婴幼儿先心病术后当日疼痛管理现状调查

目的 ：描述婴幼儿先天性心脏病（以下简称＂先心病＂）外科术后当日拔除气管插管后8h内疼痛情况以及护理人员进行疼痛管理现状。方法 ：采用一般资料登记表、疼痛行为评估量表（FLACC）、镇痛镇静药物及非药物镇痛措施登记表对北京市某心血管病专科医院20名PICU患儿进行调查。结果 ：先心病婴幼儿外科术后当日拔除气管插管后疼痛情况存在波动,0h、2-4h疼痛评分较高,镇痛镇静药物以及非药物镇痛措施在2-4h中使用比例由15%增加到了70%,5-8h疼痛评分明显降低。结论：先心病婴幼儿术后当日疼痛状况较重,药物及非药物镇痛措施使疼痛状况得到一定改善,但疼痛管理仍须加强。     

联合使用右旋美托嘧啶对术后吗啡静脉自控镇痛的影响

<正>最大限度地缓解疼痛和最小化镇痛引起的副作用对于外科术后患者的恢复是非常重要的。多模式镇痛是目前推荐较多的方法[1]。在临床实践中,对于疼痛管理,吗啡联合辅助药物静脉PCA是一个非常便利的方法并获得广泛的认可。不同的辅助药物,包括止吐药[2]、非甾体类抗炎     

沉浸式虚拟现实技术在创面操作性疼痛管理中的应用进展

操作性疼痛对患者的生理、心理及伤口愈合具有不良影响，有效缓解换药时的创面操作性疼痛是亟需解决的难题。沉浸式虚拟现实技术可缓解创面操作性疼痛。该文介绍了沉浸式虚拟现实技术的镇痛机制及其在创面操作性疼痛管理中的应用形式，总结了沉浸式虚拟现实技术在创面操作性疼痛管理中的应用优势与效果，并分析了现阶段研究与应用中存在的不足，以期为推动沉浸式虚拟现实技术在创面操作性疼痛管理中的应用提供借鉴。     

术后PCA的临床应用及护理进展

术后疼痛是手术患者最常见的症状,疼痛对患者生理的影响是多方面的,因此术后镇痛越来越受到重视,在使用药物、给药技术和其他非侵袭性方法止痛等方面都得到了很大发展。尤其是麻醉镇痛泵的临床应用,有效地解决了病人术后疼痛的问题,由此带动了术后疼痛的护理工作,也逐渐引起人们的关注,该文就术后病人自控镇痛术(PCA)的使用及护理进行了综述。     

虚拟现实疗法干预创面操作性疼痛效果的Meta分析

[目的]系统评价虚拟现实疗法干预创面操作性疼痛的临床效果。[方法]计算机检索中国知网(CNKI)、万方、中国生物医学文献数据库、PubMed、OVID循证数据库、Web of Science、Springer、Cochrane循证医学数据库中关于虚拟现实疗法干预创面操作性疼痛研究的随机对照试验,由2位研究人员独立筛选文献并提取资料。[结果]共纳入11篇文献,其中9篇研究质量为A级,2篇为B级。Meta分析结果显示:试验组(虚拟现实干预)和对照组(无虚拟现实干预)在减轻创面换药过程疼痛、揭除敷料时不适症状、缩短伤口护理操作总时间3方面差异有统计学意义(P0.05)。[结论]虚拟现实疗法作为非药物性辅助镇痛干预,能减轻病人创面操作性疼痛,减少换药不适症状,节省伤口护理时间,但仍需设计严谨、大样本的随机对照试验进一步验证其疗效。     

加巴喷丁胶囊在围术期镇痛中的应用

术后急性疼痛问题越来越受到关注。然而如何有效处理术后急性疼痛,从而降低术后慢性疼痛的发生率是目前临床上非常关注而且棘手的问题。传统的术后镇痛方案虽然疗效尚可,应用广泛,但在减少慢性疼痛发生率方面作用欠佳。抗惊厥药物如加巴喷丁等在神经病理性疼痛中具有良好疗效,目前,将加巴喷丁在术后镇痛中作为辅助药物具有明显的临床意义。本文回顾近年来关于加巴喷丁在围术期中的临床应用的报道,为围术期复合应用加巴喷丁,从而确定多模式镇痛方案提供一种新的方法。     

多模式疼痛管理在创伤足踝外科无痛病房建设中的应用探讨

目的:探讨多模式疼痛管理在创伤足踝外科护理中的应用效果。方法:将90例急诊伤后24 h入院患者随机分为对照组30例,观察组60例。两组患者均采用规范化的疼痛宣教和疼痛评估模式。对照组采用非药物镇痛结合单一报告镇痛模式,评估过程中按照三阶梯用药原则进行疼痛处理;观察组采用多模式镇痛方案(非药物镇痛、预先镇痛、基础镇痛结合报告镇痛及残余痛处理模式),同时评估过程中按照三阶梯用药原则进行调整用药。并记录每例患者于术前及术后4 h、8 h、12 h、24 h、48 h、72 h的疼痛评分,对在两种不同的疼痛管理治疗模式干预下患者疼痛评分的分值进行比较。结果:在术后4~12 h内疼痛评分有统计学差异(P0.05)。其他时间点无显著性差异(P0.05)。观察组患者疼痛评分平均值及疼痛主诉及追加镇痛药物次数较对照组低,差异具有统计学意义(P0.05)。结论:多模式镇痛管理方案可在围手术期平稳镇痛,减少临时性中重度疼痛主诉,及追加阿片类镇痛药物用量。     

非药物干预对下肢骨科术后硬膜外镇痛效果的影响

目的：观察非药物干预措施对下肢骨科术后硬膜外镇痛效果的影响,评价非药物干预措施在术后镇痛中的临床价值。方法将80例择期下肢骨科手术患者按随机数字表法分为观察组和对照组,每组40例。两组均采用硬膜外麻醉,术后使用自控式镇痛泵。对照组采用常规护理,包括镇痛泵的使用、口腔护理、饮食护理、导管护理、会阴护理、常规宣教及适当体位等。观察组在常规护理的基础上增加以责任护士为主导的一系列非药物干预措施,如加强医护人员疼痛管理教育、患者参与的预期疼痛教育、使用三维立体冰袋、心理干预和音乐干预。观察两组术后48 h内疼痛强度以及不良反应的发生情况及镇痛泵按压总次数。结果观察组在术后4,8,12,24,48 h各时段疼痛强度均低于对照组,差异有统计学意义（P＜0．05）。观察组不良反应总发生率为7．5％,低于对照组的25．0％,差异有统计学意义（χ^2＝4．5006,P＜0．05）。观察组的镇痛泵按压次数为（2．2±1．1）次,低于对照组的（3．3±1．2）次,差异有统计学意义（t＝4．2737,P＜0．05）。结论非药物干预措施能有效降低疼痛程度,减少镇痛泵按压次数及不良反应的发生率。     

疼痛管理新进展 刘盈盈 杨瑛 (上海交通大学医学院附属仁济医院南院 上海201112)

本文章对患者术后疼痛的管理现状进行了综述,了解疼痛的概念、术后疼痛的概念及对机体的影响,疼痛管理已经从麻醉师为主体发展到以护士为主体。运用不同的疼痛评估方法对患者的疼痛进行准确的评估,并根据评估结果给予相应的镇痛措施。术后的镇痛措施多样化,主要措施包括药物止痛、患者自控镇痛、多模式镇痛、低温物理镇痛、疼痛教育、音乐疗法、冥想训练和合适体位的应用等。     

外科护士疼痛认知与实践能力多因素调查分析

摘要：目的 调查某中医医院外科护士疼痛知识与态度,以及术后患者疼痛控制护理质量现状,分析影响因素以制定相应对策。方法：采用《护理人员的疼痛知识和态度问卷》对某中医医院81名外科护士进行疼痛评估、疼痛一般知识、药物镇痛知识、综合应用知识调查,以及静脉自控镇痛知识掌握能力、临床术后患者疼痛控制护理质量现状调查,分析其对术后疼痛知识的掌握及应用情况。结果： 81名外科护士疼痛管理知识与态度总体处于较低水平（47.03±9.74）,不同学历、职称、护龄对护理人员疼痛知识与态度得分无相关性（P>0.05）。外科护士药物镇痛知识、静脉自控镇痛知识缺乏,并影响术后患者疼痛管理护理质量,同时术后患者普遍存在忍痛现象。结论：全面及深入地开展疼痛知识继续教育,改变护士疼痛管理行为,对术后患者进行多形式疼痛健康教育,探讨以护士为主体的术后疼痛管理模式及有中医特色的疼痛护理。     

Real Bodies Not Required? Placebo Analgesia and Pain Perception in Immersive Virtual and Augmented Reality

Pain represents an embodied experience, wherein inferences are not only drawn from external sensory inputs, but also from bodily states. Previous research has demonstrated that a placebo administered to an embodied rubber hand can effectively induce analgesia, providing first evidence that placebos can work even when applied to temporarily embodied, artificial body parts. Using a heat pain paradigm, the present study investigates placebo analgesia and pain perception during virtual embodiment. We examined whether a virtual placebo (a sham heat protective glove) can successfully induce analgesia, even when administered to a virtual body. The analgesic efficacy of the virtual placebo to the real hand (augmented reality setting) or virtual hand (virtual reality setting) was compared to a physical placebo administered to the own, physical body (physical reality setting). Furthermore, pain perception and subjective embodiment were compared between settings. In this mixed design experiment, healthy participants (n = 48) were assigned to either an analgesia-expectation or control-expectation group, where subjective and objective pain was measured at pre- and post-intervention time points. Results demonstrate that pre-intervention pain intensity was lower in the virtual reality setting, and that participants in the analgesia-expectation group, after the intervention, exhibited significantly higher pain thresholds, and lower pain intensity and unpleasantness ratings than control-expectation participants, independent of the setting. Our findings show that a virtual placebo can elicit placebo analgesia comparable to that of a physical placebo, and that administration of a placebo does not necessitate physical bodily interaction to produce analgesic responses.PerspectiveThis study demonstrates that a virtual placebo treatment, even when administered to a virtual body, can produce placebo analgesia. These findings indicate that the efficacy of a virtual placebo is comparable to that of a physical placebo, which could pave the way for effective new non-pharmacological approaches for pain management.     

Effects of a structured educational programme on patient‐controlled analgesia (PCA) for gynaecological patients in South Korea

Aims and objectives. The purpose of the study was to evaluate the effects of a structured educational programme on the patient‐controlled analgesia device in terms of postoperative pain, dose of analgesics used, adverse reactions, patient knowledge and attitudes of patient‐controlled analgesia and patient satisfaction with postoperative pain management among gynaecological patients in South Korea. Background. Patient‐controlled intravenous analgesia has become the most common method to manage postoperative pain. Although the patient‐controlled analgesia device can be very effective in managing pain, patients using external pump delivery have several problems because of their lack of knowledge of patient‐controlled analgesia. To minimise these problems, nursing interventions that may decrease the number of problems should be developed and adopted into clinical practice. Design. A non‐equivalent control group, non‐synchronised design. Methods. The participants were 79 patients who had gynaecological surgery under general anaesthesia. Of the 79 patients, 39 were assigned to the experimental group and 40 to the control group. A day before surgery, 40 minutes of structured education on the patient‐controlled analgesia device was provided individually to the patients in the experimental group using both a CD‐ROM and brochure. Results. Pain level and adverse reactions were significantly lower in the experimental group than in the control group. Furthermore, the analgesic dose administered and the level of patient satisfaction with postoperative pain management increased significantly in the experimental group compared with the control group. Conclusion. A structured educational programme on the patient‐controlled analgesia can be an effective nursing intervention for pain management in gynaecological patients. Relevance to clinical practice. Nurses caring for the patients who are using the patient‐controlled analgesia should provide a structured educational programme to increase knowledge of pain management with patient‐controlled analgesia, patient satisfaction with pain management, as well as more effective management of the pain and adverse reaction caused by patient‐controlled analgesia.     

Effects of Hypnotic Analgesia and Virtual Reality on the Reduction of Experimental Pain Among High and Low Hypnotizables

This research compared a no-treatment control condition and 3 experimentally induced pain treatment conditions: (a) virtual reality distraction (VRD), (b) hypnotic analgesia (HA), and (c) HA + VRD in relieving finger-pressure pain. After receiving baseline pain stimulus, each participant received hypnosis or no hypnosis, followed by VRD or no VRD during another pain stimulus. The data analysis indicated that, overall, all 3 treatments were more effective compared to the control group, irrespective of whether it involved hypnotic analgesia, virtual reality distraction, or both (hypnosis and virtual reality). Nevertheless, the participants responded differently to the pain treatment, depending on the hypnotizability level. High hypnotizables reported hypnotic analgesia, but low hypnotizables did not show hypnotic analgesia. VR distraction reduced pain regardless of hypnotizability.     

Pre-emptive analgesia and protective premedication. What is the difference?

The management of postoperative pain has been greatly informed by an increasing understanding of the basic science of pain transmission. The idea that analgesia given before the injury would be more effective than the same analgesia given after the injury was named pre-emptive analgesia. The evidence for this phenomenon in postoperative pain management has been very mixed. The methodological problems of such studies, and the difficulties of all the major outcome measures make comparison of the studies available difficult. In the 20 years since the concept was proposed there has been a change in anaesthetic practice that in effect incorporates pre-emptive analgesia with opiates. Evidence for any pre-emptive analgesic with non-steroidal anti-inflammatory drugs is very poor, but the use of local anaesthetic blocks continues to be an area of study. Pre-emptive use of analgesic drugs is not the magic bullet to prevent postoperative pain, but is a strategy of use, among others for managing postoperative pain. Protective analgesia is a strategy that has grown out of the same desire to give drugs before injury to reduce the pain experienced afterwards. In this case the drugs under study have not been primary analgesics, but adjuvant drugs used commonly in the non-acute pain arena. In particular, the drug gabapentin, and to a lesser extent its related drug pregabalin. These drugs have been given by mouth as a pre-medicant, 1 hour before surgery in a variety of operations. A recent meta-analysis of the existing literature shows reduction of postoperative morphine consumption but little reduction in reporting of opiate side effects. Pregabalin, which has a better pharmacokinetic profile, may be a better alternative, and is currently under study. Neither gabapentin nor pregabalin are licensed for use in postoperative pain, and it is unlike that the manufacturers will seek such a licence.     

Importance of intrathecal pain therapy

Intraspinal drug infusion using implantable pumps and catheter systems is a safe and effective therapy for selected pain patients with severe chronic pain. It improves pain relief, reduces drug-related side effects, decreases the need for oral analgesia and enhances quality of life in a segment of chronic pain patients whose pain has not been controlled with more conservative therapies. Intrathecal drug therapy has therefore established its role in the treatment of malignant pain, benign pain and severe spasticity.Careful patient selection and management as well as a multidisciplinary approach are determinants of successful treatment. Current practices for patient selection and management, screening, drug selection, dosing and implantation for intrathecal drug delivery systems are discussed.     

Stellenwert der intrathekalen Schmerztherapie

Intraspinal drug infusion using implantable pumps and catheter systems is a safe and effective therapy for selected pain patients with severe chronic pain. It improves pain relief, reduces drug-related side effects, decreases the need for oral analgesia and enhances quality of life in a segment of chronic pain patients whose pain has not been controlled with more conservative therapies. Intrathecal drug therapy has therefore established its role in the treatment of malignant pain, benign pain and severe spasticity. Careful patient selection and management as well as a multidisciplinary approach are determinants of successful treatment. Current practices for patient selection and management, screening, drug selection, dosing and implantation for intrathecal drug delivery systems are discussed.     

Virtual Reality Hypnosis for Pain Associated With Recovery From Physical Trauma

Pain following traumatic injuries is common, can impair injury recovery and is often inadequately treated. In particular, the role of adjunctive nonpharmacologic analgesic techniques is unclear. The authors report a randomized, controlled study of 21 hospitalized trauma patients to assess the analgesic efficacy of virtual reality hypnosis (VRH)—hypnotic induction and analgesic suggestion delivered by customized virtual reality (VR) hardware/software. Subjective pain ratings were obtained immediately and 8 hours after VRH (used as an adjunct to standard analgesic care) and compared to both adjunctive VR without hypnosis and standard care alone. VRH patients reported less pain intensity and less pain unpleasantness compared to control groups. These preliminary findings suggest that VRH analgesia is a novel technology worthy of further study, both to improve pain management and to increase availability of hypnotic analgesia to populations without access to therapist-provided hypnosis and suggestion.     

Treatment of postoperative pain in anaesthesiological units in Croatia

The treatment of postoperative pain is a problem that has too often been neglected. The aim of this survey was to examine the current situation in postoperative pain treatment in anaesthesiological units in Croatia. The knowledge of practice, habits and standpoints of our anaesthesiologists could serve as the basis for the formulation of unique guidelines for the treatment of postoperative pain. A questionnaire and a letter explaining the purpose of the study were used in the survey. Twenty-eight out of 49 mailed questionnaires were returned (57%).The results of the survey show that there is no formal organisation within the anaesthesiological units to provide postoperative pain treatment. Intermittent parenteral application of analgesics is instituted in the majority of responses (81%) and infusion analgesia in 23.7% of responses. Of the regional methods, only epidural analgesia — used ‘predominantly’ in 8% of responses and ‘occasionally’ in 43% of responses — can compete with parenteral application of analgesics.Tramadol (24% of responses) and pethidine (21% of responses) are mild opioids frequently used for systemic drug therapy. Of the strong opioids, fentanyl (17% of responses), morphine (11% of responses) and methadone (5% of responses) are used most often. This reflects clearly the lack of other strong opioids on the Croatian market (piritramide, buprenorphine). Patients are poorly informed about possible postoperative pain (they are informed in only 25.9% of responses). The intensity of postoperative pain is infrequently measured and rarely documented (14.3% occasionally), yet such data is the very prerequisite for the successful treatment of postoperative pain. Lack of time is the most frequently quoted cause of inadequate analgesia (50% of responses). Improved organisation, better environmental conditions, better trained personnel and more equipment would contribute to superior postoperative pain management. Better patient information is also expected to make an improvement, whilst only a small improvement is expected from advanced methods and analgesics. Better protocols for the evaluation of pain management ranked lowest of the suggestions (6.1% of responses). The fact that pain is neither measured nor recorded and that the treatment of pain is not organised results in inadequate postoperative analgesia.     

医护人员和非医护人员对术后止痛认识态度的调查比较

目的：比较医护人员和非医护人员之间对术后止痛的知识和态度之差别。方法：用问卷式调查表采取面对面方式调查了２所综合医院的１３０名医生,护士和２１２名非医护人员,结果：（１）分别有１２８人（９８．３％）和２０８人（９８．１％）完成答卷。（２）医护人员能更好地认识到术后痛可致并发症,应有效控制,更了解术后止痛药物,而较少对术后止痛存有误解。（３）两组人群均较多选择外科医师和麻醉医师为术后止痛的主要负责人