疼痛的综合护理干预对乳腺癌术后康复的影响

目的 探讨针对性疼痛护理干预对根治性乳腺癌切除术后功能康复的影响.方法 80例行乳腺癌根治性切除术的患者随机分为实验组和对照组,每组各40例.在围手术期,实验组除了接受常规护理以外,还接受缓解疼痛的综合护理干预,而对照组则仅接受常规护理.术后5 d内每天应用疼痛数字评估量表（NRS）和Athens失眠量表（AIS）对80例患者进行疼痛评分和睡眠质量评估;在术后1个月内,对患者的拔管时间、住院时间、患侧肩关节活动起始时间、患肢水肿情况、上肢功能恢复情况等康复指标进行评估.结果术后5 d每天实验组的平均NRS评分和平均MS评分均低于实验组的相关指标;实验组与对照组相比,术后疼痛强度显示了较快的下降趋势;在康复指标方面,实验组除了拔管时间外,其余指标均优于对照组.结论 疼痛护理干预可明显减轻乳腺癌根治性切除术患者术后切口的疼痛,促使患者早日恢复患肢功能锻炼,进而改善术后康复的整体效果.

Effects of integrated nursing intervention for pain on postoperative rehabilitation of the patients with breast cancer

Objective To explore the effects of nursing intervention for pain on postoperative rehabilitation of the patients with breast cancer after radical mastectomy. Methods Eighty patients with breast cancer undergoing radical mastectomy were divided into two groups preoperatively: integrated pain nursing intervention (IPNI) group and control group. During the perioperative period, the patients in IPNI group underwent the integrated nursing intervention for postoperative pain including psychological care, medication, physical therapy and behavior therapy,in addition to accept the regular nursing care related to the surgery. The patients in control group only underwent the regular nursing care. Numeric Rating Scale ( NRS) and Athens Insomnia Scale ( AIS) were employed to access the effects of IPNI on the postoperative pain and the sleep quality of the patients within 5 days after surgery in both groups. The parameters related to postoperative rehabilitation including the time of drainage catheter removal, hospital stay, the start time of shoulder exercise, arm lymphoedema and shoulder movements were evaluated as well. Results The age, operation type, infection occurrence and the operation on the side of the dominant hand were not statistically different between the groups. The average scores of NRS and AIS in IPNI group within 5 days after surgery were significantly lower than those in control group(both P <0.001). Quicker descending trends in both NRS and AIS were seen in IPNI group in compared to the control group. A majority of postoperative rehabilitation except the time of drainage catheter were in IPNI group significantly better than those in control group (all P <0. 05). Conclusions IPNI may be an easy and effective approach to relieve the wound pain of the patients underwent radical mastectomy, which could improve the sleep quality, start the exercise upper extremity early and finally promote the whole postoperative rehabilitation of the patients.