OEC模式在骨科无痛病房患者康复护理中的应用

目的探讨OEC模式在无痛病房无痛康复护理中的应用效果。方法将无痛病房收治的576例需手术治疗的骨科患者,评估其一般情况及生活质量指标后,采用随机数字表法分为观察组和对照组各288例。对照组采用骨科无痛病房护理模式进行围手术期的镇痛护理干预;观察组在骨科无痛病房护理模式下开展OEC模式,建立护理工作的检查体系、责任体系和考评体系,落实护理工作的考核机制。比较两组患者疼痛评分平均值、平均住院日、护理工作满意度,临床护理路径落实率和患者对无痛病房满意度。结果术后观察组疼痛评分与对照组比较,干预主效应P0.05。观察组患者对护理工作满意率、疼痛护理落实率和患者对无痛病房满意率显著高于对照组,平均住院日显著短于对照组(均P0.05)。结论采用OEC管理模式,可有效提高无痛康复护理质量,提升护理工作效率,提高护理服务满意度。     

术后疼痛护理流程的制定与执行在优质护理中的作用

目的:研究通过制定疼痛护理流程,规范护士的疼痛护理行为,能否起到缓解术后疼痛、提高满意度、提升专科护理内涵的作用。方法:拟行择期乳房肿块切除术的50例患者随机分为实验组和对照组(每组n=25)。实验组制定并执行疼痛护理流程,对照组不作干预。观察2组患者的术后疼痛水平、镇痛药物使用及其副作用和患者对镇痛的满意度及医生对护士的满意度。结果:实验组术后3天的疼痛评分低于对照组(P<0.05),实验组并发症的发生率较对照组低(P<0.05),患者镇痛满意度、医生对护士的满意度评分较对照组高(P<0.05)。结论:护士通过执行术后疼痛护理流程,可以提高术后镇痛效果、提高患者和医生的满意度、提升专科护理内涵的目的。     

护理干预对老年术后疼痛的影响

目的探讨护理干预对术后老年患者疼痛的影响。方法将泰山疗养院外科老年手术患者70例分为实验组(35例)和对照组(35例)采用随机顺序排列的方法,给予适当的药物镇痛治疗,对实验组给予护理干预,具体措施包括术前心理指导、放松转移注意力的训练、术后加强生活护理、强调病人的疼痛管理。结果实验组较对照组对术后疼痛的反应轻且耐受性好,疼痛天数短,P<0.05,差异具有统计学意义。结论应重视护理干预对减轻患者术后疼痛的作用。     

个体化镇痛方案对双膝关节置换术后疼痛的疗效观察

【】 目的：观察个体化镇痛方案对双膝关节置换术后疼痛的效果。方法：将122例双膝关节置换术后的患者随机抽样分为实验组(58例)和对照组(64例),对照组在双膝关节置换术后采用传统疼痛护理,实验组在双膝关节置换术后采用个体化镇痛方案,比较两组患者的疼痛及膝关节功能情况。结果：根据疼痛数字评分法(NRS法)测评结果实验组疼痛程度显著低于对照组 (P＜0.01),AKS膝关节功能实验组优于对照组(P＜0.01)结论：个体化镇痛方案能有效减轻患者疼痛,促进膝关节功能快速康复,更好建立无痛病房。     

骨科患者术后疼痛的护理

目的:探讨骨科术后患者疼痛个体化护理的疗效.方法:将100例骨科术后患者随机分为观察组和对照组,各50例,观察组采用个性化护理,对照组采用常规护理,观察并比较2组患者术后疼痛缓解情况.结果:2组患者术后疼痛情况比较无显著性差异(p>0.05),采取不同护理方法后,观察组疼痛积分的缓解较对照组有显著性差异(p<0.01).结论:对于骨科术后患者,根据疼痛评估进行个体化护理,可有效缓解疼痛.     

规范化术后疼痛护理改善泌尿科急诊术后疼痛效果评价

目的总结规范化术后疼痛护理用于泌尿科急诊术后疼痛的效果。方法随机将98例接受泌尿科急诊手术的患者分为2组,各49例。对照组采用常规护理,观察组采用规范化术后疼痛护理,对比分析2组的护理效果。结果 2组的术后疼痛情况、并发症对比,差异具有统计学意义(P0.05)。结论规范化术后疼痛护理用于泌尿科急诊术后的镇痛效果明显。     

妇产科手术后患者切口疼痛的人性化护理

目的探讨妇产科术后患者切口疼痛的人性化护理措施,减轻患者的痛苦,以利患者康复。方法将68例妇产科手术患者随机分为观察组和对照组,每组34例。对照组患者进行常规的护理措施,观察组在常规护理的基础上采取人性化护理措施。观察和比较2组患者术后切口疼痛的程度。结果观察组和对照组患者的术后疼痛程度差异具有统计学意义(P<0.05),观察组疗效优于对照组。结论采用人性化护理措施,可有效减小患者术后的切口疼痛,有利于患者顺利康复,值得临床推广应用。     

无痛护理在经皮肾镜碎石取石术的效果观察

目的 探讨无痛护理在经皮肾镜碎石手术围手术期的临床应用价值.方法 2011年1月～2012年12月64例肾结石在全麻下行经皮肾镜碎石取石术,按患者入院顺序号分为2组:奇数者为实验组32例,术后实施无痛护理;偶数者为对照组32例,术后接受常规护理.比较2组患者术后疼痛评分和满意度.结果 64例手术均顺利,实验组术后疼痛视觉模拟评分(4.5±1.2)分,对照组为(6.7±1.9)分,2组有统计学差异(t=5.538,P=0.000).实验组满意度为93.8％(30/32),明显高于对照组对照组40.6％(13/32)(Z=-4.537,P=0.000).结论 无痛护理能够有效减轻经皮肾镜碎石术后患者疼痛,提高患者满意度.     

探讨医护一体化模式在妇科开腹手术切口护理中的应用与效果

目的探讨医护一体化模式在妇科开腹手术切口护理中的应用与效果。方法随机将200名患者分为2组,对照组实施普通护理服务模式,实验组实行医护一体化服务管理模式,6个月后,比较2组患者术后切口疼痛的程度、愈合情况及患者满意度。结果 6个月后,实验组患者切口疼痛程度及切口愈合情况较对照组明显改善,患者满意度明显提高,差异有统计学意义(P<0.05)。结论医护一体化模式不仅能有效降低妇科患者术后切口疼痛,促进切口愈合,还进一步促进了医护合作,提高患者满意度,值得临床推广应用。     

综合护理缓解骨科手术患者术后疼痛的效果分析

目的探讨综合护理缓解骨科手术患者术后疼痛的效果。方法依据不同护理方法将2017-01—2018-10间在息县人民医院接受骨科手术的84例患者分为2组,每组42例。对照组实施常规护理,观察组实施综合护理。比较2组患者术后疼痛缓解效果和总体满意率。结果术后第1、3、5天,观察组患者疼痛评分明显优于对照组,总体满意率高于对照组,2组差异均有统计学意义(P0.05)。结论对骨科术后患者实施综合护理,能有效缓解术后疼痛,提高患者对护理工作的满意率,有利于患者早期进行康复锻炼和功能的恢复。     

Phantom pain and posttraumatic pain conditions

After limb or body part amputation, three different types of perceptual sensitive phenomena can be recognized. They can be all named posttraumatic neuropathies: painless sensations in phantom limb, painful phantom limb and painful posttraumatic stump. Painless sensations in phantom limb can be seen in 90% of cases in resected body parts as soon as first postoperative day, less often during the first week, and its clinical characteristics are usually stabilized during the first year. Painful posttraumatic stump appears because of pain neuroma existing, that forms at the proximal end of amputational stump as a consequence of physiological nerve regeneration attempt. Frequency of pain significantly varies considering authors from 5-90%, depending on definition of this phenomena and criteria used. It is considered that 5-10% mast be under permanent medicament treatment. Phantom pain appears more often in elderly and people with specific affective personality construction. It can be permanent, burning, nettling, tearing (25%), or intermittent, lancerating, in the shape of electrical discharging (32%), but it can also have bizarre attributes. Phantom pain appearance usually announces its duration in the longer period. After two years it is present at 59% of patients, with decreasing intensity, and only 5-10% suffer severe pain. In our Institute in the period from 1980-2003, 48 patients have been treated, 36 patients with medicamentous treatment, local blockades and chronic stimulations, and 12 patients, who did not react at conservative treatment were operated. In operated group in 10 patients pain disappeared, one patient it was with decreasing intensity, and one patient was without change.     

Discogenic pain in acute nonspecific low-back pain

Acute nonspecific low-back pain is characterized by the sudden onset and severe unendurable low-back pain without radicular pain or neurological deficit in the lower extremities. The study was carried out using 55 patients who visited our hospital for acute nonspecific low-back pain, who exhibited degeneration on T2-weighted MR images, and underwent intradiscal injection of local anesthetics,steroid and contrast medium. Intervertebral disc sites with an obvious enhanced region in the posterior annulus of the disc on enhanced T1-weghted MR images was selected for intradiscal injection. When no enhaced region was detected, the most severely degenerated disc on T2-weighted MR images was selected. Acute nonspecific low-back pain with an improvement rate of 70% or higher 5min after injection was judged to be discogenic. The clinical characteristics and pathogenesis of discogenic acute nonspecific low-back pain were investigated. Forty of the 55 patients (73%) had discogenic acute nonspecific low-back pain. As for the characteristics of patients, the mean age was 37 years, and onset occurred upon casual daily movements in 18 patients (45%). Nineteen patients (48%) had bilateral low-back pain, and 29 patients (73%) had no tenderness in the paravertebral muscles. On plain X-ray radiograms, degeneration of the disc was normal or mild in 36 patients(91%). On the discograms, a radial tear extending to the posterior annulus was noted in all patients, but epidural leakage was seen only in six patients (15%). The degree of disc degeneration on T2-weighted MR images (Gibsons classification) was grade 3 in 30 patients (75%). Gadolinium-DTPA enhanced T1-weighted MR images showed an obvious enhanced region in the posterior annulus of the intervertebral disc in 19 patients (48%). As for the clinical characteristics of discogenic acute nonspecific low-back pain, the relatively young adult patients had no tenderness in the paravertebral muscles, and showed moderately degererated intervertebral discs. The pathogenesis of discogenic acute nonspecific low-back pain is mostly considered to be a re-rupture in an asymptomatic ruputured region in the posterior annulus, repaired by granulation tissue, in a moderately degenerated intervertebral disc with a radial tear.     

Improvement of burn pain management through routine pain monitoring and pain management protocol

Introduction

Pain management is an important aspect of burn management. We developed a routine pain monitoring system and pain management protocol for burn patients. The purpose of this study is to evaluate the effectiveness of our new pain management system.

Methods

From May 2011 to November 2011, the prospective study was performed with 107 burn patients. We performed control group (n = 58) data analysis and then developed the pain management protocol and monitoring system. Next, we applied our protocol to patients and performed protocol group (n = 49) data analysis, and compared this to control group data. Data analysis was performed using the Numeric Rating Scale (NRS) of background pain and procedural pain, Clinician-Administered PTSD Scale (CAPS), Hamilton Depression Rating Scale (HDRS), State-Trait Anxiety Inventory Scale (STAIS), and Holmes and Rahe Stress Scale (HRSS).

Results

The NRS of background pain for the protocol group was significantly decreased compared to the control group (2.8 ± 2.0 versus 3.9 ± 1.9), and the NRS of procedural pain of the protocol group was significantly decreased compared to the control group (4.8 ± 2.8 versus 3.7 ± 2.5). CAPS and HDRS were decreased in the protocol group, but did not have statistical significance. STAIS and HRSS were decreased in the protocol group, but only the STAIS had statistical significance.

Conclusion

Our new pain management system was effective in burn pain management. However, adequate pain management can only be accomplished by a continuous and thorough effort. Therefore, pain control protocol and pain monitoring systems need to be under constant revision and improvement using creative ideas and approaches.     

Chronic regional pain and chronic pain syndromes

This paper seeks to consider the validity and utility of two related terms in spinal and other injuries: complex regional pain syndrome (CRPS) and chronic pain syndrome (CPS). It is argued that the words chronic regional pain syndrome convey neither understanding of the condition nor of its mechanism. They simply redefine the clinical problem, but fail to establish specific diagnostic features or consistent primary pathogenesis. CRPS is best construed as a reaction to injury, or to excessive, often iatrogenic, immobilization after injury; but it is not an independent disease. The diagnosis of CPS groups together ill-defined symptoms under a convenient, but medically untestable and therefore inept label. Patients, lawyers, and support groups commonly deny psychogenesis, with the sadly mistaken notion that this implies a bogus or spurious cause.     

Myofascial pain in patients with postthoracotomy pain syndrome

OBJECTIVE: Postthoracotomy pain syndrome is generally considered to be neuropathic pain due to intercostal nerve injury. However, nonneuropathic pain can also occur following thoracic surgery. We present a series of cases with postthoracotomy pain syndrome in which myofascial pain was thought to be a causative component of postthoracotomy pain syndrome. CASE REPORT: Twenty-seven patients (17 men and 10 women) were treated with trigger point injections, intercostal nerve blocks, and/or epidural blocks. Clinical criteria were used to diagnose the myofascial pain. A visual analogue scale was used, and sensory disturbances were recorded before and after treatment. A trigger point in a taut muscular band within the scapular region, which we diagnosed as myofascial pain, was observed in 67% of the patients. The existence of this trigger point significantly increased the rate of success for the treatments. CONCLUSIONS: Postthoracotomy pain may result, at least in part, from a nonneuropathic origin (myofascial pain). It is recommended that each patient be examined in detail to determine whether there is a trigger point in a taut muscular band within the scapular region. If found, this point is suggested as a good area for anesthetic injection.     

Chronic musculoskeletal pain: Ultrasound guided pain control

The review demonstrates the unique advantages of ultrasonography in pain control. Several imaging modalities can be used to guide pain control, such as computed tomography, magnetic resonance imaging, and radiography. Ultrasonography has unique advantages over these other modalities in terms of its non-ionizing radiation, real-time imaging, portability, and cost-effectiveness. Ultrasonography with color Doppler and elastography can provide safer guidance to avoid blood vessels and the nerve trunk when using steroid or xylocaine infusions to encase the nerve trunk. This review focuses on the control of chronic pain in the upper limbs, lower limbs, and trunk.