规范化疼痛管理在肺癌患者围手术期的研究

发布时间：2018-06-15 10:45

本文选题：肺癌 + 疼痛管理　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]肺癌患者术后疼痛一直是困扰胸外科医生的难题之一,术后疼痛不仅导致患者生活质量大大下降,而且可以导致并发症发生率的增加及住院时间的延长,故肺癌患者术后有效的镇痛显得十分重要。近年来规范化的疼痛管理在临床逐渐看展研究,本文以此为背景,在昆明医科大学第一附属医院胸外科针对肺癌患者在围手术期开展了临床规范化疼痛管理的探索,探讨我科采用规范化疼痛管理后的临床意义。[方法]收集昆明医科大学第一附属医院胸外科自2016年3月实施无痛病房疼痛管理开始至2016年12月收治的肺癌手术患者病例资料,根据入组条件筛选出共212例患者,其中将采用我科围手术期规范化疼痛管理的112例患者设计成观察组,将采用传统疼痛管理的100例患者设计为对照组。用疼痛视觉模拟评分法对术后疼痛进行评分,作为判断患者术后疼痛的标准。对观察组和对照组术后疼痛程度、发生肺部感染等并发症的概率及住院时间进行对比研究,以此来探讨肺癌患者围手术期的规范化疼痛管理的临床应用价值。[结果]1.同一手术方式下观察组和对照组在年龄,性别上均无统计学意义,(P0.05)。2.早期的拔管减轻了患者术后疼痛,在采用我科规范化综合管理情况下提前拔管并未出现并发症的增加。3.相同手术方式下观察组较对照组在入院时疼痛评分无统计学意义(P0.05);观察组在麻醉清醒时,术后第一天、第二天、第三天及出院时对比对照组疼痛程度上有明显减轻(P0.05)。4.全组患者均手术成功,术后无死亡病例。观察组发生肺部感染2例、肺不张2例、房颤2例、压疮1例;对照组发生肺部感染5例、肺不张4例、房颤2例、压疮3例,观察组并发症概率较对照组显著减少(P0.05)。5.相同手术方式下的观察组住院时间较对照组有明显缩短(P0.05)。[结论]经过我科开展的规范化疼痛管理能够使肺癌围手术期患者减轻术后疼痛,提高了患者术后的生活质量,降低了术后并发症的概率,缩短了住院时间,在我科临床疗效显著,值得在今后临床进一步深入实践和研究以及在临床各科室大力推广。
[Abstract]:[objective] postoperative pain in patients with lung cancer has been one of the difficult problems for thoracic surgeons. Postoperative pain not only leads to a great decline in the quality of life of patients, but also increases the incidence of complications and prolongs the length of stay in hospital. Therefore, effective postoperative analgesia in patients with lung cancer is very important. In recent years, standardized pain management has been studied gradually in clinic. Based on this background, the chest surgery of the first affiliated Hospital of Kunming Medical University carried out the exploration of clinical standardized pain management for lung cancer patients during perioperative period. To explore the clinical significance of standardized pain management in our department. [methods] A total of 212 patients with lung cancer were collected from chest surgery department of the first affiliated Hospital of Kunming Medical University from the beginning of painless ward pain management in March 2016 to December 2016. 212 patients were selected according to the condition of admission. 112 patients with standardized pain management during perioperative period in our department were designed as observation group and 100 patients with traditional pain management as control group. Visual analogue score was used to evaluate postoperative pain. The clinical value of standardized pain management in patients with lung cancer during perioperative period was studied by comparing the degree of postoperative pain, the probability of pulmonary infection and the length of hospitalization in the observation group and the control group. [result] 1. There was no significant difference in age and sex between the observation group and the control group under the same operation mode. The early extubation alleviated the postoperative pain of the patients, and there was no increase of complications in the early extubation under the condition of standardized comprehensive management in our department. There was no significant difference in pain score between the observation group and the control group at admission under the same operation mode (P 0.05), and the pain degree of the observation group on the first day, the second day, the third day after operation and at the time of discharge was significantly reduced compared with the control group at the first day, the second day, the third day and the time of discharge. All patients were successfully operated and there were no death cases after operation. There were 2 cases of pulmonary infection, 2 cases of atelectasis, 2 cases of atrial fibrillation, 1 case of pressure sore in the observation group, 5 cases of pulmonary infection, 4 cases of atelectasis, 2 cases of atrial fibrillation and 3 cases of pressure sore in the control group. The probability of complications in the observation group was significantly lower than that in the control group. The hospitalization time of the observation group under the same operation mode was significantly shorter than that of the control group (P 0.05). [conclusion] the standardized pain management carried out by our department can relieve postoperative pain, improve the quality of life, reduce the probability of postoperative complications and shorten the hospitalization time in patients with lung cancer during perioperative period. It is worthy of further practice and research in clinical practice and popularization in clinical departments.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2

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