急性疼痛应用PCA的护理体会

术后患者自控镇痛(patient controlled analgesia,PCA)自1994年国内开展起来,镇痛效果理想,已受到患者的普遍欢迎。国内外文献一致认为术后PCA的管理／护理是影响术后PCA质量的主要影响因素之一。不同PCA途径、用药对不同手术、不同患者的镇痛效果和并发症等有较大差异,本研究结合我院1000例术后PCA患者管理／护理情况探讨了术后PCA护理的特殊要求。     

以护士为基础的疼痛管理模式在普通外科应用的临床效果研究

目的 评价以护理为基础的镇痛管理模式下连续硬膜外镇痛(PCEA)对外科术后镇痛效果以及患者生理功能恢复的影响.方法 对实施PCEA镇痛模式的520例外科术后病人进行开放性、前瞻性、非随机性的观察性研究,分为两组,即观察组(实施PCEA镇痛模式管理组);对照组(非PCEA镇痛管理组).结果 与对照组比较,实观察组术后镇痛效果指标VAS值显著降低(P＜0.01),术后24 h和48 h睡眠时间显著增加(P＜0.01),术后下床活动时间提前、住院时间显著缩短(P＜0.01),病人总体满意度提高(P＜0.01);药物不良反应皮肤瘙痒、呼吸困难、尿潴留、恶心呕吐等差异无显著性意义(P＞0.05).结论 该项研究表明以护理为基础的镇痛管理模式应用于PCEA术后镇痛能有效提高镇痛效果.     

术后疼痛评估及自控镇痛泵的临床应用

国际研究会给疼痛的定义为“疼痛是一种令人不快的感觉和情绪上的感受，伴有实际的或潜在的组织损伤。”自控镇痛泵（PCA）是一种由患者自行控制的仪器，它是根据患者的镇痛需要，将镇痛药物个性化地适量地输注到患者体内，可发挥较长时间的镇痛作用。二十世纪九十年代中期，PCA开始在我国普及，对其用法、注意事项、药物不良反应，应选择多个时间点强化宣教，从而减轻疼痛，使患者舒适。     

病人自控镇痛在英国成人病人术后疼痛管理中的应用及启示

介绍了英国布里斯托皇家医院成人术后疼痛管理中病人自控镇痛(PCA)的临床应用、护理,结合我国临床PCA使用现状进行分析讨论。认为我国可以借鉴西方PCA管理中的经验,以促进病人术后无痛,达到优质护理的目标。     

疼痛管理在围手术期中的应用

多年来,外科手术是治疗疾病的重要手段之一,而手术作为一种应激源,常使患者产生强烈的生理、心里应激反应,表现为不同程度的焦虑、恐惧,引起患者生命体征及心里变化_【！】。术后急性疼痛不仅降低患者的生活质量,也对其术后恢复产生不利影响,因此需要在围手术期积极采取防御性措施进行疼痛管理。     

骨科术后疼痛护理干预效果观察

[目的]观察疼痛护理干预在骨科术后的应用效果.[方法]选择300例骨科手术病人,将其随机分为对照组和干预组,对照组给予常规护理;干预组除按医嘱采取镇痛措施外,在采用常规护理方法的基础上实施疼痛护理,包括术前、术后疼痛宣教、营造舒适的病室环境、心理护理、镇痛等,根据视觉模拟评分法比较两组病人疼痛程度.[结果]术后6 h、24 h及48 h干预组病人VAS评分明显低于对照组(P<0.05).[结论]对骨科术后病人施行疼痛护理,可有效减轻骨科术后病人的疼痛.     

骨科术后疼痛护理干预效果观察

[目的]观察疼痛护理干预在骨科术后的应用效果。[方法]选择300例骨科手术病人,将其随机分为对照组和干预组,对照组给予常规护理;干预组除按医嘱采取镇痛措施外,在采用常规护理方法的基础上实施疼痛护理,包括术前、术后疼痛宣教、营造舒适的病室环境、心理护理、镇痛等,根据视觉模拟评分法比较两组病人疼痛程度。[结果]术后6 h、24 h及48 h干预组病人VAS评分明显低于对照组(P<0.05)。[结论]对骨科术后病人施行疼痛护理,可有效减轻骨科术后病人的疼痛。     

静脉自控镇痛在隆乳术中的应用与护理

目的 探讨静脉自控镇痛(PCIA)在隆乳术中的临床应用与护理。方法 将206例隆乳术病人随机分成两组。实验组采用静脉自控镇痛法术后镇痛;对照组采用传统镇痛法术后镇痛。结果 实验组术后镇痛效果优于对照组,病人入睡情况明显优于对照组(P<0.01),但恶心呕吐发生率高于对照组(P<0.01)。结论 实施PCIA能有效改善术后疼痛,同时要加强临床观察和护理。     

术后疼痛的护理

过去，术后病人担心止痛药物产生不良反应，因此病人及家属一般对于疼痛都会极力忍耐，而护士则传统地认为病人一旦疼痛就会报告。使得临床约2／3的病人在主动寻求治疗时已达到严重疼痛程度。现代护理人员应加强对病人疼痛感受的主动询问并及时给予止痛措施。     

规范化疼痛管理在肝胆外科术后患者疼痛控制中的应用

目的探讨规范化疼痛管理在肝胆外科术后患后疼痛控制中的应用效果。方法选取2017年11月—2018年4月住院行肝胆外科手术治疗的患者547例,分为对照组369例和观察组178例。对照组采用常规疼痛管理,观察组采取规范化疼痛管理。比较2组患者中重度静息疼痛的发生率、活动性疼痛评分等指标。结果观察组患者术后3天内中重度静息痛的发生率为20.22%,低于对照组的23.31%,差异有统计学意义(P<0.05)。术后6、12、24、48 h时观察组活动性疼痛评分低于对照组,差异有统计学意义(P<0.01)。结论规范化疼痛管理能有效控制肝胆外手术患者术后疼痛程度,有利于患者的快速康复。     

术后疼痛管理新进展

术后疼痛管理的新理念包括多模式镇痛、超前镇痛和个体化镇痛,目前国外的术后疼痛管理完成了从以麻醉医生为主体到以护士为主体的转变,术后疼痛评估常态化、常规化,同时将个人数字助理（PDA)用于术后镇痛随访,使用无线远程镇痛监控系统进行术后疼痛管理。这些措施有效地提高了术后镇痛的效果,并实现了个体化的术后疼痛管理,提高了患者对术后镇痛的满意度,减少了医护人员的工作量,提高了工作效率。     

Relationship between nurses' pain knowledge and pain management outcomes for their postoperative cardiac patients

Nurses' knowledge and perceived barriers related to pain management have been examined extensively. Nurses have evaluated their pain knowledge and management practices positively despite continuing evidence of inadequate pain management for patients. However, the relationship between nurses' stated knowledge and their pain management practices with their assigned surgical cardiac patients has not been reported. Therefore, nurses (n=94) from four cardiovascular units in three university-affiliated hospitals were interviewed along with 225 of their assigned patients. Data from patients, collected on the third day following their initial, uncomplicated coronary artery bypass graft (CABG) surgery, were aggregated and linked with their assigned nurse to form 80 nurse-patient combinations. Nurses' knowledge scores were not significantly related to their patients' pain ratings or analgesia administered. Critical deficits in knowledge and misbeliefs about pain management were evident for all nurses. Patients reported moderate to severe pain but received only 47% of their prescribed analgesia. Patients' perceptions of their nurses as resources with their pain were not positive. Nurses' knowledge items explained 7% of variance in analgesia administered. Hospital sites varied significantly in analgesic practices and pain education for nurses. In summary, nurses' stated pain knowledge was not associated with their assigned patients' pain ratings or the amount of analgesia they received.     

Acute pain teams and the management of postoperative pain: a systematic review and meta-analysis

BACKGROUND: The introduction of acute pain teams (APTs) in every hospital performing surgery in the UK has been recommended in order to reduce postoperative pain. However, recent evidence suggests that many APTs are under-resourced. Purchasers may be more prepared to invest in these services if they are persuaded that they result in measurable improvements in patient outcomes. AIM: A systematic review of the literature and meta-analysis were performed to determine the effectiveness of APTs in improving the quality of analgesia and other postoperative outcomes of adult patients undergoing surgery. METHODS: A broad search strategy using the terms 'pain team' and 'pain service' was adapted for a variety of databases. Key journals were hand-searched and reference lists of selected reports were reviewed. Subject experts and study authors were contacted. Studies describing the impact of the APT/acute pain service (APS) on postoperative pain relief, other postoperative outcomes or the processes of postoperative pain were included. Study quality was assessed using a multidimensional instrument. A broad qualitative overview of the included studies was conducted. Continuous outcome data for pain in the first 24 hours postoperatively (in one case worst pain at 24-48 hours) were pooled. RESULTS: Fifteen studies were included in the review. There were considerable differences in study design and quality, the nature of the APT and the outcomes measured. Of the nine studies measuring pain, it was possible to present data as Standardized Mean Differences for only four studies. Quantitative synthesis indicates a statistically significant overall estimate of effect using a fixed effects model only. LIMITATIONS: Only published studies in English were included. Study inclusion decisions and data extraction were performed by one reviewer only. CONCLUSION: There is insufficient robust research to assess the impact of APTs on postoperative outcomes of adult patients or on the processes of postoperative pain relief.     

Comparison of postoperative pain management using two patient-controlled analgesia methods: nursing perspective

Title. Comparison of postoperative pain management using two patient‐controlled analgesia methods: nursing perspective. Aim. To compare the effect of fentanyl iontophoretic transdermal system and morphine intravenous patient‐controlled analgesia on the time‐efficiency and convenience of postoperative patient care. Background. Intravenous patient‐controlled analgesia with morphine is effectively used to manage postoperative pain; however, it takes time to set up and administer. Methods. Nurses evaluated patient‐care tasks with fentanyl iontophoretic transdermal system and/or morphine intravenous patient‐controlled analgesia in two phase IIIb studies (n = 1305) using a nurse ease‐of‐care questionnaire. A responder for time‐efficiency and convenience responded with one of the top three positive choices on all items; for satisfaction, a responder chose one of the top two positive choices on both items. Data were collected between March 2004 and April 2005. Findings. In both studies, greater proportions of nurses were responders for fentanyl iontophoretic transdermal system than for morphine intravenous patient‐controlled analgesia, respectively, for time‐efficiency [total hip replacement surgery, 80·9% (250/309) vs. 57·7% (172/298), P < 0·001; abdominal/pelvic surgery, 84·8% (162/191) vs. 57·7% (113/196), P < 0·001], convenience [total hip replacement surgery, 85·5% (271/317) vs. 64·1% (191/298), P < 0·001; abdominal/pelvic surgery, 89·2% (166/186) vs. 62·8% (123/196), P < 0·001], and satisfaction [total hip replacement surgery, 66·6% (247/371) vs. 33·3% (108/324), P < 0·001; abdominal/pelvic surgery, 67·4% (155/230) vs. 38·2% (84/220), P < 0·001]. Higher proportions of nurses favoured fentanyl iontophoretic transdermal system than morphine intravenous patient‐controlled analgesia in both studies (P < 0·001). Conclusion. The fentanyl iontophoretic transdermal system appears to be simpler, easier to use, and more satisfactory for nurses than morphine intravenous patient‐controlled analgesia.     

Postoperative pain control - the impact of an acute pain team

A two year prospective audit of the severity of postoperative pain and sedation in 1,781 patients receiving either patient controlled or epidural infusion analgesia (PCA or EIA) is presented. The introduction of an acute pain team (APT) led to sequential changes in procedures and policies, including nurse prescribing. The percentage of patients with moderate to severe pain fell from 35 to 11% for PCA and 35 to 22% for EIA following the introduction of the APT.     

Acute pain management: Implications of scientific evidence for nursing practice in the postoperative context

Unrelieved acute pain remains prevalent in hospitalized patients despite advances in pain management. A decade after the Australian National Health and Medical Research Council called for improved pain management practices by health professionals, it released clinical guidelines to provide clinicians with current scientific evidence to augment their clinical decision-making. This paper examines the implications of national guidelines on nursing practice and highlights the inadequacies of current implementation policies. Pain management guidelines have failed to decrease patients' postoperative pain because organizations and researchers have ignored the impact of contextual influences on clinicians' decision-making. It is recommended that for successful implementation of national guidelines to occur at the local level of practice, organizations must assist clinicians to identify local influences on their decision-making, to address the issues specific to their own work environment and to evaluate any changes in practice.     

Non-invasive methods for PCA in pain management

Patient controlled analgesia (PCA) with an intravenous opioid has become one of the most effective techniques in the management of acute postoperative pain. In order to increase patient convenience non-invasive patient controlled analgesia by different routes of drug administration has been developed. This article gives a short review of transdermal, nasal, and oral PCA which are currently under extensive investigation.