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| 活动性疼痛评估在脑卒中偏瘫肩痛患者疼痛管理中的应用效果研究 | |
| 引用本文： | 吴康顺,于卫华,戈倩,许可彩. 活动性疼痛评估在脑卒中偏瘫肩痛患者疼痛管理中的应用效果研究[J]. 中国全科医学, 2020, 23(33): 4241-4246. DOI: 10.12114/j.issn.1007-9572.2020.00.448 |
| 作者姓名： | 吴康顺 于卫华 戈倩 许可彩 |
| 作者单位： | 230061安徽省合肥市，安徽医科大学第三附属医院 合肥市第一人民医院 *通信作者：于卫华，副教授，主任护师；E-mail：ywh-zr@tom.com |
| 摘 要： | 背景 偏瘫肩痛作为脑卒中最常见的并发症之一，容易被脑卒中偏瘫的症状所掩盖而忽视。国内外多数研究报道针对偏瘫肩痛患者的疼痛调节与适应，但鲜见提及疼痛时患者的功能性活动状态。目的 探讨活动性疼痛评估在脑卒中偏瘫肩痛患者疼痛管理中的应用效果。方法 选取2018年6月-2019年9月在合肥市第一人民医院、合肥市滨湖医院康复科住院治疗的76例脑卒中偏瘫肩痛患者为研究对象，随机分为对照组和干预组，各38例。对照组于每日7：00和16：00，采用视觉模拟评分法（VAS）评估静止时偏瘫侧肩关节疼痛，并根据评分结果进行疼痛指导和康复锻炼。干预组在对照组基础上，采用VAS评估时进行Bobath握手，采用四等级功能活动评分法对活动的限制等级进行评定，并进行疼痛指导和康复锻炼。分别于入组时（干预前）、出院时（干预后），采用VAS、简明疼痛程度量表（BPI）和肩关节被动活动度进行评定。结果 干预前、后，两组VAS评分比较，差异均无统计学意义（P>0.05）；两组干预后VAS评分均低于干预前（P<0.05）。干预前，两组日常生活、情绪、行走能力、工作、与他人关系、睡眠、生活兴趣评分比较，差异均无统计学意义（P>0.05）；干预后，两组睡眠评分比较，差异无统计学意义（P>0.05）；干预组日常生活、情绪、行走能力、工作、与他人关系、生活兴趣评分均低于对照组（P<0.05）。干预前，两组肩关节前屈、外展、外旋、内旋、后伸被动活动度比较，差异均无统计学意义（P>0.05）；干预后，干预组肩关节前屈、外展、外旋、内旋、后伸被动活动度高于对照组（P<0.05）。结论 活动性疼痛评估能有效促进脑卒中偏瘫肩痛患者的疼痛管理质量提高。 |
| 关 键 词： | 卒中 偏瘫 肩痛 疼痛管理 功能活动评分法 护理评估 |
Dynamic Pain Assessment in Pain Management of Hemiplegic Shoulder Pain among Stroke Patients |
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| WU Kangshun,YU Weihua,GE Qian,XU Kecai. Dynamic Pain Assessment in Pain Management of Hemiplegic Shoulder Pain among Stroke Patients[J]. Chinese General Practice, 2020, 23(33): 4241-4246. DOI: 10.12114/j.issn.1007-9572.2020.00.448 | |
| Authors: | WU Kangshun YU Weihua GE Qian XU Kecai |
| Affiliation: | The Third Affiliated Hospital of Anhui Medical University/Hefei First People's Hospital，Hefei 230061，China *Corresponding author：YU Weihua，Associate professor，Chief superintendent nurse；E-mail：ywh-zr@tom.com |
| Abstract: | Background As one of the most common complications of stroke，hemiplegic shoulder pain is easily ignored due to being hidden by hemiplegic symptoms.Related studies are mainly about the modulation and adaptation of hemiplegic shoulder pain，but rarely involve the functional motion in such patients.Objective To evaluate the application effects of dynamic pain assessment for hemiplegic shoulder pain among stroke patients.Methods 76 stroke patients with hemiplegic shoulder pain were selected from rehabilitation department of Hefei First People's Hospital and Hefei Binhu Hospital from June 2018 to September 2019，and were randomized into the intervention group and control group with 38 cases in each.The control group received guidance on pain relief and rehabilitation exercise with range of motion dependent on the pain severity measured using the VAS in resting state at 7:00 and 16:00 o'clock every day.The intervention group received the same guidance on pain relief，and the same pain severity measurement by the VAS，but during which they also underwent Bobath handshake，and received rehabilitation exercise with range of motion dependent on the Functional Activity Score（FAS）.At group admission and discharge，the pain severity was measured by the VAS and Brief Pain Inventory（BPI），and shoulder passive range of motion （PROM） was evaluated in both groups.Results There were no significant differences in the average pre-intervention VAS score between the two groups （P>0.05）.After the intervention，although the average VAS score decreased significantly in both groups（P<0.05），there was still no significant intergroup difference（P>0.05）.Before the intervention，the average scores of general activity，mood，walking ability，normal work，relations with other people，sleep，and enjoyment of life were similar between the two groups （P> 0.05），but after the intervention，they decreased more significantly in the intervention group（P<0.05） except the average sleep score was still similar in both groups （P>0.05）.Before intervention，the forward flexion，abduction，outward rotation，inward rotation，and backward extension of PROM were similar in both groups （P>0.05），but they improved more significantly in the intervention group after the intervention （P<0.05）.Conclusion Dynamic pain assessment may effectively promote the pain management level in hemiplegic shoulder pain. |
| Keywords: | Stroke Hemiplegia Shoulder pain Pain management Functional activity score Nursing assessment |
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