规范化疼痛管理对全膝关节置换术后48h内疼痛控制的影响

目的探讨规范化疼痛管理对全膝关节置换术(Total Knee Arthroplasty,TKA)后48h内患者疼痛控制的效果。方法将80例全膝关节置换患者随机分为对照组和干预组各40例。对照组给予常规护理,干预组在此基础上采用规范化疼痛管理,比较两组患者早期的康复效果。结果干预组术后24h、48h疼痛评分低于对照组(P0.05);睡眠时间长于对照组(P0.05);首次下地时间早于对照组(P0.05);屈曲角度大于对照组(P0.05)。结论对全膝关节置换患者术后早期实施规范化疼痛管理,能够有效减轻术后疼痛,促进膝关节功能的恢复,值得临床推广。     

疼痛控制对人工全膝关节置换术后患者早期康复效果的影响

目的观察不同镇痛方法对人工全膝关节置换术后患者早期康复效果的影响。方法选择84例行单侧人工全膝关节置换的患者,随机分为2组。观察组采用多模式镇痛方法,对照组术后应用硬膜外自控镇痛泵。两组术后均进行康复锻炼。观察两组患者术后不同时间点的疼痛程度、康复计划的完成情况、膝关节功能恢复情况及患者对于康复情况的满意度。结果两组比较,观察组术后各时间点静息状态的疼痛视觉模拟评分及术后24h、48h、72h膝关节活动时的疼痛视觉模拟评分均低于对照组,差异有统计学意义(P0.01)。观察组术后24h、48h、72h、1周、2周、4周膝关节的活动度明显高于对照组(P0.01)。观察组术后4周康复方案的完成情况显著优于对照组(P0.05),患者对于康复效果的满意度显著高于对照组(P0.05)。结论多模式镇痛方法应用于人工全膝关节置换围术期疼痛的镇痛效果满意,能够促进术后康复计划的顺利实施。     

疼痛管理联合阶段性健康教育在膝关节置换术患者中的应用

目的:探讨疼痛管理联合阶段性健康教育在膝关节置换术患者中的应用方法与效果。方法:将84例膝关节置换术患者随机分为对照组与观察组各42例,对照组围术期行常规护理干预,观察组在对照组基础上实施疼痛管理联合阶段性健康教育。比较两组患者干预效果。结果:观察组术后24、48、72 h及出院时的疼痛评分均显著低于对照组(P0.05);观察组24 h睡眠时间、首次下地时间、膝关节屈曲≥90°所需时间、主动直腿抬高时间及住院时间均短于对照组(P0.05);观察组术后并发症发生率低于对照组(P0.05);观察组术后1、7、14 d的膝关节活动度(ROM)水平显著高于对照组(P0.05);术后3个月两组患者生活质量量表(SF-36)各维度评分均显著高于术后1 d(P0.05),且除精力与情感职能维度外,观察组提高幅度高于对照组(P0.05)。结论:疼痛管理联合阶段性健康教育有助于缓解膝关节置换术患者术后疼痛程度,促进患者术后恢复,提高生活质量。     

无痛病房管理对人工膝关节置换术后疼痛控制的效果观察

目的探讨骨科实施无痛病房管理在人工膝关节置换(TKA)术后疼痛控制的效果。方法将80例人工膝关节置换患者按照入院时间随机分为观察组和对照组,观察组患者入院后即进入无痛病房管理模式,对照组采用传统的镇痛方法按需镇痛,两组均在术后72 h内评估和记录患者疼痛评分,比较两组患者术后中、重度疼痛出现频次,同时比较两组患者第一次主动屈膝90°时间及对护理工作的满意度。结果观察组术后中、重度疼痛出现频次显著低于对照组,差异有统计学意义(P0.05);第一次主动屈膝90°时间及对护理工作的满意度均优于对照组,差异有统计学意义(P0.05)。结论对人工膝关节置换患者实施规范化的疼痛护理管理,能使患者疼痛明显减轻,术后发生中重度疼痛的频次显著减少;有效缩短术后膝关节屈曲90°所需的时间,提高医护人员对患者的疼痛控制质量;使患者获得更加积极和舒适的康复状态,有效提高患者对护理工作的满意度。     

膝关节骨性关节炎病人全膝关节置换术后疼痛护理效果观察

[目的]探讨膝关节骨性关节炎病人全膝关节置换术后疼痛护理效果。[方法]将84例行全膝关节置换术(TKA)治疗的膝关节骨性关节炎病人根据抽签法分为观察组与对照组各42例,对照组围术期给予骨科常规性护理,观察组在对照组基础上应用疼痛护理干预,观察两组病人术后疼痛情况及康复情况。[结果]观察组术后12h、24h、48h、72h时疼痛模拟评分(VAS)低于对照组(P0.05);观察组术后肢体肿胀持续时间、主动屈膝达90°时间、主动抬腿时间、住院时间短于对照组(P0.05),出院时膝关节主动活动度大于对照组(P0.05);观察组术后1个月、3个月、6个月美国膝关节协会(KISS)评分、简易健康评分(SF-36)评分均高于对照组(P0.05)。[结论]术后疼痛干预能有效减轻膝关节骨性关节炎病人全膝关节置换术后疼痛感,有助于病人术后膝关节功能恢复,缩短病人住院时间,提高病人生活质量。     

综合疼痛护理干预对全膝关节置换术后患者康复效果的影响

目的 探讨围手术期综合疼痛护理干预对全膝关节置换术后患者的康复效果的影响.方法 选择行全膝关节置换手术的患者100例,采用随机分组法将患者分为对照组和干预组各50例,对照组实施常规的术后护理,干预组在常规护理的基础上,施行综合疼痛护理干预措施,观察并记录两组患者术后的康复训练情况.结果 干预组术后4,8,12,24,48,72 h的疼痛评分分别为(3.12±0.13),(2.35±0.92),(2.42±1.23),(1.92±0.17),(1.65±1.17),(1.73±0.63)分;对照组分别为(4.80±0.30),(6.12±1.65),(7.42±2.09),(3.70±0.22),(3.80±1.67),(3.48±1.67)分;两组比较,差异有统计学意义(f分别为4.72,13.77,14.73,14.09,8.23,7.69;P＜0.01).术后干预组患者的主动直腿抬高时间、膝关节主动屈膝活动达90.时间均显著低于对照组[分别为(14.50±1.90)比(24.73±3.04)h,(3.27±0.73)比(4.10±1.05)d],差异有统计学意义(t分别为24.24,5.75;P＜0.01).干预组出院时膝关节主动活动度显著大于对照组[(106.46±11.65)比(98.60±11.36)°],差异有统计学意义(t=2.57,P＜0.05).干预组的出院满意度显著高于对照组(x2=63.25,P＜0.01).结论 综合疼痛护理干预可以减轻膝关节置换术患者的术后疼痛,增加患者的舒适度,有助于患者尽早进行功能锻炼,促进患者的早期康复,提高护理质量,提高患者满意度.     

全程疼痛护理干预对全膝关节置换术后疼痛状况的影响

目的 探讨全程疼痛护理干预对全膝关节置换术后疼痛状况的影响。方法 选取2018年2月～2019年4月我院收治的104例全膝关节置换术患者,随机分为研究组和对照组各52例,对照组给予常规术后护理,研究组给予全程疼痛护理干预,比较两组干预前后疼痛程度和生活质量评分。结果 干预前两组疼痛和生活质量评分比较,无显著差异(P0.05);干预后研究组术后2、4、7d疼痛评分显著低于对照组(P0.05);干预后研究组活动能力、认知能力、康复训练能力及情绪缓解的评分均显著高于对照组(P0.05)。结论 全程疼痛护理干预能显著减轻全膝关节置换术后患者的疼痛,能有效提高患者术后的生活质量,值得推广应用。     

多学科疼痛管理模式在乳腺癌手术患者中的应用

目的:探讨多学科疼痛管理模式在乳腺癌手术患者中的应用效果。方法:将2018年1月1日～2020年12月31日收治的86例乳腺癌手术患者随机分为对照组42例和观察组44例。对照组采用常规疼痛管理干预,观察组采用多学科疼痛管理模式干预。比较两组住院时间、卧床时间、医疗费用,术后1、12、24、48 h疼痛情况[采用视觉模拟评分法(VAS)],干预前后心理状况[采用抑郁自评量表(SDS)和焦虑自评量表(SAS)],术前、术后1个月功能恢复情况[采用肩关节Neer评分]和生活质量[采用生活质量综合评定问卷(GQOLI-74)]。结果:观察组住院时间、卧床时间短于对照组(P0.01),且医疗费用低于对照组(P0.01);观察组术后1、12、24、48 h的VAS评分均低于对照组(P0.01);干预后两组SDS、SAS评分均低于干预前(P0.05),且观察组低于对照组(P0.01);观察组Neer、GQOLI-74评分高于对照组(P0.01)。结论:对乳腺癌手术患者采取多学科疼痛管理模式干预,可缓解患者术后疼痛和不良情绪,提高生活质量。     

骨关节术后急性疼痛规范化镇痛护理干预的临床分析

目的 探讨规范化镇痛护理干预对骨科术后患者急性疼痛治疗的效果.方法 将40例骨关节手术治疗的患者随机分为观察组和对照组各20例.对照组患者根据疼痛主诉,给予常规镇痛护理.观察组患者在围手术期准确评估疼痛,给予规范化镇痛护理干预.观察并比较两组患者术后72 h的疼痛程度及住院天数的差异.结果 观察组患者术后72 h疼痛程度显著低于对照组(P＜0.05);观察组患者平均住院天数明显少于对照组(P＜0.05).结论 对骨科术后急性疼痛患者进行规范化镇痛护理干预能有效控制术后疼痛,减轻痛苦,缩短住院天数,促进康复.     

疼痛管理在全膝关节置换术围手术期中的应用

目的 探讨围手术期疼痛管理在全膝关节置换术中开展的效果。方法 选取2009年7～2011年7月来我科实施全膝关节置换术的患者共108例,随机分为对照组和实验组各54例,对照组采用全膝关节术后常规术后止痛。实验组在此基础上予以系统化的围手术期疼痛管理进行护理干预。对两组患者首次下床时间、24小时睡眠时间、主动开始锻炼时间、住院天数、患者对控制或减轻疼痛的措施及效果满意度及术后并发症发生情况六方面进行比较。结果 试验组患者的住院天数及并发症发生率显著低于对照组(P<0．01),24h睡眠时间显著长于对照组,而患者对控制或减轻疼痛的措施及效果满意度显著高于对照组,其中首次下床和主动开始锻炼时间均提早于对照组,促进了术后早日康复。结论 在骨科全膝关节置换术围手术期开展规范的疼痛管理可有效改善术后镇痛质量,促进患者早日康复,缩短患者的住院天数,提高患者的满意度。     

Fear of pain in orofacial pain patients

In the present study, we examined whether fear of pain, dental fear, general indices of psychological distress, and self-reported stress levels differed between 40 orofacial pain patients and 40 gender and age matched control general dental patients. We also explored how fear of pain, as measured by the Fear of Pain Questionnaire-III (J Behav Med 21 (1998) 389), relates to established measures of psychological problems in our sample of patients. Finally, we examined whether fear of pain uniquely and significantly predicts dental fear and psychological distress relative to other theoretically-relevant psychological factors. Our results indicate that fear of severe pain and anxiety-related distress, broadly defined, are particularly elevated in orofacial pain patients relative to matched controls. Additionally, fear of pain shares a significant relation with dental fear but not other general psychological symptomology, and uniquely and significantly predicts dental fear relative to other theoretically-relevant variables. Taken together, these data, in conjunction with other recent studies, suggest greater attention be placed on understanding the fear of pain in orofacial pain patients and its relation to dental fear and anxiety.     

Electronic momentary assessment in chronic pain II: pain and psychological pain responses as predictors of pain disability

OBJECTIVES AND METHODS: More than 7,100 electronic diaries from 80 patients with chronic pain (mean: 89.3, range 30-115) entered multilevel analyses to establish the statistical prediction of disability by pain intensity and by psychological functioning (fear avoidance, cognitive, and spousal pain responses). We also tested the differences between pre-chronic, recently chronic, and persistently chronic pain in the prediction of disability (impaired physical and mental capacity, pain interference with activities, immobility due to pain). RESULTS: Pain intensity explained 8% to 19% of the disability variance. Beyond this psychological functioning explained 7% to 16%: particularly fear-avoidance and cognitive pain responses predicted chronic pain disorder disability; spousal responses predicted immobility better than other aspects of disability. Immobility due to actual pain occurred infrequently. When it did, however, it was better predicted by avoidance behavior in the patient and by spousal discouragement of movement than by actual pain intensity. The prediction of immobility due to pain by, respectively, avoidance behavior and catastrophizing was better in chronic pain (>6 months) and that of physical impairment by catastrophizing better in persistently chronic pain (>12 months) than in pain of shorter duration. DISCUSSION: The psychological prediction of chronic pain disorder disability was determined beyond that accounted for by pain intensity. Nonetheless, psychological functioning explained substantial variance in chronic pain disorder disability. The psychological prediction of immobility and physical impairment was stronger with longer pain duration. Patient characteristics and momentary states of disability-and in particular of immobility-should be carefully distinguished and accounted for in chronic pain disorder.     

From past pain to future pain through the pain of others: Information about other people's pain ratings can alleviate our subsequent pain

Background

Previous studies have shown that pain memories have a profound impact on subsequent pain experiences. This study investigated whether pain ratings derived from other people can modify an individual's memory of past pain. This study also examined whether pain memory modified by others' pain ratings determines subsequent pain experiences.

Methods

Participants were divided into two groups: an experimental group and a control group. Participants in both groups were exposed to pain stimulation; then, they recalled its intensity twice over a period of time; after a break, they were again exposed to pain stimulation of the same intensity. The final sample consisted of 53 participants. The only difference between the experimental group and the control group was that in the former the pain ratings of other alleged participants were presented between the two consecutive pain recalls. These ratings suggested that other people experienced the same pain as less intense.

Results

The pain ratings derived from other people did not alter the pain memory; nevertheless, they affected an individual's next pain experience even for a certain period of time after their presentation. This type of pain-related information shaped participants' subsequent pain experiences regardless of their empathy, conformity, and susceptibility to social influence.

Conclusions

Information on pain derived from other people not only shapes the response to a novel stimulation but also substantially modifies the subsequent experience of that stimulation.

Significance

The study demonstrates the importance of social information on pain and provides evidence that this type of information substantially modifies the subsequent experience of the same pain. These results suggest that social information on pain can be used to alleviate pain associated with recurring medical procedures and thus increase patients' willingness to continue treatment.     

无痛静脉穿刺技术的研究进展

静脉穿刺技术是临床上常用的基础护理操作技术，可通过静脉给药而达到治疗疾病的目的，而穿刺同时引起的疼痛同样令人难以忍受。疼痛是人的一种生理、心理感受，是在实际上或潜在因素造成组织损伤的情感经历。疼痛不只是主观上使人感觉不适，客观上还能引起病人生命体征的改变，打针痛已成为人们脑海里固有的概念，患儿则常以哭闹的方式拒绝穿刺。因此，如何减轻静脉穿刺引起的疼痛，一直成为护理同仁们研究的课题，现就无痛静脉穿刺的方法及技术进展综述如下。