patients negative emotions such as anxiety and depression,improve their sleep quality,and promote patients comfort.

关 键 词：截肢 幻肢痛 循证 管理方案 疼痛 负性情绪 舒适度 

分 类 号：R683.2[医药卫生—骨科学]