开展无痛病房对经ERCP胆总管取石术患者术后疼痛的影响

发布时间：2018-03-29 12:54

本文选题：无痛病房　切入点：胆总管取石术　出处：《山东大学》2014年硕士论文

【摘要】：目的：探讨开展无痛病房对经ERCP胆总管取石术患者术后疼痛强度及疼痛护理满意度的影响。方法：本研究采用问卷调查法的方法,以方便抽样的方式,选取2012年5-12月在山东省某三甲医院住院的胆总管结石并且行经ERCP取石术的患者84例为对照,选取2013年5-12月在山东省某三甲医院消化科住院的胆总管结石并且行经ERCP取石术的患者84例为研究对象。研究工具为患者一般资料调查表、简明疼痛量表(BPI)、疼痛护理满意度量表、数字疼痛分级法(NRS)。一般资料调查表由研究人员参阅国内外文献后,结合本研究的情况自行设计,用以统计病人的一般资料。简明疼痛量表和疼痛护理满意度量表广泛应用在国内外,具有良好的信度和效度。具体方法为选取2012年5-12月在山东省某三甲医院消化科住院的胆总管结石并且行经ERCP取石术的患者,术前30分钟用数字疼痛分级法(NRS)评估患者的疼痛,术后24小时对患者发放一般资料调查表及简明疼痛量表,出院时对患者发放疼痛护理满意度量表。2013年1-4月,在科室内开展疼痛知识培训,健全无痛病房各项规章制度,完善各项硬件措施,制定无痛病房工作程序,创建无痛理念,全面开展无痛病房。选取2013年5-12月在山东省某三甲医院消化科住院的胆总管结石并且行经ERCP取石术的患者,对其进行无痛病房管理,同样,术前30分钟用数字疼痛分级法(NRS)评估患者的疼痛,术后24小时为患者发放一般资料调查表及简明疼痛量表,出院时为患者发放疼痛护理满意度量表。比较两组患者术后疼痛强度及疼痛护理满意度的差别。数据处理上,应用SPSS16.0软件包进行数据录入与分析,以P0.05表示有显著统计学差异。以描述性统计(均数、标准差)、t检验、卡方检验、Fisher准确概率法等统计分析方法,分析两组患者术后疼痛强度及疼痛护理满意度的差别。结果：共168名患者参与本次研究,其中无痛病房开展前84例,无痛病房开展后84例,两组患者在年龄、性别、文化程度、民族、婚姻状态、付费方式、居住地等方面比较,差异均无统计学意义(P0.05)。具体结果如下： 1两组患者术前30分钟评估的疼痛得分：开展无痛病房前组为(1.18-0.88),开展无痛病房后组为(1.19±0.86),经t检验,显示统计学无差异(PO.05)。 2两组患者术后24小时评估的疼痛得分：24小时疼痛最剧烈的程度,开展无痛病房前组为(3.70-1.95),开展无痛病房后组为(2.92±1.50),经t检验,显示统计学有差异(PO.05)。24小时疼痛最轻微的程度,开展无痛病房前组为(1.23±1.10),开展无痛病房后组为(0.76±0.41),经t检验,显示统计学有差异(PO.05)。24小时疼痛平均程度,开展无痛病房前组为(2.21±1.19),开展无痛病房后组为(1.77±0.99),经t检验,显示统计学有差异(PO.05)。患者目前的疼痛程度,开展无痛病房前组为(1.25±1.07),开展无痛病房后组为(0.86±0.49),经t检验,显示统计学有差异(PO.05)。 3两组患者疼痛护理满意度比较：整体护理满意度比较,开展无痛病房前组得分(70.30±10.21),,开展无痛病房后组得分(76.89±10.08),经t检验,显示统计学有差异(PO.05)。从量表的3个维度分别比较：信任关系：开展无痛病房前组得分(34.83±5.49),开展无痛病房后组得分(37.51±7.66),经t检验,显示统计学有差异(PO.05)。专业技术能力：开展无痛病房前组得分(17.71±4.64),开展无痛病房后组得分(19.70±3.39),·经t检验,显示统计学有差异(PO.05)。教育关系：开展无痛病房前组得分(17.76±4.90),开展无痛病房后组得分(19.68±3.570),经t检验,显示统计学有差异(PO.05)。 4开展无痛病房前,84例患者,有4例发生术后急性胰腺炎,其中2例转外科手术治疗,2例内科保守治疗治愈；有8例患者术后应用了镇痛药物；开展无痛病房后,84例患者,有2例发生术后急性胰腺炎,均内科保守治疗治愈；有4例患者术后应用了镇痛药物。结论：开展无痛病房能显著降低胆总管结石行ERCP取石术患者的术后疼痛强度；开展无痛病房能显著提高胆总管结石行ERCP取石术患者的疼痛护理满意度；开展无痛病房能降低胆总管取石术患者术后并发症的发生率,降低患者术后镇痛药物的使用比例。
[Abstract]:Objective : To investigate the effect of painless ward on the postoperative pain intensity and pain nursing satisfaction of patients undergoing endoscopic retrograde cholangiography .

Methods : 84 cases of common bile duct stone who were hospitalized in a 3A hospital in Shandong Province from May to December 2012 were selected and 84 cases of patients who had been hospitalized in the digestive department of a 3A hospital in Shandong Province from May to December of 2013 were selected by the method of questionnaire investigation .

Results : A total of 168 patients were involved in the study , of which 84 cases were performed in painless wards and 84 in painless wards . There was no significant difference in age , sex , culture , nationality , marital status , payment mode and place of residence ( P0.05 ) . The results were as follows :

Pain scores of the two groups were evaluated 30 minutes prior to operation : ( 1.18 - 0.88 ) in the anterior group of painless ward and ( 1.19 卤 0.86 ) in the non - painful ward , and no difference was found between the two groups ( P . 05 ) .

The pain scores of the two groups were ( 2.92 卤 1.50 ) and ( 2.92 卤 1.50 ) after 24 - hour post - operative pain , and ( 2.92 卤 1.50 ) in the patients with painless ward .

The scores of pain nursing satisfaction were compared between the two groups : the score of the former group of painless ward was ( 76.89 卤 10.21 ) , the score of the group after painless ward was ( 76.89 卤 10.08 ) , the score of the post - painless ward group was ( 19.70 卤 3.39 ) , the score of the post - painless ward group ( 19.68 卤 3.570 ) was performed , and the difference was statistically significant ( PO.05 ) .

4 of 84 patients had acute pancreatitis after operation without pain ward , 2 of them were treated with surgical treatment and 2 cases were treated with conservative treatment .
There were 8 patients who had postoperative analgesia .
After the painless ward , 84 patients , 2 patients with post - operative acute pancreatitis , were treated with conservative treatment .
Four patients had postoperative analgesia .

Conclusion : Carrying out painless ward can significantly reduce the postoperative pain intensity in patients with bile duct stone .
Carrying out painless ward can significantly improve the patient ' s pain nursing satisfaction in patients with bile duct stone .
To carry out painless ward can reduce the incidence of postoperative complications and reduce the use proportion of postoperative analgesia drugs in patients .

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R473.6

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