合理情绪化疗法对高龄髋关节置换术患者术后负性情绪及疼痛感的影响

目的探讨合理情绪化疗法对高龄髋关节置换术患者术后负性情绪及疼痛感的影响。方法选取2014年10月~2016年10月我院120例高龄髋关节置换术患者,根据随机数字表法分为观察组和对照组,各60例。对照组应用常规护理。观察组在对照组的基础上应用合理情绪化疗法。分别于干预前及干预后应用汉密尔顿抑郁量表(HAMD)及汉密尔顿焦虑量表(HAMA)对两组负性情绪进行评价,记录两组术前、术后1、3、5、7d疼痛情况。结果观察组干预后HAMD、HAMA评分显著低于对照组(P0.05)。观察组术后1、3、5、7d视觉模拟评分量表(VAS)评分显著低于对照组(P0.05)。结论合理情绪化疗法能有效减轻高龄髋关节置换术患者焦虑、抑郁情绪,改善患者心理状态,有利于促进患者术后康复。     

舒适护理干预对腹腔镜子宫肌瘤切除术患者效果研究

目的探讨舒适护理干预对腹腔镜子宫肌瘤切除术患者的护理效果。方法选择该院82例腹腔镜子宫肌瘤切除术患者,采用随机数字表法分为观察组和对照组,各41例。对照组患者给予妇科腹腔镜子宫肌瘤切除术常规护理,观察组患者在对照组的基础上增加舒适护理干预。比较2组患者手术相关指标、视觉模拟疼痛评分(VAS)、汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)、术后并发症。结果观察组患者气管插管拔除时间、早期下床活动时间、平均住院时间均明显短于对照组,差异有统计学意义(P0.05);VAS、HAMD、HAMA、并发症均低于对照组,差异有统计学意义(P0.05)。结论舒适护理干预有助缓解疼痛程度及焦虑抑郁情绪,减少术后并发症,促进患者康复。     

持续质量改进在颈椎骨折患者中的应用

目的:探讨持续质量改进在颈椎骨折患者中的应用方法及效果。方法:将124例颈椎骨折患者随机分为观察组和对照组各62例,对照组给予常规性护理,观察组实施持续质量改进,比较两组护理效果。结果:两组患者干预后汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评分及视觉模拟评分(VAS)均低于干预前(P0.05),观察组干预后HAMA、HAMD评分及VAS评分低于对照组(P0.05);两组护理质量评分比较差异有统计学意义(P0.05)。结论:持续质量改进能有效改善颈椎骨折患者的负性情绪,减轻疼痛,提高护理质量。     

个性化疼痛护理对子宫内膜异位症患者术后疼痛及负性情绪的影响

目的探讨个性化疼痛护理对子宫内膜异位症患者术后疼痛及负性情绪的影响。方法选择2013年6月~2014年6月我科手术治疗的80例子宫内膜异位症患者为研究对象,根据随机数字表法将患者分为观察组和对照组,各40例。对照组术后实施常规护理。观察组术后实施个性化疼痛护理干预。观察两组术后疼痛感、术后康复情况及负性情绪的变化。结果观察组术后6h、12h、24h、48h、72h疼痛评分显著低于对照组(P0.05)。观察组干预后HAMA、HAMD评分显著低于对照组(P0.05)。观察组术后肛门排气时间、下床活动时间、进食时间、切口愈合时间、平均住院时间少于对照组,患者满意度高于对照组(P0.05)。结论个性化疼痛护理能有效减轻子宫内膜异位症患者术后疼痛感,改善患者术后焦虑、抑郁情绪,促进患者术后康复。     

针刺肌筋膜触发点联合疼痛康复治疗对脊髓损伤后中枢性疼痛的抑制作用

目的探讨给予脊髓损伤后中枢性疼痛患者针刺肌筋膜触发点联合疼痛康复治疗的疼痛抑制效果。方法选取76例脊髓损伤后中枢性疼痛患者随机分为对观察组与对照组各38例,对照组患者给予常规疼痛康复治疗,观察组患者给予针刺肌筋膜触发点联合疼痛康复治疗,比较两组疗效。结果治疗后,观察组疼痛评估指数(PRI)、视觉模拟评分(VAS)、现时疼痛强度评分(PPI)及汉密尔顿抑郁量表(HAMD)、汉密尔顿焦虑量表(HAMA)评分均显著低于对照组(t=10.678、3.897、4.455、14.910、18.441,P<0.05);观察组治疗总有效率(92.11%)显著高于对照组(78.95%)(χ~2=4.145,P<0.05)。结论给予脊髓损伤后中枢性疼痛患者针刺肌筋膜触发点联合疼痛康复治疗,可有效减轻患者疼痛,改善其心理状态,提高总体治疗效果。     

合理情绪化疗法对髋关节置换术患者术后负性情绪及疼痛感的影响

目的探讨合理情绪化疗法对老年髋关节置换术患者术后负性情绪及疼痛感的影响。方法选取2015年6月至2016年6月120例接受髋关节置换术的老年患者,按照随机数字表法将患者平均分为两组,各60例。对照组围手术期应用常规性护理,观察组围手术期应用"合理情绪化疗法",分别于干预前及干预后应用汉密尔顿抑郁量表(HAMD)及汉密尔顿焦虑量表(HAMA)对两组负性情绪进行评价,记录两组术前、术后1 d、术后3 d、术后5 d、术后7 d疼痛情况。结果观察组患者干预后HAMD评分、HAMA评分显著低于对照组(P0.05)。观察组术后术后1 d、术后3 d、术后5 d、术后7 d视觉模拟评分(VAS)显著低于对照组(P0.05)。结论老年髋关节置换术患者接受合理情绪化疗法有助于改善患者情绪,促进患者康复,值得临床推广。     

全程护理对外科术后患者应激反应的影响

目的:探讨全程护理对外科术后患者应激反应的影响。方法:将2012年6月~2014年6月我院普外科收治的128例患者随机分为观察组和对照组各64例,对照组给予常规护理,观察组给予全程护理;分别于干预前后应用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)对两组患者心理应激反应进行评价,测量两组患者干预前后血压及心率变化,并观察两组患者术后康复效果。结果:观察组干预后HAMA、HAMD评分显著低于对照组(P0.05),干预后收缩压、舒张压、心率水平显著低于对照组(P0.05),术后睡眠质量及满意度均高于对照组(P0.05),下床活动时间、住院时间均少于对照组(P0.05),疼痛评分(VAS)低于对照组(P0.05)。结论:全程护理能有效改善外科术后患者应激反应,促进患者术后康复。     

护理团队协同疼痛管理对胃癌术后的作用及睡眠质量的影响

目的：探究护理团队协同疼痛管理对胃癌术后的作用及睡眠质量的影响。方法：选取2021年6月至2023年6月福建省龙岩市博爱医院胃肠外科接受手术治疗的胃癌患者52例作为研究对象,按照随机原则分为对照组和观察组,每组26例。对照组患者给予常规护理,观察组患者给予护理团队协同疼痛管理,比较2组护理前后的疼痛程度[简化McGill疼痛问卷(SF-MPQ)]、睡眠质量[匹兹堡睡眠质量指数量表(PSQI)]、心理状况[汉密尔顿焦虑量表(HAMA)和汉密尔顿抑郁量表(HAMD)]及生命质量[生命质量量表(SF-36)]变化。结果：观察组SF-MPQ评分显著低于对照组(P<0.05);护理后观察组PSQI、HAMA、HAMD评分均较本组护理前显著下降,SF-36评分较本组护理前显著提高(P<0.05),且观察组护理后PSQI、HAMA、HAMD评分显著低于对照组,SF-36评分显著高于对照组(P<0.05)。结论：护理团队协同疼痛管理能够显著降低胃癌患者术后疼痛程度,提高睡眠质量,改善心理状况及出院后的生命质量,值得临床推广应用。     

综合护理在胆结石患者行腹腔镜胆囊切除术围手术期的应用效果观察

目的:研究综合护理干预在胆结石患者行腹腔镜胆囊切除术围术期中的应用效果。方法:选取2015年1月~2017年1月我院择期行腹腔镜胆囊切除术治疗的胆结石患者96例,随机分为对照组和观察组各48例。对照组采取常规护理,观察组在对照组基础上实施综合护理干预。比较两组患者治疗前后焦虑评分(HAMA)、抑郁评分(HAMD)、疼痛评分(VAS)及术后恢复情况。结果:治疗前,两组患者HAMA、HAMD、VAS评分比较无显著性差异(P>0.05);治疗后,观察组HAMA、HAMD、VAS评分均低于对照组(P<0.05);观察组术后首次进食时间、首次排气时间及住院时间均低于对照组(P<0.05)。结论:综合护理干预在胆结石患者行腹腔镜胆囊切除术围手术期中应用效果显著,可减轻患者不良情绪及疼痛程度,促进患者术后康复。     

耳穴埋豆联合舒适护理对扁桃腺切除术后病人疼痛及负性情绪的影响

[目的]探讨耳穴埋豆联合舒适护理对扁桃腺切除术后病人疼痛及负性情绪的影响。[方法]将84例扁桃腺切除术后病人根据随机数字表法将病人分为观察组及对照组各42例,对照组病人围术期应用舒适护理,观察组在舒适护理的基础上实施耳穴埋豆护理,比较两组术后疼痛感、负性情绪、术后假膜形成时间、创面愈合时间、住院时间及病人满意度。[结果]观察组术后第1天、第3天、出院前1天疼痛评分均低于对照组同期评分;观察组干预后汉密尔顿焦虑量表(HAMA)以及汉密尔顿抑郁量表(HAMD)评分低于对照组;观察组术后假膜形成时间、创面愈合时间、住院时间短于对照组,而病人满意度评分高于对照组,差异均有统计学意义(P0.05)。[结论]耳穴埋豆联合舒适护理能有效缓解扁桃腺切除术后病人疼痛感,减轻病人负性情绪,提高病人满意度,促进病人康复。     

Effects of a pain education program on nurses' pain knowledge, attitudes and pain assessment practices in China

The purpose of this study was to develop, implement, and evaluate the impact of a Pain Education Program (PEP) for nurses in China. The effects of PEP were measured in a quasi-experimental design. A total of 196 nurses who met the inclusion criteria from five nursing units in two teaching hospitals participated in the study. Randomization took place at the hospital level to select experimental and control groups. The research intervention was the PEP, which had two components: (1) to educate nurses about pain management and (2) to implement daily pain assessment by using the Changhai Pain Scale. The duration of PEP was five weeks and intervention methods included focused education, group activity, and individual instruction. After the baseline data were collected, PEP was implemented in the experimental group. The control group (n = 90) received no intervention, and the experimental group (n = 106) received six hours of focused education training. During the fourth and fifth weeks of the training program, the researcher and the faculty instructed nurses in five nursing units on how to use the Changhai Pain Scale to assess patients’ pain levels and demonstrated how to document pain condition in the nursing records. Nurses in both groups filled out a set of questionnaires, which included a background information form and the Nurses’ Knowledge and Attitude Survey form, before the PEP (T1), at one month after the PEP (T2), and at three months after the PEP (T3). Nurses in the experimental group who received the PEP had a significant improvement in their pain knowledge and attitudes. Their scores on the Nurses’ Knowledge and Attitude Survey increased from 15.67 at T1 to 26.13 at T2 and 35.14 at T3. The scores of nurses in the control group were unchanged (from 15.20 at T1 to 14.29 at T2 and 14.93 at T3, P > 0.05). In addition, experimental group nurses had an improvement in pain assessment. The percentage of nurses who correctly used the Changhai Pain Scale to assess patients’ pain intensity increased significantly after the PEP, and the increased usage of the assessment tool between experimental and control groups also shows a statistical difference in trend (χ²=93.281, P < 0.001). The PEP has been demonstrated to be effective in improving nurses’ pain knowledge, attitudes, and assessment.     

Early visceral pain predicts chronic pain after laparoscopic cholecystectomy

Chronic pain after laparoscopic cholecystectomy is related to postoperative pain during the first postoperative week, but it is unknown which components of the early pain response is important. In this prospective study, 100 consecutive patients were examined preoperatively, 1 week postoperatively, and 3, 6, and 12 months postoperatively for pain, psychological factors, and signs of hypersensitivity. Overall pain, incisional pain (somatic pain component), deep abdominal pain (visceral pain component), and shoulder pain (referred pain component) were registered on a 100-mm visual analogue scale during the first postoperative week. Nine patients developed chronic unexplained pain 12 months postoperatively. In a multivariate analysis model, cumulated visceral pain during the first week and number of preoperative biliary pain attacks were identified as independent risk factors for unexplained chronic pain 12 months postoperatively. There were no consistent signs of hypersensitivity in the referred pain area either pre- or postoperatively. There were no significant associations to any other variables examined. The risk of chronic pain after laparoscopic cholecystectomy is relatively low, but significantly related to the visceral pain response during the first postoperative week.     

Improving the quality of pain treatment by a tailored pain education programme for cancer patients in chronic pain.

Educational interventions, aiming to increase patients' knowledge and attitude regarding pain, can affect pain treatment. The purpose of this study was to evaluate the effects of a Pain Education Programme (PEP), on adequacy of pain treatment, and to describe characteristics predicting change in adequacy. The PEP consists of a multi-method approach in which patients are educated about the basic principles regarding pain, instructed how to report pain in a pain diary, how to communicate about pain, and how to contact healthcare providers. The effects of the PEP were evaluated taking into consideration the lack of well-established outcome measures to evaluate adequacy of pain treatment, the lack of long-term follow-up, and the influence of missing data.A prospective, randomized study was utilized in which 313 chronic cancer patients were followed-up until 8 weeks postdischarge. Adequacy of pain treatment was evaluated by means of the Amsterdam Pain Management Index (APMI), consisting of an integrated score of patients' Present Pain Intensity, Average Pain Intensity, and Worst Pain Intensity, corrected for patients' Tolerable Present Pain, with the analgesics used by the patient. At pretest, 60% of the patients in the hospital were treated inadequately for their pain. Postdischarge, the control group patients were significantly more inadequately treated at 2 weeks after discharge (56% vs 41%), at 4 weeks after discharge (62% vs 42%) and at 8 weeks after discharge (57% vs 51%) than the intervention group patients. While the level of inadequacy in the control groups remained relatively stable at all assessment points, a slight increase in the percentage of patients being treated inadequately was found in the intervention group patients over time. A beneficial effect of the PEP was found for patients both with and without district nursing. Variables predicting an improvement in adequacy of pain treatment consisted of the PEP, the APMI score at baseline, patients' level of physical functioning, patients' level of social functioning, the extent of adherence to pain medication, patients' pain knowledge, and the amount of analgesics used.These findings suggest that quality of pain treatment in cancer patients with chronic pain can be enhanced by educating patients about pain and improving active participation in their own pain treatment. The benefit from the PEP, however, decreases slightly over time, pointing at a need for ongoing education.     

脑卒中后疼痛

脑卒中后引起的各种急慢性疼痛对病人整体功能的康复,患者的生存质量均有很大的影响。脑卒中的各种康复治疗措施应特别强调对各种疼痛的处理。以下就脑卒中引起的常见疼痛的有关问题进行综述。     

Affective pain modulation in fibromyalgia,somatoform pain disorder,back pain,and healthy controls

Previous research suggested that patients with fibromyalgia (FM) experience a higher pain intensity (clinical pain) than do patients with musculoskeletal pain after negative emotional priming compared to positive priming. To further examine affective pain modulation in FM, we applied an experimental pain induction to compare 30 patients with FM with 30 healthy (pain‐free) participants (HC), and 30 patients with back pain (BP). For another group of 30 patients with somatoform pain disorder (SF), we predicted the same pain modulation as for FM. As primes we presented positive, neutral, negative, and pain‐related pictures and assessed pain intensity in response to a fixed pressure weight. Overall, picture valence modulated pain intensities (in the order of pain‐related>negative pictures>neutral), but the pain intensities between neutral and positive pictures did not differ significantly. SF reported significantly higher pain intensities than did BP and HC; FM were in between, but did not differ significantly from the three other groups. There was no interaction of priming and group. Affective modulation of pain was not specifically altered in FM and SF, but SF were more sensitive to pressure pain than BP and HC.     

Chronic pain reconsidered

Chronic pain has been traditionally defined by pain duration, but this approach has limited empirical support and does not account for chronic pain’s multi-dimensionality. This study compared duration-based and prospective approaches to defining chronic pain in terms of their ability to predict future pain course and outcomes for primary care patients with three common pain conditions: back pain (n = 971), headache (n = 1078), or orofacial pain (n = 455). At baseline, their chronic pain was classified retrospectively based on Pain Days in the prior six months and prospectively with a prognostic Risk Score identifying patients with “possible” or “probable” chronic pain. The 0–28 Risk Score was based on pain intensity, pain-related activity limitations, depressive symptoms, number of pain sites, and Pain Days. Pain and behavioral outcomes were assessed at six-month follow-up, and long-term opioid use was assessed two to five years after baseline. Risk Score consistently predicted clinically significant pain at six months better than did Pain Days alone (area under the curve of 0.74–0.78 for Risk Score vs. 0.63–0.73 for Pain Days). Risk Score was a stronger predictor of future SF-36 Physical Function, pain-related worry, unemployment, and long-term opioid use than Pain Days alone. Thus, for these three common pain conditions, a prognostic Risk Score had better predictive validity for pain outcomes than did pain duration alone. However, chronic pain appears to be a continuum rather than a distinct class, because long-term pain outcomes are highly variable and inherently uncertain.     

Postoperative pain management: study of patients' level of pain and satisfaction with health care providers' responsiveness to their reports of pain

The present prospective survey was conducted in a 1200-bed hospital to examine postoperative patients' current pain intensity, most intense pain experienced, satisfaction with postoperative pain management, and differences regarding pain and satisfaction levels. All adult patients admitted to a hospital in Hong Kong for surgery, except those receiving local anesthesia, were eligible to enter this study. The patient outcome questionnaire developed by the American Pain Society was used to solicit data about patients' pain and satisfaction with pain relief. The subjects were 294 postoperative patients. Approximately 85% complained about varying degrees of pain during the 24 h prior to the assessment of their pain. When interviewed, most patients complained of mild to moderate pain (median = 2 on a 10-point scale), while the median for 'worst pain intensity' was 5. Approximately 80% of the subjects indicated that both the nurses and physicians reminded them to report pain when it occurred. Only 143 (48.6%) agreed that the nurses and physicians sufficiently emphasized the importance of pain relief. Those who received acute pain services, provided by anesthetists, reported lower levels of current pain intensity. Over 65% of the subjects were satisfied with all levels of health care providers, regarding their postoperative pain management.