腰椎术后患者疼痛管理智能化方案的制订及应用

doi:10.3761/j.issn.0254-1769.2020.10.004

摘要/Abstract

摘要：

目的制订腰椎术后患者疼痛管理智能化方案并探讨其实施效果。方法采用非同期对照研究,便利选取郑州市某三级甲等综合医院脊柱病区腰椎术后患者,其中2018年5月—2019年2月115例为试验组,成立多学科协作团队,依托骨科远程辅助诊断智能机器人及自控镇痛电子泵,实施疼痛管理智能化方案;2017年12月—2018年3月120为对照组,实施常规疼痛管理。比较两组疼痛管理及康复的相关指标。结果试验组护士疼痛评估时间、患者疼痛控制时间及平均住院日短于对照组,患者术后最严重疼痛程度低于对照组,患者镇痛满意度优于对照组,差异均有统计学意义（均P<0.05）。结论腰椎术后患者疼痛管理智能化可提高疼痛管理的效率,改善患者疼痛结局,缩短患者平均住院日。

关键词: 腰椎手术, 智能化, 疼痛管理, 护理

Abstract:

Objective To develop a intelligent pain management program and analyze effects for the post lumbar surgery patients. Methods A non-synchronous controlled study was conducted from a tertiary hospital in Zhengzhou. 115 patients from May 2018 to February 2019 were selected as the experimental group receiving intelligent pain management. Totally 120 patients who underwent post lumbar surgery in the Department of Orthopedics of our hospital from December 2017 to March 2018 were selected as the control group receiving routine nursing care. Pain and rehabilitation indicators of post lumber surgery patients before and after intervention by intelligent pain management were compared. Results There were statistically significant differences in pain assessment time of nurses,pain controlled time by nurses,most severe pain scores of patients after operation,patients’ satisfaction of pain relief,and length of stays between the 2 groups（P<0.05）. Conclusion Intelligent pain management can improve work efficiency of nurses and the pain status,shorten length of stays of the post lumbar surgery patients.

Key words: Lumbar Surgery, Intelligence, Pain Management, Nursing Care

徐慧萍,赵辉,李东哲,关丽娜,梅展展,张春霖,刘延锦. 腰椎术后患者疼痛管理智能化方案的制订及应用[J]. 中华护理杂志, 2020, 55(10): 1465-1469.

XU Huiping,ZHAO Hui,LI Dongzhe,GUAN Lina,MEI Zhanzhan,ZHANG Chunlin,LIU Yanjin. Formulation and application study on intelligent pain management program of patients after lumbar spine surgery[J]. Chinese Journal of Nursing, 2020, 55(10): 1465-1469.

图/表 3

表1 两组一般资料比较

Table 1 Baseline characteristics of 2 groups of patients

表2 两组疼痛控制质量比较（分,$\bar{x}$±s）

Table 2 Comparison of pain control quality between 2 groups（scores,$\bar{x}$±s）

表3 两组康复指标比较[例（百分比,%）]

Table 3 Comparison of patient rehabilitation indicators between 2 groups[cases（percentage,%）]

参考文献 20

[1]	疼痛新定义(2018版)[J]. 中国疼痛医学杂志, 2016,22(11):808-809.
	New definition of pain[J]. Chin J Pain Med, 2016,22(11):808-809.
[2]	邱贵兴, 裴福兴, 唐佩福, 等. 骨科常见疼痛管理临床实践指南(2018版)[J]. 中华骨与关节外科杂志, 2019,12(3):161-167.
	Qiu GX, Pei FX, Tang PF, et al. A guideline for the management of common pain in orthopaedic clinical practice in China(2018 Edition)[J]. Chin J Bone Joint Surg, 2019,12(3):161-167.
[3]	Klimek M, Ubben JFH, Ammann J, et al. Pain in neurosurgically treated patients:a prospective observational study[J]. J Neurosurg 2006,104(3):350-359. DOI URL PMID
[4]	Bajwa SJS, Haldar R. Pain management following spinal surgeries:an appraisal of the available options[J]. J Craniovertebral Junction Spine, 2015,6(3):105-110. DOI URL
[5]	周宗科, 廖刃, 唐佩福, 等. 中国骨科手术加速康复围手术期疼痛管理指南[J]. 中华骨与关节外科杂志, 2019,12(12):929-938.
	Zhou ZK, Liao R, Tang PF, et al. Guideline on perioperative pain management for the enhanced recovery after orthopedic surgery in China[J]. Chin J Bone Joint Surg, 2019,12(12):929-938.
[6]	Chan CW, Peng P. Failed back surgery syndrome[J]. Pain Med, 2011,12(4):577-606. DOI URL
[7]	Rawal N, Berggren L. Organization of acute pain services:a low-cost model[J]. Pain, 1994,57(1):117-123. DOI URL PMID
[8]	陈方蕾, 陆敏, 陈蓓. 骨科病房疼痛管理研究现状[J]. 护理研究, 2013,27(15):1415-1417.
	Chen FL, Lu M, Chen B. Research status quo of pain management in orthopedic wards[J]. Chin Nurs Res, 2013,27(15):1415-1417.
[9]	罗秀铭, 刘其桃, 彭莉, 等. 骨科患者对术后疼痛管理策略的评价[J]. 护理学杂志, 2012,27(10):28-29.
	Luo XM, Liu QT, Peng L, et al. Postoperative pain management appraised by orthopaedic patients[J]. J Nurs Sci, 2012,27(10):28-29.
[10]	段娜, 郑雪梅, 王强, 等. 麻醉科疼痛“云病房”管理模式构建与实施[J]. 中国卫生质量管理, 2019,26(5):30-33.
	Duan N, Zheng XM, Wang Q, et al. Establishment of “Cloud Ward” Pain Management Mode in the Anesthesiology Department[J]. Chin Health Qual Manag, 2019,26(5):30-33.
[11]	Aubrun F, Nouette-Gaulain K, Fletcher D, et al. Revision of expert panel’s guidelines on postoperative pain management[J]. Anaesth Crit Care Pain Med, 2019,38(4):405-411. DOI URL PMID
[12]	北京护理学会肿瘤专业委员会, 北京市疼痛治疗质量控制和改进中心. 北京市癌症疼痛护理专家共识(2018版)[J]. 中国疼痛医学杂志, 2018,24(9):641-648.
	Oncology Committee of Beijing Nursing Society, Beijing Pain Treatment Quality Control and Improvement Center. Beijing Cancer Pain Care Expert Consensus(2018 Edition)[J]. Chin J Pain Med, 2018,24(9):641-648.
[13]	Chou R, Gordon DB, de Leon-Casasola OA, et al. Management of postoperative pain:a clinical practice guideline from the American pain society,the American society of regional anesthesia and pain medicine,and the American society of anesthesiologists’ committee on regional anesthesia,executive committee,and administrative council[J]. J Pain, 2016,17(2):131-157. DOI URL PMID
[14]	丁群芳, 黄静, 江子芳, 等. 癌症疼痛规范化管理信息平台的构建及应用[J]. 中华护理杂志, 2020,55(3):387-391.
	Ding QF, Huang J, Jiang ZF, et al. Effect assessment of an information platform for standardized nursing management of cancer pain[J]. Chin J Nurs, 2020,55(3):387-391.
[15]	陈瑜, 黄道琼, 李海燕, 等. 肝癌栓塞术后疼痛患者择时给药时间点的改进及效果[J]. 中华护理杂志, 2019,54(3):393-395.
	Chen Y, Huang DQ, Li HY, et al. Improvement in timing of medication administration and its application in relieving pain after liver cancer embolization[J]. Chin J Nurs, 2019,54(3):393-395.
[16]	Jamison RN, Ross MJ, Hoopman P, et al. Assessment of postoperative pain management:patient satisfaction and perceived helpfulness[J]. Clin J Pain, 1997,13(3):229-236. DOI URL PMID
[17]	Innis J, Bikaunieks N, Petryshen P, et al. Patient satisfaction and pain management[J]. J Nurs Care Qual, 2004,19(4):322-327. DOI URL PMID
[18]	刘京宇, 张巧云, 周谋望, 等. 腰椎退行性疾病术后功能恢复的影响因素研究[J]. 中国康复医学杂志, 2019,34(8):907-912.
	Liu JY, Zhang QY, Zhou MW, et al. A study on the prognostic factors of postoperative function recovery of lumbar degenerative diseases[J]. Chin J Rehabil Med, 2019,34(8):907-912.
[19]	朱炜, 杨玉英. 创建手术后无痛护理病房的效果[J]. 中华护理杂志, 2007,42(9):791-792.
	Zhu W, Yang YY. The effect of creating painless nursing wards after surgery[J]. Chin J Nurs, 2007,42(9):791-792.
[20]	Muñoz-Narbona L, Cabrera-Jaime S, Lluch-Canut T, et al. E-Learning course for nurses on pain assessment in patients unable to self-report[J]. Nurse Educ Pract, 2020,43:102728. DOI URL PMID