腹部手术加速康复患者疼痛控制结局影响因素的研究

目的探讨腹部手术加速康复患者疼痛控制结局的影响因素,为改进疼痛控制提供依据。方法2018年5-11月,采用目的抽样法选取浙江省人民医院肝胆胰外科15例接受加速康复的腹部手术患者,以质性研究中现象学方法为指导对其进行半结构式访谈。应用Colaizzi 7步分析法分析资料,归纳出主题。结果通过对访谈资料进行分析,归纳出影响疼痛控制结局的5个主题:活动性疼痛和撤除患者自控镇痛泵后疼痛的管理;止痛治疗不良反应;患者、家属对疼痛及疼痛治疗的认知;疼痛治疗信息支持;非医疗技术服务因素对患者疼痛控制满意度的影响。结论建议探索符合我国国情的急性疼痛服务组织的运作模式,通过多学科协作,加强对腹部手术患者活动性疼痛和撤除患者自控镇痛泵后疼痛的管理,加强对止痛治疗不良反应的预防和治疗,加强对疼痛治疗的信息支持,改变患者及其家属的疼痛及疼痛治疗的认知,注重应用非医疗技术服务因素提高患者对疼痛控制的满意度,改进疼痛控制结局。

Influencing factors of pain control among abdominal surgery patients with the enhanced recovery after surgery

Objective To explore the influencing factors of pain control among abdominal surgery patients with the enhanced recovery after surgery(ERAS)so as to provide a basis for improving pain control.Methods From May 2018 to November 2018,we selected 15 abdominal surgery patients with ERAS in Hepatobiliary and Pancreatic Surgery at Zhejiang Provincial People's Hospital by purposive sampling.Semi-structured interview was carried out with the method of phenomenology in qualitative research.Colaizzi 7-step analysis was used in data analysis to conclude themes.Results By interview data analysis,a total of 5 themes that had influences on pain control were concluded:activity-related pain and pain management after removing patient-controlled analgesia(PCA);adverse reaction related to pain management;recognition of patients and their family members on pain or pain treatment;information support for pain treatment;influence of non-medical service on patient satisfaction with pain control.Conclusions We should explore the operation mode of acute pain service organization suitable for our country.Muti-disciplinary team should be used for abdominal surgery patients to strengthen the management of activity-related pain and removing PCA,prevention and treatment for adverse reaction related to pain treatment,information support for pain treatment,and improve the recognition of patients and their family members on pain or pain treatment,and pay attention to the influence of non-medical service on patient satisfaction with pain control so as to improve pain control.